Factors affecting effective ventilation during newborn resuscitation: a qualitative study among midwives in rural Tanzania

Glob Health Action. 2018;11(1):1423862. doi: 10.1080/16549716.2018.1423862.


Background: Intrapartum-related hypoxia accounts for 30% of neonatal deaths in Tanzania. This has led to the introduction and scaling-up of the Helping Babies Breathe (HBB) programme, which is a simulation-based learning programme in newborn resuscitation skills. Studies have documented ineffective ventilation of non-breathing newborns and the inability to follow the HBB algorithm among providers.

Objective: This study aimed at exploring barriers and facilitators to effective bag mask ventilation, an essential component of the HBB algorithm, during actual newborn resuscitation in rural Tanzania.

Methods: Eight midwives, each with more than one year's working experience in the labour ward, were interviewed individually at Haydom Lutheran Hospital, Tanzania. The audio recordings were transcribed and translated into English and analysed using qualitative content analysis.

Results: Midwives reported the ability to monitor labour properly, preparing resuscitation equipment before delivery, teamwork and frequent ventilation training as the most effective factors in improving actual ventilation practices and promoting the survival of newborns. They thought that their anxiety and fear due to stress of ventilating a non-breathing baby often led to poor resuscitation performance. Additionally, they experienced difficulties assessing the baby's condition and providing appropriate clinical responses to initial interventions at birth; hence, further necessary actions and timely initiation of ventilation were delayed.

Conclusions: Efforts should be focused on improving labour monitoring, birth preparedness and accurate assessment immediately after birth, to decrease intrapartum-related hypoxia. Midwives should be well prepared to treat a non-breathing baby through high-quality and frequent simulation training with an emphasis on teamwork training.

Keywords: Helping Babies Breathe; barriers bag mask ventilation; facilitators bag mask ventilation; qualitative Tanzania; simulation training.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Clinical Competence*
  • Clinical Protocols*
  • Female
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Infant, Newborn
  • Inservice Training
  • Interviews as Topic
  • Labor, Obstetric / physiology
  • Middle Aged
  • Midwifery / education*
  • Pregnancy
  • Qualitative Research
  • Resuscitation / methods*
  • Resuscitation / psychology
  • Rural Population
  • Tanzania

Grants and funding

The study was funded by the Global Health and Vaccination Research (GLOBVAC) programme at the Research Council of Norway (project number 228203). HLH has received research grants from Laerdal foundation for acute medicine. The funds are used to pay for the salaries of the research staff at the hospital, the internet connection and the capacity-building of the staff. The external funding source had no role in the study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit the paper for publication.