Recoletos de Bacolod Graduate School

University of Negros Occidental- Recoletos

Bacolod City

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Level of Midwifery services and Maternal health outcomes among mothers in Bacolod City

Chapter 1
INTRODUCTION

Background of the Study

Midwifery services play a key role in maternal and neonatal healthcare worldwide. The
quality of midwifery care directly influences maternal and neonatal health outcomes,
encompassing factors such as skilled attendance during childbirth, prenatal care, and postnatal
support. Countries with well-established midwifery programs have demonstrated improved
maternal health outcomes, highlighting the significance of investing in quality midwifery care
(Renfrew et al., 2014; ten Hoope-Bender et al., 2014).

In addition to the quality of midwifery care, demographic variables such as the age of
mothers and socioeconomic status play significant roles in determining maternal health outcomes
globally. Disparities in healthcare access and outcomes exist among different demographic
groups, highlighting the need for targeted interventions to address these inequalities and improve
overall maternal health (Shaw et al., 2016; Souza et al., 2013).

In the Philippines, where maternal health remains a significant concern, midwifery

services are vital for public healthcare. The country faces challenges such as high maternal
mortality rates. Enhancing the quality of midwifery care has become a priority to address these
challenges and improve maternal health outcomes (Philippine Statistics Authority, 2018; United
Nations Population Fund, 2017).

In Bacolod City, access to quality healthcare, particularly for expecting mothers and
newborns, is essential. However, disparities in healthcare access based on factors like the age of
mothers and socioeconomic status exist. Understanding these local conditions is crucial for
improving maternal health outcomes in Bacolod City (Bacolod City Health Office, 2020).

Existing literature, such as Smith, J. et al. (2019), has extensively explored the role of
midwifery services in maternal health outcomes, yet it reveals a notable gap concerning the
nuanced impact of midwifery care across various demographic groups. Despite studies like
Garcia, L. et al. (2020), which examine associations between midwifery care quality and
outcomes in low-income communities, and longitudinal investigations like Chen, S. et al. (2021),
focusing on urban areas, there remains limited research addressing how demographic factors
intersect with midwifery care quality to influence maternal health outcomes, particularly in
Bacolod City. These studies highlight the necessity for further research to understand how
factors such as the age of mothers and their socioeconomic statuses interact with midwifery care
quality to shape outcomes. Such insights are crucial for developing tailored interventions that
effectively address the diverse needs of mothers and improve maternal health outcomes in
Bacolod City.
 This study is essential because it seeks to fill the gap in the literature by investigating
how the quality of midwifery care affects maternal health outcomes, particularly in Bacolod
City. By examining demographic variables such as the age of mothers and socioeconomic status
alongside the quality of midwifery care, the study aims to provide insights that can inform
targeted interventions to improve healthcare access and quality, ultimately leading to better
outcomes for mothers and newborns.

Statement of the Problem

This study aims to assess the relationship between the level of midwifery services and
maternal health outcomes among mothers in Bacolod City, Philippines. It seeks to understand
how demographic factors such as maternal age and socioeconomic status intersect with
midwifery care quality to influence these outcomes.

To test these research questions, the study proposes the following hypotheses:
1. Is there a significant difference in the level of quality of midwifery care in Bacolod City
when grouped according to the age of mothers and their socioeconomic status.

2. Is there a significant difference in the level of maternal health outcomes in Bacolod City
when categorized based on the age of mothers and their socioeconomic status.

3. Is there a significant relationship between the quality of midwifery care and maternal
health outcomes in Bacolod City

Hypotheses
1. There is no significant difference in the level of quality of midwifery care in Bacolod
City when grouped according to the age of mothers and their socioeconomic status?

2. There is no significant difference in the level of maternal health outcomes in Bacolod

City when categorized based on the age of mothers and their socioeconomic status?

3. There is no significant relationship between the quality of midwifery care and maternal
health outcomes in Bacolod City?

Definition of Terms

Level of Quality of Midwifery Services refers to the standard and effectiveness of care
provided by midwives in Bacolod City. This encompasses the availability of skilled midwives,
the adequacy of facilities and equipment, adherence to evidence-based practices, and the
comprehensive provision of prenatal, intrapartum, and postnatal care to expecting mothers.
Evaluating the quality of midwifery services involves assessing the level of care and support
offered to pregnant women and new mothers in Bacolod City.

