Background
Methods
Setting
Study design
Sampling procedure and data collection
Analysis
Ethical approval
Results
Participants | |||
---|---|---|---|
Traditional Birth attendant | Age in years | Parity | Years of experience and training |
TBA 1, Buwama | 80 years | Para 10. | More than 60 years of practice. Learnt from her mother. Untrained. All her children were delivered at home. |
TBA 2, Kamengo | 65 years | Para 10. | Thirty years of practice. Learnt from her mother in law. Trained by World Vision |
TBA 3, Kamengo | 56 years | Nulliparous. | Thirty-two years of practice. Learnt from her mother. Trained by World Vision. |
TBA 4, Buwama | 52 years | Para 5. | Twenty years of practice. Learnt from her mother. Trained by World Vision. |
TBA 5, Buwama | 46 years | Para 12. | Thirteen years of practice. Learnt from her aunt. Trained by World Vision. |
TBA 6, Kamengo | 60 years | Para 7. | Forty years of practice. Learnt from her aunt. Trained by World Vision. |
TBA 7, Muduma | 70 years | Para 10. | Fifteen years of practice. Worked initially as a nursing aide at the hospital; started assisting women to deliver at home upon retirement. |
TBA 8, Muduma | 42 years | Para 10. | Sixteen years of practice. Learnt from her mother. Trained by the District Health Office. |
TBA 9, Kamengo | 67 years | Para 6. | Eighteen years of practice Training by World Vision. |
Women | Parity | Delivery history | |
Woman 1, Muduma | 20 years | Para 1. | Home birth |
Woman 2, Muduma | 22 years | Para 3. | Last delivery was the only one at home |
Woman 3, Kamengo | 27 years | Para 4. | Last two deliveries occurred at home |
Woman 4, Kamengo | 32 years | Para 8. | Seven deliveries were at home and one at the TBA’s home. |
Woman 5, Buwama | 47 years | Para 9. | All nine deliveries at home. Four were delivered alone. |
Woman 6, Buwama | 28 years | Para 2. | Both deliveries at the road side |
Defining excessive bleeding
“I have a plastic mug that I use when a mother delivers. I collect blood from the mackintosh into this mug and that helps me estimate how much the woman has lost. If a woman I have delivered bleeds more than one cup, then that is excessive bleeding, I refer her to hospital for further management” (TBA 3).
“We were told from the training organized by World Vision that the right amount to be lost after delivery should be not more than two mugs. When blood loss is more than two mugs, then the mother is in danger” (TBA 9).
“When a woman after delivery complains of dizziness, starts sweating and losses consciousness, she is in danger. She fails to sit up on the bed or she is feeling palpitations, that woman has excessive bleeding” (TBA 6).
“In the morning after giving birth, I compressed my tummy with warm banana leaves, then blood flow increased. I removed the cloth that I used as a pad and replaced it with another. Within short time that pad was also soaked. This flow was more than my menstrual period bleeding.”(Woman 3)
Vaginal bleeding after childbirth as a normal and cleansing process
“When that blood that flows immediately after the baby is born comes out, you are now clean”. (TBA 8)
“I gave birth to my baby in the middle of the night. In the morning, my aunt got some banana leaves with warm water and compressed my abdomen to expel the bad blood. She repeated the process in the evening. … The blood that flows after childbirth is bad blood because for the whole pregnancy you are not menstruating and this is a long period. When that blood remains in your womb, you might get some complications”. (Woman 1)
Fear of blood retention
“The dirty blood may retain in the womb and it is difficult to treat. When you do not press the abdomen, you will get complications, which may call for an operation, because you did not take good care of yourself. Even if they give you tablets to swallow at the hospital, you have to press your tummy. Traditional medicine (Kamunye) is also very good in cleansing the womb, however, you must use it after pressing your tummy.” (Woman 2)
“I got a woman who didn’t bleed a lot after delivery. My concern was that the blood loss in vagina was very little. This was not normal from what I am used to seeing when I assist women. I told her to go to the hospital, but she refused because she was not feeling bad.” (TBA 2)
“Personally I can’t swallow those tablets that stop bleeding because I want the blood to come out. That blood is bad and dirty, so it must come out. …If my attendant gives me those tablets, I will pretend that I have ingested them and keep them. I will only ingest them to make her happy if she insists that I swallow when she is observing me.”(Woman 1)
Perceived risk factors for PPH
“Women who have been on family planning methods bleed a lot after childbirth. These women will have taken some time without menstruating, for example three years and immediately she gets pregnant. When she is giving birth, she will bleed a lot.” (TBA 5).
Actions women take in response to excessive bleeding in home birth
“At the hospital, the midwife gave me an injection and she told me that the injection was to prevent excessive bleeding. When I delivered at home, I did not receive any medicine to reduce excessive bleeding. I don’t know what other women who deliver at home use to prevent bleeding.” (Woman 2)
“If excessive bleeding happens, I massage the abdomen and I get out all the ‘dirty’ blood because it also leads to PPH. I have an injection that I administer to the mother so that the bleeding reduces. If a mother tells me that she usually bleeds a lot after every delivery, I do not wait any minute. I give the mother the injection immediately after the baby is born.” (TBA 7)
“Normally I call the health worker and she comes. She gives an injection and the bleeding stops.” (TBA 6)
“If the blood loss is much, I can give the mother cold water or any drink that is cold, then the flow reduces. If you don’t do that, she might lose all the blood in the body.” (TBA 8) “Apart from cold water, I don’t give anything else. I don’t even give any herbs to stop bleeding. When you give cold water, the bleeding is controlled. When I give the woman the water to drink and it doesn’t stop, then I refer her to the Health Centre so that she gets an injection which will control the bleeding.” (TBA 5)
“Cold water can make matters worse. I can not use it all. I give warm tea but I don’t give cold water to the mother. How can you give cold water to a woman who has delivered? The mother needs something warm to go in the stomach.” (TBA 7)
“When I was giving birth, my mother in law used to give me a certain ‘mumbwa’. Ever since we went for these trainings, we were told not to give any herbs to the mother.” (TBA 2)
Why do women not deliver at the health facility?
“Sometimes I hear other women say that there is no money, let me go to the TBA. The TBA will get her money in installments, which cannot be the case when you go to the hospital.” (Woman 4“There are times when the woman does not have the necessary things needed in the hospital. The nurses will ask for gloves, cotton, clothes for baby etc., and yet she does not have them. So, when she comes here, I devise a means of helping her. I also give her water to drink and food to eat.” (TBA 2)
“I have had the two births at the road side. I prepared to leave the house but I did not reach the hospital. In the recent birth, I got the labour pains at night and we went to the road to catch a Boda boda (motorbike) to take me hospital in Buwama. We failed to get any transport at that time. I could not sit on a bicycle, the only transport my husband had. When my husband saw that the labour pains were frequent and there was no Boda boda to take me, he rode his bicycle to Buwama to bring a motorbike to take me to the hospital. When I saw that I could not contain the pains, I slowly walked and reached a home near the road, where I found a woman who helped me give birth. By the time my husband arrived with motor bike, I was pushing the baby.” (Woman 6
“The nurses are very rude to the mothers in labour. So you make a decision to stay at home.” (Woman 2)
“There are times when you go to hospital to deliver and the nurse asks irritating questions like; how many children do you have? Are you looking for the president? Such comments make women not want to deliver at the health centre. A nurse can even call her colleagues to come and see a mother who has ten children, and is pregnant again. This will make the mother not to deliver from the hospital. (TBA 2)