Result of quantitative parts (A)
Two hundred and twenty-eight (228) questionnaires were administered to selected respondents and all completed the questionnaire; thus, a response rate of 100% was achieved.
Descriptive characteristics of respondents
Socio-demographic characteristics
The mean age of women who participated in the study was 32.9 ± 8.1 years; classification of the age record showed that. 50 (21.9%) were in the age range of 15 – 25 years, 80 (35.1%) were in the age range 26 – 35 years, 88 (38.6%) were of ages between 36 – 45 years, and 10 (4.4%) were above 45 years. Two thirds of the respondents were married as at the time of this study154 (67.5%), 41 (18.0%) were divorced, 28 (12.3%) widowed, while only. 5 (2.2%) were single. A bit more than half of the women had no formal education 118 (51.8%), almost a quarter had just primary education 55 (24.1%), about 40(17.5%) had not more than secondary education, not more than 15(6.6%) had a tertiary education. Almost half of the participants were unemployed 108 (47.4%) as at time of the study, 55(24.1%) were self-employed, about 27(11.8%) engaged in farming or agricultural businesses, 26(11.4%) engaged in a form of skilled labour, while 12 (5.3%) engaged in an unskilled labour. (Table 4.1)
The report on monthly income of the women’s household revealed an average income of $225; classification of the income record showed that about 84 (36.8. %) earned between $50 - $150,80(35.1%) earned between $160 - $250, 36(15.8%) reported a monthly income level of $260 - $350, and 28(12.3%) reported monthly earning above $350. Record of the women’s partner’s educational level showed that half of the women 113 (49.6%) had partners with no formal education, 39 (17.1%) had partners with just primary education, 36(15.8%) reported their partners had attained secondary education, while 40(17.5%) reported they had partners with a tertiary level of education.
Table 4.1: Socio-demographic Characteristics of respondents [n = 228]
|
Frequency
|
Percentage (%)
|
Age Group (Years) (
|
|
|
15 – 25 years
|
50
|
21.9
|
26 – 35 years
|
80
|
35.1
|
36 – 45 years
|
88
|
38.6
|
> 45 years
|
10
|
4.4
|
Marital Status
|
|
|
Single
|
5
|
2.2
|
Married
|
154
|
67.5
|
Divorced
|
41
|
18.
|
Widowed
|
28
|
12.3
|
Highest Level of Education
|
|
|
Non-formal education
|
118
|
51.8
|
Primary education
|
55
|
24.1
|
Secondary education
|
40
|
17.5
|
Tertiary
|
15
|
6.6
|
Occupation
|
|
|
Unemployed
|
108
|
47.4
|
Self-employed
|
55
|
24.1
|
Farming/Agriculture
|
27
|
11.8
|
Skilled labour
|
26
|
11.4
|
Unskilled labour
|
12
|
5.3
|
Monthly Income ($)
|
|
|
50 – 150
|
84
|
36.8
|
160 – 250
|
80
|
35.1
|
260 – 350
|
36
|
15.8
|
Above 350
|
28
|
12.3
|
Partner’s Level of Education
|
|
|
Non-formal education
|
113
|
49.6
|
Primary education
|
39
|
17.1
|
Secondary education
|
36
|
15.8
|
Tertiary
|
40
|
17.5
|
Obstetrics experience of the respondents
The parity record of the women showed that 79 (34.6%) had between 1 – 3 children, 84 (36.8%) reported having 4 – 7 children, 56(24.6%) had delivered up to 8 – 10 children, and just 9(4.0%) had more than 10 children.
Information obtained on the delivery experience of the women showed that an average woman from the study had conceived about 5 pregnancies; 75(32.9%) reported having had 1 – 3 pregnancies, 68(29.8%) reported having had 4 – 6 pregnancies, 51(22.4%) hinted having 7 – 9 pregnancies prior the study, and 34(14.9%) reported having 10 or more pregnancies. Averagely, a woman from the study had delivered 5 children; further revealing was that, 80 (35.1%) had 1 – 3 children, 72(31.6%) had delivered 4 – 6 children, and 47(20.6%) reported having delivered 7 – 9 children, while 29(12.7%) had 10 or more children.
