Training of maternity service providers on supportive and dignified maternity care: pre-post training assessment

Poor psychosocial support and lack of respectful care for women during childbirth are commonplace in health facilities in low- and middle-income countries. While WHO recommends providing supportive care to pregnant women, there is a scarcity of material for building the capacity of maternity staff to provide systematic and inclusive psychosocial support to women in the intrapartum phase and prevent work stress and burnout in maternity teams. To address this need we adapted WHO's mhGAP and its training manual for maternity care staff to provide psychosocial support in labour room settings. Mental Health Gap Action Programme (mhGAP)  is an evidence-based intervention which focuses on providing psychosocial support to people with mental, neurological and substance-use disorders  (MNS).

The objective of this paper is to describe the adaptation of mhGAP to develop psychosocial support-capacity-building materials for maternity staff to provide support to maternity patients, and also to staff, in the labour room.

Adaptation was conducted within the Human-Centered Design framework in three phases: inspiration, ideation, and implementation feasibility. In the inspiration phase, a review of national-level maternity service-delivery documents and formative study via in-depth interviews of maternity staff were conducted. Ideation involved a multidisciplinary team to develop capacity-building materials by adapting mhGAP. This phase was iterative and included cycles of pretesting with staff, deliberations among the core team, and revision of materials. In the implementation feasibility phase, materials were tested via the training of 98 maternity staff and exploring system feasibility via post-training visits to health facilities.

The inspiration phase identified gaps in policy directives and implementation. A formative study found that staff lacked the understanding and skills to assess patients' psychosocial needs and provide appropriate support. Allied with this, it became evident that maternity staff themselves needed psychosocial support. In ideation, the team developed capacity-building materials comprising two modules: one dedicated to conceptual understanding, and the other to implementing psychosocial support in collaboration with maternity staff. In the implementation feasibility phase, Staff found the materials relevant, acceptable and feasible for the labour room setting. Finally, users and experts reviewed and endorsed the relevance and usefulness of the materials. 

Our work in developing psychosocial-support training materials for maternity staff extends the utility of mhGAP by building the capacity of maternity staff to identify specific, hitherto-neglected needs of patients and staff, and by supporting, respectively, pregnant women to have positive birthing experiences, and maternity staff to manage workplace stress and avoid burnout. These materials can be used in a similar maternity setting after cultural adaptation.