title: You have no Choice but to go on: How Physicians and Midwives in Ghana Cope with High Rates of Perinatal Death.
abstract: Objectives Healthcare providers in low-resource settings confront high rates of perinatal mortality. How providers cope with such challenges can affect their well-being and patient care; we therefore sought to understand how physicians and midwives make sense of and cope with these deaths. Methods We conducted semi-structured interviews with midwives, obstetrician-gynecologists, pediatricians and trainee physicians at a large teaching hospital in Kumasi, Ghana. Interviews focused on participants' coping strategies surrounding perinatal death. We identified themes from interview transcripts using qualitative content analysis. Results Thirty-six participants completed the study. Themes from the transcripts revealed a continuum of control/self-efficacy and engagement with the deaths. Providers demonstrated a commitment to push on with their work and provide the best care possible. In select cases, they described the transformative power of attitude and sought to be agents of change. Conclusions Physicians and midwives in a low-resource country in sub-Saharan Africa showed remarkable resiliency in coping with perinatal death. Still, future work should focus on training clinicians in coping and strengthening their self-efficacy and engagement.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
authors.forename: Alissa D
authors.initials: AD
authors.lastname: Petrites
authors.affiliation: Department of Medical Education, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Mullan
authors.affiliation: Family Medicine, Polyclinic Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Spangenberg
authors.affiliation: Department of Family Medicine and, Department of Obstetrics and Gynecology, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1218, USA. ktgold@umich.edu.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Gold
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001291:Attitude of Health Personnel; D002755:Choice Behavior; D005260:Female; D005869:Ghana; D006801:Humans; D007231:Infant, Newborn; D007407:Interviews as Topic; D008875:Middle Aged; D008880:Midwifery; D009721:Nurse Midwives / Q000523:psychology*; D066087:Perinatal Death; D010820:Physicians / Q000523:psychology*; D011247:Pregnancy; D036301:Qualitative Research; D020377:Self Efficacy
keywords: Coping; Ghana; Healthcare professional; Low-resource country; Perinatal death