Childbirth practices of facilities in district Thatta : a qualitative exploratory study

In past two decades there has been sustained decline in maternal and infant mortality. However, it is estimated that most of maternal and perinatal mortality is clustered around the time of childbirth and most of the deaths occur in the first twenty-four hours after delivery. Evidence suggests that all these deaths can be prevented by inexpensive and simple interventions during the pregnancy, at the time of birth and in postnatal period. Effective management and prevention of conditions in late-pregnancy; childbirth and the early newborn period are more likely to lessen the number of maternal-deaths, ante-partum and intrapartum related stillbirths and early-neonatal deaths, substantially. Thus, improvement of the quality of curative and preventive care during this period could have significant impact on maternal, new born survival. Study Objective: The study purpose was to understand healthcare providers\u27 and women\u27s, perception regarding quality of childbirth practices. Secondly, to observe childbirth practices in facility based delivery of district Thatta. Thirdly, to identify the gaps and barriers faced by healthcare providers in childbirth practices and finally to grasp women experiences who received services before, during and after the childbirth. Methodology: An exploratory qualitative study design using in-depth interviews with doctors, nurses and lady health workers, and focus group discussions with women who received antenatal and postnatal care were carried out. In addition direct observations of childbirth practices at the facilities were made to validate information from above two sources. Content analysis was used to code the interviews based on four broad themes (Perceptions regarding safe childbirth practices, care at the time of birth to discharge, referral system and counseling and barriers to safe childbirth practices). Emerging sub themes and codes were then developed using comparative analysis. Results: This research found that healthcare providers emphasized that for safe childbirth it is important for a woman to seek antenatal and postnatal care, as by doing so, any complications in the earlier stages of pregnancy are identified and would be easier to manage whereas diversity was observed in the perception of women regarding safe childbirth practices. Some women highlighted the importance of visiting hospital during and after pregnancy, rest believed that it was not as important especially when they are feeling healthy. With regard to practices; Doctors, Nurses and LHWs reported their way of providing care at the time of birth to discharge. The findings from the study highlighted that essential supplies and medicines were available to the providers to boost the performance of childbirth practices. On observation it was revealed that there were gaps in their practices for example no-use of Partograph, management of woman reporting to hospital after trials of labor or with fits, management of newborn infection, vaginal examination after childbirth, bleeding status before discharge and counseling about breast feeding and family planning were not performed. Findings from this study revealed that there was a complete absence of a proper referral system in both public and private hospitals. The study also explored the barriers to safe childbirth practices; healthcare providers mentioned that illiteracy among women, mismanagement at different level of care before reaching the hospital, unavailability and poor maintenance of medical equipment and medications at the public hospitals as some of the barriers. Women not coming for antenatal and postnatal care were identified as additional barriers. According to women; financial limitations, restrictions from husband, lack of information about antenatal and postnatal services, busy with household chores, non-availability of staff (public healthcare facility) and limited consultation hours were major barriers for low utilization of services. Conclusion According to data triangulation in this study, it was highlighted that disparity was found between health care providers\u27 practices and experiences of community women during ANC, delivery and PNC visits. The observations made in this study mostly supported/authenticated what women experienced. It is recommended that emphasis should be made to the quality of care at the time of the birth and in this regard to use or follow World Health Organization\u27s simple checklist which is provided for birth giving mothers will help. The Checklist is cost effective and especially designed for lower middle income countries. Keywords: Safe childbirth checklist, maternal health, neonatal health, quality of care, district \u27Thatta