Journal of Gynecology & Obstetrics Research Article
Birth Preparedness and Complication Readiness Knowledge and Practice by Pregnant Women in a Cottage Hospital Nigeria Chioma Rose Nkwocha1, Omosivie Maduka2 and Faith C Diorgu3* Department of Nursing Science, University of Port Harcourt, Nigeria Department of Preventive and Social Medicine, Faculty of clinical Sciences, University of Port Harcourt, Port Harcourt, Nigeria 3 Department of Nursing Science, Faculty of Clinical Sciences, University of Port Harcourt, Nigeria 1 2
*Corresponding author: Faith C Diorgu, Email:
[email protected] Received: 08 February 2017; Accepted: 03 April 2017; Published: 13 April 2017
Abstract Background: Maternal mortality and morbidity poses a huge public health burden. It is difficult to envisage which women will experience obstetric complications that may lead to maternal mortality or morbidity. Each pregnant woman should therefore be adequately prepared for birth. Consequently, birth preparedness and complication readiness is a key concept involving the preparation for normal birth and anticipating the interventions needed in case of an emergency. Aim: To assess the knowledge and practice of birth preparedness and complication readiness among pregnant women attending the ante-natal clinic in Obio Cottage Hospital, Port Harcourt. Materials and Methods: A descriptive cross sectional study using questionnaires on 407 mothers. Data were collected using structured and pre-tested questionnaire. The data analysis was supported by SPSS version 16. Data analysis was made by descriptive statistics and chi square tests at 0.05 significance level. Results: More than half of the pregnant women in the study 322 (79 .12 %) know about birth preparedness and complication readiness. Majority of the women 333 (81.8%) obtained the information from their healthcare providers. The practice of birth preparedness and complication readiness in the respondents showed that 381 (93.61%) had identified a place of delivery, 342 (84.03%) were saving money in case of emergencies, 366 (89.93%) were preparing essential items for safe delivery and the post-partum period, and 237 (58.23%) could detect early signs of an emergency. No statistical significant relationship was found between level of education of the pregnant women in the study and their practice of birth preparedness and complication readiness (P.>0.05). Conclusion: Birth preparedness and complication readiness knowledge and practice among the respondents was found to be satisfactory. The study noted that pregnant women rely so much on information provided by their health care providers during antenatal period. Information, Education and Communication (IEC) on birth preparedness and complication readiness may be introduced earlier in pre-conception classes.
Keywords: Birth Preparedness; Complication Readiness; Place of Delivery; Antenatal Care Introduction Maternal mortality which is the death of a pregnant woman within 42 days of termination of pregnancy occurs from pregnancy-related or aggravated conditions [1]. Globally, more than half a million of
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women die from pregnancy and childbirth related complications each year, and 99% of these deaths occur in the developing countries [2]. In sub-Sahara Africa, the maternal mortality rate is 1 in 16, while in developed countries it is 1 in 2,800 per life time [3]. Literature also recorded similar increase in Nigeria [4,5]. The increase in the maternal mortality poses a huge burden and remains a public health problem especially in the developing countries [6]. The possibility of dying from pregnancy-related causes is highest in Africa, this could be that African women give birth to more children than women on other continents and for each pregnancy the risks are greater [7,8]. Majority of the maternal deaths have been associated directly or indirectly to pregnancy and childbirth such as unsafe abortion, severe bleeding, infection, hypertensive disorders, and obstructed labor among those pregnant women who received poor health care service or inadequate care [7]. In addition, access to care is slowed down by delays in deciding to seek care, delays in reaching care, and delays in receiving care. These delays arises from logistic and financial concerns, unsupportive policies, and gaps in services, as well as inadequate awareness and knowledge about maternal and newborn health issues. Since it is not possible to predict which women will experience lifethreatening obstetric complications that lead to maternal mortality, every pregnant woman faces the risk of sudden, unpredictable complications that could end in death or injury to herself or her infant. So preparing for emergency and complication readiness during childbirth has been identified as the single most important intervention in safe motherhood [6]. The concept entails planning for normal birth and anticipating the actions to take in view of an emergency [9]. The birth plan enables the pregnant woman and her family to identify place of delivery, arrange for transport to the health facility, save money for services, get a compactable blood donor and have birth companion ready before birth [10], as preparing for childbirth and being ready for complications reduces risk of maternal and infant mortality. It entails making plans prior to birth to ensure that a pregnant woman is prepared for normal birth and complications [11,12]. Despite the fact that birth preparedness and complication readiness is essential for further improvement of maternal and child health, little is known about the knowledge and practice of birth preparedness and complication readiness by pregnant women in Nigeria where most pregnancies are unplanned [13]. This study therefore aims to fill this gap by assessing pregnant women attending antenatal care in Obio Cottage Hospital, Port Harcourt, Nigeria regarding birth preparedness and complication readiness during childbirth. It is hoped that the results of the study will highlight their current status of awareness and practice.
