‘Waiting-to-see’ if the baby will come: Findings from a qualitative study in Kafa Zone, Ethiopia

Background: Much of the quantitative research on maternal mortality in developing countries focuses on the need for health service interventions such as skilled attendants at birth and emergency obstetric and newborn care. A growing number of studies document the need for a more comprehensive perspective and include the macrostructural, that is, the social, cultural, economic and political determinants of health.Objectives: To examine the salient aspects of birth at home and variables that influence decision making around transfer to a health facility during prolonged/obstructed labor.Methods: Ethnography using participant observation and semi-structured interviews was conducted in 2007. A total of 56 mothers in Kafa Zone were selected: 20 in-depth interviews with women who gave birth at home; four who gave birth in a health facility; and 32 during antenatal care. Interviews were also conducted with health staff from Bonga Hospital and 15 health centers or health posts. Analysis followed a process of data reduction, data display and conclusion drawing/verification with the data organized around key themes.Results: Most women gave birth at home assisted by their neighbor, mother, mother-in-law, or husband. It is likely women who gave birth at home feel ‘safe’ because that is where birth normally takes place and where they feel supported by close relatives and neighbors. Prolonged labor or ‘waiting-to-see’ if the baby would come was somewhat normalized and resulted in considerable delays to seeking assistance. Women felt it was ‘unsafe’ to go to a health facility because of the very real possibility that they would die on the way.Conclusion: The findings highlight the importance of educating the local communities to recognize pregnancy related risks and to develop and implement appropriate responses, especially early referral, as communities play an important mobilizing role to health services