Women's Decision Making on Birthing Choices in the Private Sector of Namibia: Midwives' Perspectives

In this study, the views of midwives regarding decision making in the Namibian private sector hospital labour wards were investigated with the aim of understanding the reasons for the high prevalence of caesarean sections in the Namibian private sector. The study objective was to determine the views of midwives about how women in the private sector labour wards decide on a birthing method. A qualitative design with an exploratory approach was followed, with the application of purposive sampling in the selection of research participants. Seven individual and in-depth interviews with midwives were conducted in two private hospitals in Windhoek. Data analysis was done using the six steps proposed by Creswell. Findings indicated that decision making depended on the woman, the doctor and the institution. Aspects such as the midwife's relationship with the doctor, as well as the pregnant woman and the institution have an influence on such decisions made. Furthermore, the trust among and between health professionals, the availability of policies and guidelines, as well as the information received during antenatal care also affect the choice. It was found that women are not well informed about the choices they have for childbirth, the advantages and disadvantages of the chosen mode of birthing, as well as what to expect during the active stages of labour. In conclusion, decision making in the labour wards is important as it determines the birthing method outcome for every woman in the labour ward. Further studies need to be done in the same context and public hospital settings, to explore the dynamics in the public sector.