Plain English summary
Background
Methods
Study Design & Setting
Participants and data collection
SN | Interview question and probes |
---|---|
1 | Could you please explain what kind of support do you provide to mothers during labour and delivery? (Which position did women usually assume during delivery?, who decides for delivery position?, Do women have opportunity to choose position that they would like to assume during delivery? |
2 | How do women’s relatives involved during labour and delivery? (Could a woman choose to be with her husband during labour?, What barriers?) |
3 | How do you maintain women’s privacy during labour and delivery? |
4 | How do you incorporate women’s cultural, spiritual and tradition believes in caring during labour and delivery? |
5 | What happens to the baby after delivery? |
Data analysis
Ethical consideration
Results
Barriers
Space and facility limitations
“It is impossible [for mothers to walk around in the labour room] given limited space in our labour room. The room has a little space for a bed and small table”. (Skilled health personnel 1)
“[For privacy] delivery rooms have partitions. There are some partitions but the other end of the room, especially those aluminum and glass partition, do not ensure privacy of a delivering mother. Privacy does not mean only being unseen by other people when giving birth but any mother who enters the labor room expects to be alone with the midwife”. (Skilled health personne l7)
“(…) our health facilities are very small. Rooms are not separated; you can easily cross from one woman to another. I think if we would like to have such things we need to make some improvements”. (Skilled health personne l3)
Participants were also concerned with the limited staff that impacted the quality of maternal care provided, saying that the number of mothers who presented at the hospital for delivery exceeded the staff available during the shift to provide sufficient maternal care. The limited staff and space also limited the ability for mothers to stay long after delivery, with most mothers being discharged within 12 to 24 h after delivery.“We really do not allow them [family members] to stay with mothers during delivery because we have so many women, so you cannot allow every woman who comes in the labour room to stay with their relative, there is no place for them to stay”. (Skilled health personnel 5)
Institution norms and practices
“(…) few private hospitals in Tanzania allow this”. (Skilled health personnel 1)
“We do not allow them [family members] to come in, once they brought in a woman we deal with her by ourselves”. (Skilled health personnel 1)
“Because of our rooms is difficult to find a relative in the room all the time, we have nurses there who can provide details to relatives when they require them, but because of our rooms relatives do not stay to the end. Until the woman is delivered the relatives are outside and are not allowed to enter in the room. They will get all the details they want from nurses. Until after when the baby is born and the condition of the mother is stabilized, there is no chance for any relative to enter the room”. (Skilled health personnel 3)
“(…) he [husband] might see the way we are handling his wife as inappropriate and react accordingly”. (Skilled health personnel 4)
“(…) besides, when the relatives are too involved at this critical time, they may divulge sensitive medical information to the mother and share the medical records publicly by passing it to other people (…)”. (Skilled health personnel 8)
“Panic can emerge as the result of the spouse beholding the critical health condition of the woman in labour, where the mother is experiencing excessive bleed or the midwife is pressing the woman’s abdomen to push the baby out. These situations may be perceived by the spouse as coercive or abusive. This perception may cause the spouse to consider legal action against the hospital. So, yeah, much as everyone has rights, we strive to avoid such problems by encouraging minimal spouse involvement.” (Skilled health personnel 8)
Beliefs that choice of birth position should be limited
“Lithotomy position for pregnant woman is better because it will be easy to see as the baby protrudes through the woman’s vulva. (…) it is also good for the midwife to check the cervix of the mother who is about to give birth compared to when the mother is in the lateral position. In my view, the lithotomy position is better because less time will be spent for child delivery”. (Skilled health personnel 5)
“[The lithotomic position] is the professionally sanctioned standard position (…) it is the most accommodating in that it gives the mother considerable pushing power and allows the mother to grab her legs when [pushing], which is the safest way”. (Skilled health personnel 8)
“(…) what I was taught is that that is [lithotomy] a good position and it helps a mother to give birth well and exactly depending to how a baby lies. You can help her well and you can receive the baby in good condition and it makes the mother to be more comfortable. (…) I have also read that lithotomy position is best and delivery can be conducted easily”.(Skilled health personnel 3)
“You are [midwife] the one who tells the woman which position she should lie for easy delivery because other women it is their first delivery so they do not know”. (Skilled health personnel 4)
“We [midwives] have experience with that position, the one which she lies on her back”. (Skilled health personnel 3)
“Many women give birth lying on their backs. Many say that they feel more comfortable when they deliver they get strength. (…) we normally don’t ask but we instruct them how to lie”. (Skilled health personnel 6)