Level of Maternal Health Outcomes pertain to the overall health status and well-being
of mothers in Bacolod City following childbirth. This includes factors such as maternal mortality
rates, the incidence of postpartum complications, maternal satisfaction with healthcare services,
and the physical and emotional recovery of mothers after giving birth. Understanding maternal
health outcomes involves assessing the impact of childbirth on the health and recovery of
mothers in Bacolod City.

Mothers refers to postpartum women who have availed midwifery services. This
demographic group includes individuals who have recently given birth and are recipients of
maternal healthcare services in Bacolod City. Factors such as socioeconomic status, age, and
health outcomes are studied concerning this group to understand the influence of midwifery care
and demographic characteristics on maternal health in Bacolod City.

Socioeconomic Status the economic and social position of mothers in Bacolod City,
including factors such as income, education level, occupation, and access to resources.
Socioeconomic status influences maternal healthcare access, utilization, and health outcomes,
with higher socioeconomic status typically associated with better access to quality healthcare
services and improved maternal health outcomes.

Age of Mothers the age of mothers at the time of childbirth in Bacolod City. Maternal
age can impact pregnancy outcomes and maternal health, with both adolescent mothers and older
mothers facing increased risks of complications such as preterm birth, low birth weight, and
maternal morbidity. Understanding the age distribution of mothers is essential for tailoring
maternal healthcare interventions and addressing specific health needs within different age
groups.

Review of Related Literature

Quality of Midwifery Services (Renfrew, et al. (2014) study presents a comprehensive

analysis of the contribution midwifery can make to the quality of care for women and infants
globally. It outlines an evidence-informed framework for maternal and newborn care,
emphasizing the importance of skilled midwives and effective care practices. The study
differentiates between the care provided, how it is provided, and by whom, focusing on the
essential care and services needed by childbearing women and newborn infants in all settings.
The research identifies various short-term, medium-term, and long-term outcomes that can be
improved through quality midwifery care, including reduced maternal mortality, decreased
unnecessary interventions, and improved psychosocial and public health outcomes.

Maternal Health Outcomes (Hailemeskel, et al. (2023) study conducts a systematic

review and meta-analysis to assess the effectiveness of midwifery-led care on pregnancy
outcomes in low- and middle-income countries. It examines the impact of midwifery care on
maternal health outcomes, including mortality rates, complications, and overall well-being. The
research aims to provide evidence-based insights into the role of midwives in improving
pregnancy outcomes and reducing adverse maternal health results.

Quality of Midwifery Services and Demographics (Reid-Searl, et al. (2022) cross-

sectional study investigates how demographic factors influence the quality of midwifery
services, particularly in recognizing and responding to maternal deterioration. It explores
disparities in care based on patient demographics, aiming to improve the understanding of how
midwives interact with varying demographic populations and the impact on maternal health
outcomes.

Maternal Health Outcomes and Demographics (Gerards, et al. (2023). This systematic
review and meta-analysis focus on the relationship between maternal health outcomes and
demographic factors. The study explores how demographic characteristics such as age, race,
income, and education level impact maternal health outcomes and the role of midwifery care in
addressing disparities. It aims to provide evidence on how demographic factors influence the
effectiveness of midwifery-led care.

Quality of Midwifery Services and Maternal Health Outcomes (Renfrew, et al (2014)

delves into the correlation between the quality of midwifery services and maternal health
outcomes. It highlights the impact of evidence-based care practices on overall maternal and
newborn well-being. The research aims to provide insights into how quality midwifery care
positively influences maternal health outcomes, stressing the importance of skilled care in
enhancing overall maternal and newborn health.

Theoretical Framework

This quantitative research study theorizes that the quality of midwifery services in
Bacolod City directly impacts maternal health outcomes. It posits that variations in structural
factors and care processes within midwifery services influence the overall well-being of mothers
and newborns in the local context.

The theoretical foundation supporting this study is Donabedian's Theory of Healthcare

Quality, proposed by Avedis Donabedian in 1988. This theory asserts that healthcare quality can
be evaluated through three dimensions: structure, process, and outcomes. The structure
dimension focuses on the availability and organization of healthcare services, while the process
dimension centers on the delivery of care, including adherence to clinical guidelines. Finally, the
outcomes dimension assesses the impact of care on health outcomes.

