Quality of maternity care for adolescent mothers in Mbabane, Swaziland

Abstract

Early pregnancy and unplanned childbirth may have far-reaching physical, psychological and social consequences for the adolescent girl and her offspring and are therefore public health issues of concern. A number of evidence-based maternity practices might, if properly applied, prevent unnecessary health-related problems in mothers and newborns, postnatally. In order to identify the areas of maternity practice that require improvement in Swaziland, the overall aim of this study was to generate systematic data on the maternity care and social support provided by health professionals (for adolescent mothers and their children) on admission, in the labour ward, and during and after delivery. The study was carried out during a 3-month period from April to June 1998. All pregnant adolescents with an uneventful term pregnancy, admitted to the Mbabane Government Hospital maternity ward in the morning of the study days, were informed about the purpose of the study and asked if they would like to participate. A total of 33 pregnant adolescents agreed and in-depth interviews were conducted with those participants. Observations and checklists were used to assess the maternity care given to the study participants. Results revealed that on admission to the labour ward, verbal communication and interaction between the midwife and the adolescent were minimal, and none of the adolescents was encouraged to bring a social support person to remain with them during labour. During the progress of labour, nearly 50% of the adolescent mothers developed complications and approximately 27% had a lower-segment Caesarean section. Special attention should therefore be paid to adolescent sexual and reproductive health service needs. These should include contraceptive counselling in order to prevent pregnancy at a young age and also to improve their sexual and reproductive health statuses.

Adolescents’ views on decision‐making regarding risky sexual behaviour

“…The most commonly stated age of female sexual debut was 11–13 years, compared to 14–15 years for males. This finding is consistent with other studies reported on sexual reproductive health (Mngadi 1999; Zwane 2000).…”

“…Many researchers have demonstrated that adolescents and young adults with high levels of knowledge about STDs and HIV/AIDS continue to practise unsafe sex (Keller et al. 1996; Mngadi 1999; Ndubani 1997; Zwane 2000).…”

Comparing the use and content of antenatal care in adolescent and older first-time mothers in 13 countries of west Africa: a cross-sectional analysis of Demographic and Health Surveys

“…One study examining quality of maternity care received by adolescents in Swaziland described the care provided as sub-optimal and missing many essential components (such as physical examinations, blood and urine testing), resulting in increased complications during childbirth. This was attributed to poor provider training and negligence (41). The societal stigma often associated with adolescent pregnancy may play out as reduced conscientiousness in provision of care by healthcare workers when an adolescent is involved.…”

Avaliação da assistência ao parto em maternidade terciária do interior do Estado de São Paulo, Brasil

“…26 Conhecer a evolução pré-natal contribui com o planejamento da assistência ao parto a ser desenvolvida, facilitando o processo de atenção. Além disso, tratando-se de hospital de ensino, há certa rotatividade de alunos e médicos residentes, de forma que a assistência ao parto não necessariamente é realizada pela pessoa que fez a admissão, o que ratifica a importância da qualidade dos registros nos prontuários.…”

“…A não utilização de bicos de borracha e leite artificial no alojamento conjunto e unidade neonatal evidencia o empenho institucional na promoção do aleitamento materno. 30 Investigação realizada na África do Sul evidenciou que 71% das mães foram encorajadas a amamentar precocemente, 26 situação melhor que a da maternidade estudada, já que nesta o aleitamento na primeira hora de vida foi insatisfatório tanto nos prontuários quanto nos partos observados. No mesmo serviço, em 2001, profissionais que atuavam no centro obstétrico apontaram a falta de preparo técnico para essa ação.…”