Experiences of Health Professionals Regarding Existing Guidelines Used to Manage Obstetric Emergencies in a Rural Area of South Africa: A Qualitative Explorative Study

Abstract

Despite the availability of clinical guidelines aimed at managing pregnancy complications, maternal deaths related to obstetric emergencies remain unacceptably high in South Africa, especially in rural provinces like Limpopo. These preventable deaths are often linked to delayed response to complications, poor adherence to protocols, and lack of essential resources. The study aimed to explore the experiences of health professionals regarding the implementation of maternal guidelines used to manage obstetric emergencies. The study adopted a qualitative, descriptive, and explorative design. Data were analysed thematically, and trustworthiness was maintained throughout the research process. Sixteen participants from four selected hospitals in a rural area of South Africa (Vhembe District, Limpopo Province) were purposively sampled and interviewed using semi-structured interviews; data were analysed thematically. The findings highlighted multiple critical barriers to guideline implementation, including shortages of printed clinical protocols, inconsistent patient follow-up, poor referral systems, infrastructure deficits, medication stock-outs, and negative staff attitudes. Most doctors and midwives working in maternity units lacked training on the Essential Steps in the Management of Obstetric Emergencies (ESMOE), resulting in insufficient knowledge and skills to manage obstetric emergencies. Therefore, there is an urgent need for comprehensive ESMOE training for all doctors and midwives in maternity units.