Midwives’ experiences and perceptions of implementing maternal care guidelines for screening and managing hypertensive disorders in pregnancy in Limpopo, South Africa: A qualitative study

Problem Maternal mortality remains high worldwide and in South Africa, with hypertensive disorders in pregnancy being a leading cause. Although guidelines for screening and managing hypertensive disorders in pregnancy are available, there is limited understanding of midwives' perceptions and experiences in implementing these guidelines. Background Midwives play a critical role in delivering evidence-based care to ensure effective interventions during pregnancy and childbirth based on guidelines. There is a need for greater insight into midwives' experiences with guideline implementation. Aim This study explored midwives' experiences and perceptions of implementing maternal care guidelines for the screening and management of hypertensive disorders in pregnancy. Methods A qualitative, exploratory-descriptive study was conducted in the Capricorn District, Polokwane Municipality, Limpopo, South Africa, across 10 purposively selected rural and urban primary healthcare clinics and two hospitals. The study included face-to-face, semi-structured individual interviews involving 23 midwives. The data were analysed using thematic analysis. Findings Three primary themes emerged: (1) midwives demonstrated caring practices enhanced by the guidelines, (2) they faced structural and systemic obstacles hindering the implementation of maternal care guidelines for hypertensive disorders, and (3) they identified structural obstacles that limited pregnant women's ownership of and involvement in their care. Discussion and conclusion The study findings indicate that overcoming structural, systemic, socio-economic, and cultural challenges through targeted, multifaceted approaches is crucial for the effective implementation of maternal care guidelines. By addressing these barriers, midwives can ensure evidence-based practices are consistently applied, leading to better maternal and neonatal outcomes.