Midwives' perspectives on rural birthing experiences and newborn survival in Ghana

Access to essential and emergency newborn care services remains a challenge in low- and middle-income countries (LMICs), especially in rural and remote areas where various factors increase maternal and newborn vulnerability. The scarcity of midwives on a global scale further strains obstetric and neonatal services, as midwives work at the forefront in many LMICs. In Ghana, neonatal deaths at birth and within 24 h contribute significantly to infant mortality rate, with midwives caring as frontline health workers. However, there is limited exploration of midwives' experiences in managing these situations. This study aimed to unveil the meanings and articulate the experiences of midwives who face newborns with respiratory distress at birth in rural southern Ghana. Interpretive Phenomenological approach was used to explore thirteen (13) midwives’ experiences of managing newborns in respiratory distress in rural birth settings amidst scare life saving resources, skilled staff shortage and limited advanced health care. The midwives were purposively sampled from the Shai-Osudoku district and data were collected through face-to-face interviews. Content analysis was conducted on the interview transcripts and rich narratives developed in the research report. Rural midwives have limited access to newborn lifesaving equipment, adequate training, skill staff support, and timely advance care for newborns. These issues are driving factors for newborn referral in rural health care, but transportation gaps impede timely advance care delivery. Rural midwives’ inadequate psychosocial support and lack of enabling work environment engender moral distress with emotional burden requiring sustained attention from national leadership, as well as midwifery professional networks and regulatory bodies. Newly qualified midwives require sustainable support as they struggle in birth spaces where ethical questions emerge as family members are engaged as support persons in neonatal resuscitation. Future research is needed to investigate Chiefs, Queen Mothers and Community Elders’ engagement in community-based interventions to support timely access to quality care and midwives’ heroic practices of saving maternal/newborn lives in rural Ghana to help achieve SDG 3.2.