Record of the women’s delivery at the health facility revealed that, on the average, a woman had delivered about 3 children at the facility; categorization of the record exposed that, 26(11.4%) had not delivered at a health facility prior the study, 102(44.7%) had delivered 1 – 3 children at a health facility, 56(24.6)% have had 4 – 6 deliveries at a health facility, 25(11.0%) have had 7 – 9 deliveries at a health facility, while19(8.3%) have had 10 or more deliveries at a health facility. Averagely, a woman from this study had delivered a child at home; approximately 134(58.8%) had no record of home delivery among the women, 53 (23.2%) have had 1 – 3 child deliveries at home, 53(13.2%) stated they delivered 4 -6 of their children at home, 9(3.9%) have had 7 – 9 deliveries at home, not more than 2(0.9% ) have had 10 or more deliveries at home.
Table 4.1.2: Obstetric experience of respondents [n = 228]
|
Frequency
|
Percentage
(%)
|
Parity
|
|
|
1 – 3
|
79
|
34.6
|
4 – 7
|
84
|
36.8
|
8 – 10
|
56
|
24.6
|
>10
|
9
|
4.0
|
Number of Pregnancies
|
|
|
1 – 3
|
75
|
32.9
|
4 – 6
|
68
|
29.8
|
7 – 9
|
51
|
22.4
|
≥10
|
34
|
14.9
|
Number of Deliveries
|
|
|
1 – 3 children
|
80
|
35.1
|
4 – 6 children
|
72
|
31.6
|
7 – 9 children
|
47
|
20.6
|
10 or more children
|
29
|
12.7
|
Number of Deliveries at Health Facilities
|
|
|
No delivery
|
26
|
11.4
|
1 – 3 deliveries
|
102
|
44.7
|
4 – 6 deliveries
|
56
|
24.6
|
7 – 9 deliveries
|
25
|
11.0
|
10 or more deliveries
|
19
|
8.3
|
Number of Deliveries at Home
|
|
|
No delivery
|
134
|
58.8
|
1 – 3 deliveries
|
53
|
23.2
|
4 – 6 deliveries
|
30
|
13.2
|
7 – 9 deliveries
|
9
|
3.9
|
10 or more deliveries
|
2
|
0.9
|
4.1.3 Prevalence of home delivery
Figure 1 shows that 41% have had at least one child delivery at home, while 59% of the women had never delivered a child at home.
FIGURE 2. Reasons respondents gave for not delivering in health facilities
Figure 2 is showing Common reasons for not using the health facilities among the women who had a delivery at home is presented on Figure 2. Most of them hinted that their delivery happened without prior plan (17%); a few indicated their mother recommended a TBA to them, which prevented them from using the health facility (16%); about 13% indicated they lived far away from the health center (13%); 12% indicated that they decided not to use the health facility because there were no health institution available at that time; 12% indicated their reason was due to not liking the available health institution for delivery; almost 10% stated they held belief that home delivery is better than using a health facility; 7% reported they have had a bad experience on their first delivery at a health institution; 7% reported they could not afford the cost of health institution; 4% stated that their husband took them to a TBA; about 1% hinted the available health institution was not well-equipped or they rather chose to use the TBA by themselves.
THE FACTORS INFLUENCING THE CHOICE OF OBSTETRIC HOME DELIVERY
141 (.61.8%) women decided by themselves as to where they delivered their last child 50(22.0%); a few reported their husbands decided for them, while the remaining. 37 (16%) reported the decision was taken by their mother. Only 89(39.0%) of the women affirmed they lived in an area near or not more than 5km to a health facility where they could deliver their children. Regarding believe that home delivery can lead to maternal death, 71 (31.1%) of the women claimed they had this believe. 157 (68.9%) reported they had traditional custom that require pregnant women to deliver their babies at home. On Holds traditional custom that require pregnant women to deliver at home 122 (53.5%) were said yes while 106(46.5) of them said no.
