Home birth and barriers to referring women with obstetric complications to hospitals: a mixed-methods study in Zahedan, southeastern Iran

Abstract

BackgroundOne factor that contributes to high maternal mortality in developing countries is the delayed use of Emergency Obstetric-Care (EmOC) facilities. The objective of this study was to determine the factors that hinder midwives and parturient women from using hospitals when complications occur during home birth in Sistan and Baluchestan province, Iran, where 23% of all deliveries take place in non- hospital settings.MethodsIn the study and data management, a mixed-methods approach was used. In the quantitative phase, we compared the existing health-sector data with World Health Organization (WHO) standards for the availability and use of EmOC services. The qualitative phase included collection and analysis of interviews with midwives and traditional birth attendants and twenty-one in-depth interviews with mothers. The data collected in this phase were managed according to the principles of qualitative data analysis.ResultsThe findings demonstrate that three distinct factors lead to indecisiveness and delay in the use of EmOC by the midwives and mothers studied. Socio-cultural and familial reasons compel some women to choose to give birth at home and to hesitate seeking professional emergency care for delivery complications. Apprehension about being insulted by physicians, the necessity of protecting their professional integrity in front of patients and an inability to persuade their patients lead to an over-insistence by midwives on completing deliveries at the mothers' homes and a reluctance to refer their patients to hospitals. The low quality and expense of EmOC and the mothers' lack of health insurance also contribute to delays in referral.ConclusionsWomen who choose to give birth at home accept the risk that complications may arise. Training midwives and persuading mothers and significant others who make decisions about the value of referring women to hospitals at the onset of life-threatening complications are central factors to increasing the use of available hospitals. The hospitals must be safe, comfortable and attractive environments for parturition and should give appropriate consideration to the ethical and cultural concerns of the women. Appropriate management of financial and insurance-related issues can help midwives and mothers make a rational decision when complications arise.

Determinants of Institutional Delivery Among Mothers Who Gave Birth in the Last One Year in Dejen Woreda, Ethiopia, 2016: A Cross Sectional Study

“…The possible explanation might be the fact that mothers in these countries had better educational status (since only 17.6% was illiterate) and better ANC service utilization (since more than 95% had ANC follow up). The finding of this study is lower than WHO recommendation of every pregnancy should be assisted by skill attendance [11]% yet better than Kenya, institutional delivery is 38% [15], the national prevalence [3] and a study in Amhara region, Sekela [16] and Dodota district [18]. This might be due to time gap, increased opportunity for education and difference in place of residence.…”

“…World Health Organizations (WHO) strongly advocates skilled care for every birth to reduce the global burden of 536, 000 maternal deaths every year [11,12]. A community-based cross-sectional study conducted in Nepal showed that out of the total participants, 77.3% had institutional delivery [13].…”

In Reply to: Minimal Requirements in Reporting Qualitative and Quantitative Studies: Critics on Two Papers

“…Of course, having some focused interest in the form of a question is necessary for research design (5) that can be stated as a research aim (7); and although it facilitates the development of research plan, the fact is that the primary question may change. During this process the researcher may find far more interesting things than he or she at first thought (5); as we found during the study and published them within different articles (3,4).…”

“…In spite of geographical and drive-time accessibility of these hospitals, about 10% -12% of local women still choose to deliver their babies at home (3,4). Therefore, the main question is not about maternal mortality rate or the impact of childbirth place on maternal death, but about the use of available services.…”

Kepuasan Bidan Desa dalam Pelayanan Persalinan Normal pada Implementasi Kebijakan Jaminan Persalinan

“…17,18 Di Iran, kaum perempuan percaya bahwa lebih baik meninggal ketika melahirkan di rumah daripada harus bersalin pada bidan ataupun di rumah sakit. 19 Persepsi seperti itu dipengaruhi oleh tingkat pendidikan, budaya , dan kepercayaan serta tingkat ekonomi masyarakat. Di Israel, pada kajian selama sepuluh tahun, ditemukan bahwa masyarakat perdesaan tidak sepenuhnya menggunakan pengobatan medis konvensional untuk mengatasi masalah kesehatan, mereka juga menggunakan berbagai pengobatan alternatif yang membudaya di dalam masyarakat.…”