Home delivery and newborn care practices among urban women in western Nepal: a questionnaire survey

Abstract

BackgroundAbout 98% of newborn deaths occur in developing countries, where most newborns deaths occur at home. In Nepal, approximately, 90% of deliveries take place at home. Information about reasons for delivering at home and newborn care practices in urban areas of Nepal is lacking and such information will be useful for policy makers.MethodsA cross-sectional survey was carried out in the immunisation clinics of Pokhara city, western Nepal during January and February, 2006. Two trained health workers administered a semi-structured questionnaire to the mothers who had delivered at home.ResultsA total of 240 mothers were interviewed. Planned home deliveries were 140 (58.3%) and 100 (41.7%) were unplanned. Only 6.2% of deliveries had a skilled birth attendant present and 38 (15.8%) mothers gave birth alone. Only 46 (16.2%) women had used a clean home delivery kit and only 92 (38.3%) birth attendants had washed their hands. The umbilical cord was cut after expulsion of placenta in 154 (64.2%) deliveries and cord was cut using a new/boiled blade in 217 (90.4%) deliveries. Mustard oil was applied to the umbilical cord in 53 (22.1%) deliveries. Birth place was heated throughout the delivery in 88 (64.2%) deliveries. Only 100 (45.8%) newborns were wrapped within 10 minutes and 233 (97.1%) were wrapped within 30 minutes. Majority (93.8%) of the newborns were given a bath soon after birth. Mustard oil massage of the newborns was a common practice (144, 60%). Sixteen (10.8%) mothers did not feed colostrum to their babies. Prelacteal feeds were given to 37(15.2%) newborns. Initiation rates of breast-feeding were 57.9% within one hour and 85.4% within 24 hours. Main reasons cited for delivering at home were 'preference' (25.7%), 'ease and convenience' (21.4%) for planned deliveries while 'precipitate labor' (51%), 'lack of transportation' (18%) and 'lack of escort' during labor (11%) were cited for the unplanned ones.ConclusionHigh-risk home delivery and newborn care practices are common in urban population also. In-depth qualitative studies are needed to explore the reasons for delivering at home. Community-based interventions are required to improve the number of families engaging a skilled attendant and hygiene during delivery. The high-risk traditional newborn care practices like delayed wrapping, bathing, mustard oil massage, prelacteal feeding and discarding colostrum need to be addressed by culturally acceptable community-based health education programmes.

Prevalence and determinants of pre-lacteal feeding in South Sudan: a community-based survey

“…Most probably, the mothers who discarded colostrum were left with no alternative but to give pre-lacteal feeds. Studies from Egypt, Ethiopia and Nepal have also reported that discarding of colostrum was associated with PLF [30,32–34]. A report from Raya Kobo district, Ethiopia [35] found that untrained traditional birth attendants and family members encouraged mothers to discard colostrum and practise PLF [35].…”

Thermal protection of the newborn in resource-limited environments

“…Less than half (46%) of the babies were wrapped within the first 10 min after birth, and almost all of them were bathed within 10 min (89%) or half an hour (96%) after birth. 34 In another study, only 64% of the babies were observed to be wrapped within half an hour after birth, and almost all were bathed within 6 h after birth. 35 In a study from Tanzania, the practice of bathing newborns immediately after delivery was shown to be motivated by concerns about 'ritual pollution'.…”

“…5,32,33 Heating the birthplace is a critical issue for home births. Studies from Nepal reported that the birthplace was heated in only slightly over half of the settings, 34 often only after birth. 35 Wrapping the child prevents heat loss from evaporation, whereas bathing promotes heat loss.…”

Hypothermia and Related Factors in High-Risk Infants

“…Various cultural and sometimes economic barriers often interfere with implementing simple steps to prevent hypothermia. Heating the birth place is costly for families in resource-poor countries [51], and drying and wrapping the baby is often not a priority when the mother needs attention after delivery [50]. In Ghana, for example, the practice of bathing newborns immediately after delivery is sometimes rooted in concerns about 'ritual pollution' [71] or the belief of helping the baby sleep and feel clean, and reducing body odor in later life; attitudes that informants felt would be difficult to change [72] and which need to be taken into account when programming for behavior change.…”

“…It is, however, a widespread practice even in high-risk environments [48][49][50][51]. Massage and oil applications to clean the child early after birth continue to be a widespread tradition [40].…”