“[Some mothers prefer] to sit, others prefer a delivering posture the same as they are in the toilet. But others prefer to lie in sideways. I think that, on the side of the woman, the best posture is that which she feels comfortable. As a service provider, I prefer the lithotomy position, especially when we want to maintain the mother’s cleanliness. This allows me to control a mother when assisting her during delivery. So it is a two-sided perspective”. (Skilled health personnel 7)
Disrespect for traditions and culture
“Our perspective is that herbs are not scientifically tested. Although the herbs help in accelerating contraction, they have side effects. (…) we don't know exactly its composition. Actually, the issues of tradition and customs is not given due weight. I personally do not take it as a serious issue. I work as I was trained. (…) we may be performing our duties as Europeans. I take the medical training that I received is of European norms and principles. So, we take that understanding expecting mothers who has come to the hospital for treatment or childbirth has left her traditions and customs at home. She has agreed with European norms. She may perform her traditions and customs when she goes back home. I have not asked any mother about her observance regarding childbirth according to her tribe”. (Skilled health personnel 7)
“Most women use herbs to facilitate uterine contractions. (…) we need contractions but with normal required intensity and frequency. (…) most of the expecting mothers use herbs before coming to the hospital and they end up with fetal distress, because she may have good contractions but with an unopened cervix. In this situation, contractions do not go with labor progress (…)”. (Skilled health personnel 7)
Facilitators
Ongoing education of skilled health personnel on respectful maternal care
“(…) even in class we were told the mom [can] choose [the position] how to push”. (Skilled health personnel 1)
“As we were taught, we have to allow the woman to assume the position which she is comfortable to give birth, although most of time we advices them to lie with their back. But if she wants to squat, you have to allow her”. (Skilled health personnel 3)
“(…) we were educated about importance of maintaining privacy, ensuring the woman in labour is constantly supported physically and emotionally by providing psychological support and managing pain (…)”. (Skilled health personnel 1)
Institutional norms designed for continuous clinic support during childbirth
“(…) women are helped from the first stage until the fourth stage of labour and we stay with her until she is discharged and she becomes free with her relatives”. (Skilled health personnel 1)
“During a typical delivery, the doctors, while they were not always present during every uncomplicated delivery, they were close by and active in complicated deliveries or during operations”. (Skilled health personnel 4)
“(…) when a woman arrives at the reception, we always receive her quickly and do quick assessment, we prioritize women because they arrive many at once. (…), you have to check what kind of women you have because some are in true labour pain and close to deliver or sometimes we like to ask those who have urge to push”. (Skilled health personnel 1)
“When the mother arrives with labour pain, I receive her and start physical examinations. I check her to ensure her blood pressure is not high which can cause problems during delivery. After doing that then I do abdominal examinations and PV examination to asses if the cervix is open or not and if yes by how much; so that to determine the progress of labour or she will be taken to labour room directly, because others arrive already in second stage (…). After completing examinations I then check her health status; if she has tested or not. I test her if she hasn’t been tested to know if she has acquired infection or not (…)”. (Skilled health personnel 4)
“(…) here at our facility we use curtains to maintain privacy. If a woman wants to give birth, we must make sure all curtains are set. In our labour ward, there are partitions so we close the curtains very well”. (Skilled health personnel 2)
“[After the baby is born] we look up at the child's scoring, appearance (…) we also look at how the baby is crying and then we wrap up the baby. Thereafter we weight the child on a scale. After these procedures, we instantaneously carry the baby to a parched area and immediately put her to breastfeeding”.(Skilled health personnel 7)
Belief in benefit of having family to become active participants
“(…) if the partner is present from the beginning of labour up to delivery, then he will understand what the mother has been through and hence be able to help her while at home”. (Skilled health personnel 4)
“(…) a partner being present during labor is to help the expectant mother emotionally and to encourage the mother to push. (…) there are few midwives and most of the time they are outnumbered by the expectant mothers. There may be up to seven expectant mothers on beds with only one midwife making it difficult for her to work on time and with efficiency”. (Skilled health personnel 3)
“(…) normally they come with their mothers. I think her mother should be there. Because she understood, she is able to guide her (…)”. (Skilled health personnel 6)
Respecting maternal wishes when appropriate
“(…) if she tells us her best position then we have to support her in that position for her to give birth comfortably”. (Skilled health personnel 3)
“In my perspective, we are not that thoughtful of the traditional practices but we are always accommodative of the mother and family wishes, if there are any. Whether it’s the longing to pack up the placenta back home or this and that, one should simply let the mother fulfil her wish”. (Skilled health personnel 7)