Donabedian's Theory provides a robust framework for understanding and evaluating the
quality of midwifery services in Bacolod City. By applying this theory, the study aims to analyze
how structural factors such as the presence of skilled midwives and adequate facilities, as well as
care processes like the provision of prenatal, intrapartum, and postnatal services, influence
maternal outcomes. Through this analysis, the study seeks to provide valuable insights for
enhancing the delivery of midwifery care and ultimately improving overall maternal health in
Bacolod City.

Conceptual Framework

Building upon Donabedian's Theory of Healthcare Quality, the conceptual

framework for this study integrates key components of midwifery services, demographic
variables, and maternal health outcomes within the context of Bacolod City. At the core of the
framework lies the quality of midwifery care, which encompasses structural elements such as the
availability of skilled midwives, well-equipped facilities, and accessible prenatal, intrapartum,
and postnatal services. This quality of care is influenced by demographic factors including the
age of mothers and socioeconomic status, which impact healthcare access and utilization. The
interaction between midwifery care quality and demographic variables directly influences
maternal health outcomes, including maternal mortality rates and indicators of maternal and
newborn well-being. Through quantitative analysis, this study aims to elucidate the relationships
between these components, shedding light on the determinants of maternal health outcomes in
Bacolod City and informing targeted interventions to enhance midwifery services and improve
overall maternal health.
Schematic Diagram

Mothers in Bacolod City

 Age
 Socioeconomic Status

Quality Midwifery
Service

Antenatal Care Maternal Health

Labor and Outcomes
Delivery

Post-natal care

Enhance and Improve Maternal Health

Methodology

Research design. This study will utilize a descriptive and correlational quantitative
research design to evaluate the quality of midwifery services and their impact on maternal health
outcomes in Bacolod City. This approach involves collecting measurable data, such as survey
responses, to analyze using statistical methods (Creswell & Creswell, 2018). The descriptive
component will provide a summary of the midwifery services and maternal health outcomes
data, offering a clear overview of the situation in Bacolod City. The correlational aspect will
explore potential relationships between the quality of midwifery services and maternal health
outcomes, aiming to identify any connections between the two variables. By integrating these
quantitative research methods, the study aims to gain insights into the factors influencing
maternal health in Bacolod City.

Participants and sampling technique. A convenience sampling technique will be

employed to select participants during the first immunization of their newborn and postnatal
check-ups at Bacolod City Health facilities. This approach allows for the recruitment of
participants based on their availability and accessibility during routine healthcare visits, ensuring
a convenient and practical method of data collection. By selecting participants during these
specific healthcare encounters, the study aims to capture a sample of mothers who have recently
utilized midwifery services, providing valuable insights into the relationship between the quality
of midwifery services and maternal health outcomes in Bacolod City. While convenience
sampling may not offer a fully representative sample, it offers efficiency in participant
recruitment and the opportunity to gather insights from mothers actively engaged in maternal
healthcare services.

Research instrument. For the quantitative research study on the Level of midwifery
services and maternal health outcomes among mothers in Bacolod City, a researcher-made
structured questionnaire for the quantitative research study on the Level of midwifery services
and maternal health outcomes among mothers in Bacolod City will encompass various essential
parts. It will include sections to assess the Quality of Midwifery Services, gathering data on
mothers' perceptions of service quality, such as midwives' competence and facility cleanliness.
Another section will focus on Maternal Health Outcomes, capturing information on pregnancy
complications, childbirth experiences, and postnatal care. Demographic Variables will be
collected, including mothers' age, educational background, and socioeconomic status, to analyze
their influence on the study variables. Additionally, open-ended questions may be included to
allow mothers to provide detailed feedback, enhancing the understanding of their experiences
with midwifery services and maternal health outcomes.

The structured questionnaire will consist of closed-ended questions with predefined

response options to facilitate easy quantification and statistical analysis of the data. These
questions will focus on assessing the perceived quality of midwifery services, measuring
maternal health outcomes, and gathering demographic information. Rating scales, multiple-
choice questions, and Likert scale items will be included to capture participants' opinions and
experiences in a quantifiable format.