Method and Materials In April to August 2016 a cross sectional survey study was conducted using quantitative methods. The study was conducted among all pregnant women who were attending antenatal care during the study period. The inclusion criteria were women whose pregnancy was 12 weeks and above and have attended the antenatal clinic for not less than twice in Obio Cottage hospital. From the antenatal booking records, an average of two hundred and seventy pregnant women attending antenatal clinic weekly, making an average monthly attendance of 1,080 pregnant women. Based on the above information a sampling list, which enlists all eligible subjects was prepared. From the list, pregnant women with gestational age of three months and above were included in the survey. Using sampling frame generated, 407 mothers were selected by systematic random method. The minimum sample size of 407 was determined using Leslie Kish formula for estimating a single proportion. Copyright © 2017 The Authors. Published by Scientific Open Access Journals LLC.
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Data was collected using a structured questionnaire which elicited information on social demographic characteristics, awareness and practice of birth preparedness and complication readiness. A scoring system of “yes or no” responses were used to elicit the practice of birth preparedness and complication readiness. Data were entered into the Statistical Package for Social Sciences (SPSS) version 16. The data was analyzed with descriptive statistics of percentage distribution and Chi Square test for relationship with some variables.
Results A total of 407 respondents were included in this study. The mean age of the participating mothers was 30 .12 years (S.D ± 4.4). Pregnant women aged between 30 to 39 years constituted the majority n=230 (56.51%). All the subject were married, majority had post-secondary education n=298 (73.22%) and many of the women were first time mothers. By ethnicity n=204 (50.12%) were Ibos. The major predominant religions were Christianity 400 (98.28%), and Muslim n=7 (1.72% ) of the respondents (Table 1).
Knowledge of birth preparedness and complication readiness Majority of the women know about birth preparedness and complication readiness n= 322 (79.11%). Two hundred and eighty (69%) of the respondents received information on birth preparedness and complication readiness from their healthcare providers, n=5 (1.22%) obtained the information from traditional birth attendants, n=21 (5.15%) from the community health workers, n=19 (4.70%) from their mothers, n= 17 (4.17%) from the mass media, n=6 (1.47%) from books, n=2 (0.49%) from home, n=1 (0.24%) from the internet, n=2 (0.49%) from school and n= 1 (0.24%) from her sister. When asked if they knew before now how to prepare for birth and for complication related to birth, n=111 (27.27%) knew about arranging for emergency funds, n= 103 (25.30%) about arranging for a birth companion, n=106 (26,04%) about arranging for a blood donor, n=100 (24.57%) knew about identifying a health facility for emergency, n=124 (30.46%) about arranging for transportation, n=231 (57%) knew about identification of a place of delivery, n= 98 (24.07%) identification of a skilled provider, n=208 (51.10%) knew about the provision of essential items for clean delivery and post-partum period and n= 228 (56%) about saving of money. Only n= 356 (87.47%) of the respondents knew the danger signs that could occur during pregnancy, while n=51 (12.53%) did not (Table 2).
Practice of birth preparedness and complication readiness Regarding the practice of birth preparedness and complication readiness, the result showed that 381 (93.61%) had already identified a place of delivery and 26 (6.39%) had not, 342 (84.03%) were saving money and 65 (15.97%) were not, 366 (89.93%) were preparing essential items for clean delivery and post-partum, while 120 (29.48%) were not, 237 (58.23%) could detect early signs of an emergency and 170 (41.77%) could not, 244 (59.95%) had arranged for a birth companion and 163 (40.05%) had not, 181 (44.47%) had arranged for emergency funds and 226 (55.53%) had not, 301 (73.96%) had identified a means of transport and 106 (26.04%) had not, 71 (17.44%) had arranged for a blood donor and 336 (82.56%) had not, 209 (51.35%) had identified a health facility for emergency and 198 (48.65%) had not as shown in Table 3.
