Midwives’ Experience With Low-Dose Aspirin Shapes Preeclampsia Prevention in Indonesian Primary Care
Preeclampsia prevention in Indonesia’s primary healthcare system increasingly depends on the confidence, experience, and clinical judgment of midwives. A 2026 study by Sendy Dwi Pertiwi, Al-Munawir, and Tecky Indriana from the Department of Public Health, Universitas Jember, reveals how midwives’ lived experiences directly influence the successful use of low-dose aspirin to prevent preeclampsia, one of the leading causes of maternal mortality. Published in the International Journal of Contemporary Sciences, the research highlights why strengthening midwives’ competence is critical for safer pregnancies and better maternal outcomes.
Why Preeclampsia Prevention Matters
Preeclampsia is a pregnancy complication marked by high blood pressure after 20 weeks of gestation. If not detected and managed early, it can progress to life-threatening conditions for both mother and baby. Global and national data show that hypertensive disorders of pregnancy remain a major contributor to maternal and perinatal deaths, particularly in regions with limited access to specialist care.
International health guidelines, including those referenced by the World Health Organization, recommend low-dose aspirin prophylaxis for pregnant women at high risk of preeclampsia. Aspirin helps reduce abnormal blood clotting and inflammation linked to placental dysfunction. However, the effectiveness of this strategy depends heavily on frontline healthcare providers—especially midwives—who are responsible for screening, counseling, prescribing, and follow-up in primary care settings.
Research Focus and Context
The study was conducted in Jember Regency, East Java, involving midwives working at public health centers that serve high-risk pregnant women. Unlike many previous studies that focused on clinical outcomes alone, this research explored how midwives experience and interpret their role in delivering aspirin prophylaxis.
By examining daily practice, professional confidence, and ethical challenges, the authors provide a grounded view of how prevention strategies work in real-world conditions. This perspective is especially relevant for countries like Indonesia, where midwives are the backbone of maternal healthcare services.
How the Study Was Conducted
This approach allowed the authors to understand not just what midwives do, but how they feel, think, and learn while caring for pregnant women at risk of preeclampsia.
Key Findings From the Field
The study found that midwives’ competence develops gradually, shaped by experience, training access, and system support. Several important themes emerged:
- From uncertainty to confidence, Many midwives initially felt hesitant prescribing aspirin to pregnant women, worried about side effects and patient reactions. Confidence increased after witnessing stable blood pressure and fewer complications in mothers who adhered to aspirin therapy.
- Experience shapes clinical judgment, Midwives with longer professional experience demonstrated stronger risk-screening skills and were more decisive in initiating prophylaxis. Real clinical success reinforced trust in evidence-based prevention.
- Communication is as critical as medication, Effective counseling—using simple language, empathy, and real-life examples—was essential to improve adherence. Mothers who trusted their midwives were more likely to follow long-term aspirin regimens.
- System support influences consistency, Variations in practice were linked to differences in training opportunities, access to clear guidelines, interprofessional collaboration, and availability of aspirin supplies.
- Ethical dilemmas remain, Midwives often faced challenges when pregnant women refused medication. Balancing patient autonomy with preventive responsibility became an important part of professional growth.
Real-World Impact and Policy Implications
The findings underline that clinical competence is not static. It grows through reflection, mentorship, and repeated exposure to real cases. For policymakers and healthcare managers, the study offers several practical implications:
- Strengthen continuous professional development, Regular training, mentoring, and experiential learning can reduce uncertainty and improve screening accuracy.
- Support midwives as frontline decision-makers, Clear policies and legal backing empower midwives to initiate preventive therapy confidently.
- Invest in communication skills, Counseling and patient education are non-pharmacological interventions that directly affect adherence and outcomes.
- Improve system readiness, Consistent drug supply, standardized documentation, and interprofessional collaboration enhance the effectiveness of prevention programs.
As the authors emphasize, successful preeclampsia prevention is not only about clinical guidelines but also about the people who apply them daily in community settings.
Insight From the Researchers
According to Sendy Dwi Pertiwi of Universitas Jember, midwives’ experiences show that “professional confidence grows when clinical knowledge is reinforced by real outcomes and reflective practice.” This perspective highlights why experiential learning and system support must go hand in hand in maternal health services.
Author Profiles
- Sendy Dwi Pertiwi, M.PH – Lecturer and public health researcher, Department of Public Health, Universitas Jember. Expertise in maternal and child health and qualitative health research.
- Al-Munawir, M.PH – Public health academic, Universitas Jember, focusing on health systems and preventive care
- Tecky Indriana, M.Kes – Researcher in community health and health promotion, Universitas Jember.
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