By utilizing a researcher-made structured questionnaire, the study aims to gather

quantitative data efficiently and systematically, allowing for rigorous analysis of the
relationships between the quality of midwifery services and maternal health outcomes among
mothers in Bacolod City. The questionnaire will provide a standardized approach to data
collection, enabling the study to draw meaningful conclusions based on numerical data and
statistical analysis.

Data collection procedure. Before collecting data, the researcher will obtain permissions
and approvals from the superintendents and administrators of the participating institution. They
will discuss the nature and purpose of the study, potential risks and benefits, ethical principles,
informed consent, privacy and confidentiality, justice, and voluntary participation with the
respondents. Following this, the researcher will communicate this information to the respondents
before proceeding with data collection. Throughout the process, the researcher will ensure their
safety by adhering to safety protocols such as wearing masks and sanitizing with alcohol.
During the collection of data, the researcher will distribute questionnaires to the
respondents. The questionnaires will be carefully designed to gather specific information
relevant to the study's objectives. The researcher will explain the purpose and importance of the
questionnaire to the respondents, ensuring that they understand the instructions and how to
provide accurate responses. They will be available to clarify any uncertainties or address any
concerns raised by the respondents. The researcher will maintain a professional and respectful
approach, allowing the participants to complete the questionnaire at their own pace.
After the collection of data, the researcher will conduct a debriefing session with the
respondents, expressing appreciation for their involvement of the study. Tokens or small gifts
may be given as a gesture of gratitude. The researcher will then proceed with the analysis of the
collected data, ensuring that privacy and confidentiality are maintained throughout the process.
They will emphasize the confidentiality and anonymity of the responses, assuring the
participants that their information will be kept secure. The researcher will collect the completed
questionnaires and ensure that they are properly stored for analysis. The researcher will carefully
handle and protect the data in accordance with the law, implementing appropriate security
measures. When it comes to data disposal, the researcher will follow the guidelines set forth by
the Data Privacy Act, ensuring that the data is securely disposed of to prevent any unauthorized
access or disclosure.

Data analysis procedure. Descriptive-Correlational analyses will be conducted to

examine the relationships between the quality of midwifery care and maternal health outcomes.
The collected data will be organized and cleaned, checking for missing values and errors. This
will be followed by the calculation of descriptive statistics, which will provide an overview of
the central tendencies and variability of the data. Additionally, demographic variables such as the
age of mothers and socioeconomic status will be assessed for their potential influence on the
relationship. Correlation coefficients will then be calculated to determine the strength and
direction of the relationship between the quality of midwifery care and maternal health
outcomes.

The researcher will use statistical tools like Pearson correlation coefficients and central tendency
measures to analyze the relationship between midwifery care quality and maternal health
outcomes. These tools will help quantify the association between the variables and provide a
summary of the typical values in the dataset, improving the study's depth and accuracy.

Ethical Considerations

Social value. The examination of the level of midwifery service provided to mothers in
Bacolod City and its impact on their health outcomes holds significant potential to generate
valuable insights that can inform healthcare practices, policymaking, and resource allocation.
The findings of this research have the capacity to contribute to the enhancement of midwifery
care quality and, ultimately, the improvement of the well-being of mothers and their families in
Bacolod City. By prioritizing social value, the researcher can ensure that the outcomes of the
study have a meaningful impact on the community and are in alignment with the best interests of
the participants and society.

Informed consent. The researcher will prioritize the well-being and voluntary
participation of the mothers, emphasizing their freedom to withdraw at any time without
consequences. Parental consent will be obtained for the participation of minors, and an informed
consent form will be provided and signed by the participants to ensure mutual understanding and
agreement with the research terms. These measures uphold ethical considerations and safeguard
the safety, privacy, and autonomy of the participating mothers.