Relationship between the educational level of pregnant women and their practice of birth preparedness and complication readiness Logistic regression analysis showed age and educational status are not predictor of awareness and practice of birth preparedness
and complication readiness (OR=0.67, p=0.419,95% CI=0.13 -3.06) (OR=1.95,p=0.250, 95% CI=0.45-8.83) respectively.
Discussion The importance of birth preparedness and complication readiness in ante natal care cannot be overemphasized as complications during child birth are not always predictable, it is an important process involving the planning for normal birth and anticipating the actions needed in case of an emergency [14]. The results showed that majority of the women were aware of birth preparedness and complication readiness. Although few of the women got their information from different sources, most of the women were informed by their care providers, similar findings was noted by John [14], and Emma-Ukaegbu [15]. The level of information women receive during antenatal from health care professionals influences their attitude in making right decision concerning their birth. Inherent in making decisions and choices is information and a good knowledge base [16]. For an expectant mother Table 1: Socio-demographic characteristics of Respondents. Characteristics Age 80%) among the respondents, which has been demonstrated to be positively associated with the knowledge of birth preparedness [14]. The location of the study being an urban center may have also influenced the level of awareness of mothers studied, as being resident in an urban areas exposes one to information [22]. Regarding practice of birth preparedness and complication readiness, the study showed that many of currently pregnant women attending Obio Cottage hospital were prepared for delivery and obstetric emergency by practicing most specific element of birth preparedness and complication readiness which include: identify place of delivery (93.61%), save money (84.03%),prepare essential items for delivery (89.93%), and identify means of transportation (73.96%). This may be due to birth preparedness and complication readiness counseling that women received from their care providers during their antenatal care follow-up visits. Pregnant women who regularly attend ANC appointments are more likely to plan to prepare for birth and complication by 4 times as compared to non ANC attendees [23]. Attendance to antenatal care is important in monitoring the wellbeing of both the mother and the unborn child. It also provide provides an opportunity to inform and help the pregnant women plan for a safe birth and prepare for complication should it arises. Additionally, it provides an opening for the woman to be encouraged and make an appropriate plan for delivery [24]. In this study, majority of the women attended antenatal care regularly. Regarding maternal education, studies have associated level of education with practice [14,15,18], as well as influence of the orientation received from health care workers [25]. Similarly, studies reported high level of good practice of birth preparedness amongst pregnant women with higher education [26-28]. Educated mothers are more likely prepared for birth and complication readiness practice as compared to pregnant women who are unable to read and write. This finding is consistent with other studies in Nigeria, Kenya [29] and Ethiopia [20]. However this study noted no significant relationship between educational background and the practice of birth preparedness and complication readiness, rather the information received from the health care provider during antenatal have a great influence on the practice of birth preparedness. Pregnant women need to be adequately informed and supported regarding how to prepare for normal birth and plan for birth emergencies during antenatal.
Conclusion The knowledge and practice of birth preparedness and complication readiness among pregnant women studied was fairly good. The study identified that educational level was not a good predictor of practice of birth preparedness and complication readiness, rather women who registered for ante natal clinic rely heavily on the health education received from the care givers. Therefore, it is important that pregnant women are well educated regarding birth preparedness and complication readiness before birth. Nonetheless, the study showed that majority of the women were well informed and adequately prepared in case of complications during child birth.
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Citation: Nkwosa CR, Maduka O, Diorgu FC. Birth Preparedness and Complication Readiness Knowledge and Practice by Pregnant Women in a Cottage Hospital Nigeria. J Gynec Obstet 2017; 1:014.
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Citation: Nkwosa CR, Maduka O, Diorgu FC. Birth Preparedness and Complication Readiness Knowledge and Practice by Pregnant Women in a Cottage Hospital Nigeria. J Gynec Obstet 2017; 1:014.