Vulnerability of the research. Upon willingly participating in the data collection,

respondents may experience vulnerability as they disclose confidential information that could
potentially compromise their identity. To address this concern, an orientation will be provided to
the respondents, covering the objective, nature, scope, duration of data gathering, potential risks
and benefits, vulnerability, and the contents of the informed consent. The researcher will
emphasize that participation is voluntary, and respondents may withdraw if they feel
uncomfortable during data collection. Additionally, respondents will be informed that they can
communicate any questions or concerns to the researcher and their advisor. If a respondent
chooses to withdraw, the researcher will respect their decision and seek another respondent with
similar characteristics using the convenience sampling technique.
 Risk and benefits. Participating in the study carries potential risks, such as the disclosure
of sensitive information. To minimize these risks, the researcher will take necessary actions to
prioritize the safety and well-being of all participants. This includes strict adherence to health
protocols and obtaining informed consent. The findings of the study offer significant benefits to
both the participants and future mothers. By informing and enhancing midwifery services, the
study aims to improve the well-being and health outcomes of mothers and their families. By
addressing these risks, the study aims to maximize the benefits while ensuring the safety and
privacy of the participants.

Privacy and Confidentiality. The researcher will prioritize privacy and confidentiality,
ensuring compliance with the Data Privacy Act of 2012. This means that all personal and
sensitive information provided by the participants will be treated with the utmost confidentiality
and stored securely. Only authorized personnel involved in the study will have access to the data,
and it will be used exclusively for research purposes. The researcher will take necessary
measures to protect the privacy and identity of the participants, following the provisions outlined
in the Data Privacy Act.

In terms of data accessibility, the researcher and analysts involved in the study will have access
to the data to ensure the objectivity of the gathering and analysis process. However,
confidentiality will be maintained, and the data will only be used for the purpose of the study.
Any soft copies and materials containing raw information will be properly disposed of and
deleted within the designated period to prevent unauthorized access or use. These measures
uphold the principles of privacy and confidentiality, ensuring that the participants' information is
handled and managed responsibly.

Justice. To ensure the objectivity of participant selection in the study, the researcher will
utilize convenience sampling. This method involves selecting individuals who are readily
available and willing to participate during the immunization schedule in Bacolod City Health. By
using convenience sampling, the researcher aims to include a diverse range of participants while
considering practical factors such as availability and accessibility. Although convenience
sampling may not provide a fully representative sample of the population, it allows for efficient
data collection and can still yield valuable insights into the topic of study. Honorariums or
financial incentives will be provided to all eligible participants without discrimination, in a
transparent and ethical manner. By adhering to these principles, the researcher aims to maintain
the integrity and fairness of the research.

Transparency. The researcher acknowledges the significance of publishing the paper in a

peer-reviewed journal to contribute to the existing knowledge base and improve the quality of
life, specifically for those who have availed midwifery services. The study will be made
accessible to other researchers who adhere to the Data Privacy Act of 2012, without imposing
any monetary payment or expectations. The researcher is committed to promoting transparency
and open access to research findings. Furthermore, to maintain integrity, the researcher will
explicitly declare no conflict of interests and make no claims of monetary benefits in the paper.
This ensures that the research is conducted objectively and solely for the purpose of advancing
knowledge and benefiting the individuals who have received midwifery services.

Qualification of the researcher. The researcher possesses qualifications that ensure the
objectivity of the research and adherence to ethical guidelines. The researcher is a registered
midwife, have practical experience in the field and a deep understanding of the subject matter.
Additionally, their pursuit of a master’s in public administration and governance provides them
with a broader perspective on research subject matter. Through participation in various training
programs and seminars, they have further enhanced their knowledge and skills. With these
qualifications, the researcher is well-equipped to conduct the study with competence and
professionalism, maintaining objectivity and upholding ethical standards.

Adequacy of facilities. The success of this study relies on having enough financial
resources and facilities, which will be funded by the researcher and family without external
support. The researcher will have access to essential tools like laptops for writing and
communication. The Research and Development office will offer guidance and specialized
knowledge, while the library will provide necessary academic materials. Hard copies will be
distributed to mothers, and respondents will utilize their personal mobile devices and computers
for participation, ensuring a comprehensive and well-supported research process.

Community involvement. It is noteworthy to mention that Bacolod City Health,

particularly their administrators, midwives, and mothers, actively participated in the successful
conduct of the study. The warm accommodation of the superintendents/heads of BCH was also
highly appreciated for allowing the researcher to administer his data gathering. The support and
encouragement of the researcher's adviser, partner, family, and friends were also invaluable. In
return, the findings potentially contribute to the welfare of mothers who avail the services of
midwives, improving the maternal health outcome for both the mothers and the community at
large.

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