Table 4.1.3: Frequency distribution of factors influencing obstetric home delivery among respondents [N = 228]
|
Frequency
|
Percentage
(%)
|
Decision maker on where to deliver
|
|
|
Myself
|
141
|
61.8
|
Husband
|
50
|
22.0
|
Mother
|
37
|
16.2
|
Residential Area near or within 5-km to Health Facilities
|
|
|
Yes
|
89
|
39.0
|
No
|
139
|
61.0
|
Believes that Home Delivery can lead to Maternal Death
|
|
|
Yes
|
71
|
31.1
|
No
|
157
|
68.9
|
Holds traditional custom that require pregnant women to deliver at home
|
|
|
Yes
|
122
|
53.5
|
No
|
106
|
46.5
|
Experience of delivery in last home delivery
Further information collected among women (94) who had delivered a child at home revealed the experiences they had and outcome of their last home delivery.
Many 59 (62.8%) of the women hinted that their babies cried immediately at delivery; 21(22.3%) reported their baby was not okay, but were taken to a nursery or new born baby health facility for care; 14 (14.9%) reported their babies were born dead (still birth) or died immediately after birth. The condition of the mothers after the home delivery was also explored. It was revealed that 6 (6.4%) were infected by tetanus, 10(10.4%) had haemorrhage or retained placenta or ruptured uterus, 10(10.4%) reported feeling feverish or experienced a lower abdominal pain afterwards, 20(21.3%) reported experiencing an obstructed labour, 4(4.3%) reported having a swollen face or swellings of the hand or leg or felt tired and breathless, 1(1.1%) reported having felt mentally imbalanced after the home delivery 43 (45.7%) reported not experiencing any complications. The incidence of fistula after home delivery was reported by 5(5.3 %.)
From the ninety-four women who had a home delivery, 38 (40.4 %) hinted all the children delivered at home were still alive; 56(59.6%) stated they had lost at least one of the children delivered at home to death. Further inquiry made among those with all children living showed that; among the thirty-eight women with no record dead child from home delivery, exactly half of them reported the children grew up well as they expected19 (50.0%), about 3(7.9%) reported their children grew well above their expectations, while16 (42.1%) hinted their children had a stunted growth. Among those who had lost a child delivered at home, 41(73.2%) reported the child died within 28 days following delivery. Common causes of neonatal death experience of the women were: prolonged labour 24 (42.8%), hypoxia 6 (10.8%), haemorrhage 6 (10.8%), sepsis 5(8.9%), fever 5(8.9%); and.5 (8.9%) each mentioned difficulty in breastfeeding of the child, refusal of the child to drink, diarrhoea, and measles; ... 5(8.9 %) attributed their child loss to unknown causes.
Table 4.1.4: Experiences and Outcome of delivery in last home delivery among respondents.
|
Frequency
|
Percentage
(%)
|
Condition at birth of last baby delivered at home (N = 94)
|
|
|
Cried immediately
|
59
|
62.8
|
Baby “not okay”: Taken to nursery/new born unit/health facility
|
21
|
22.3
|
Born dead/died immediately
|
14
|
14.9
|
Mother’s experience at last home delivery (N = 94)
|
|
|
Had Tetanus
|
6
|
6.4
|
Haemorrhage/retained placenta or ruptured uterus
|
10
|
10.6
|
Fever/lower abdominal pain (puerperal sepsis)
|
10
|
10.6
|
Swollen face, hands, legs/tiredness and breathlessness
|
4
|
4.3
|
Obstructed labour
|
20
|
21.3
|
Mental Imbalance
|
1
|
1.1
|
Had no untoward experience
|
43
|
45.7
|
All children delivered at home still alive (N = 94)
|
|
|
Yes
|
38
|
40.4
|
No
|
56
|
59.6
|
Current health condition of child delivered at home and still alive (N = 38)
|
|
|
Growing well as expected
|
19
|
50.0
|
Growing well above expectation
|
3
|
7.9
|
Stunted growth
|
16
|
42.1
|
Loss of child within 28-days of birth among those whose child delivered at home is not alive (Neonatal death; N = 56)
|
|
|
Yes
|
41
|
73.2
|
No
|
15
|
26.8
|
Cause of death of child delivered at home (N = 56)
|
|
|
Difficulty in breathing
|
1
|
1.8
|
Refuse to drink
|
1
|
1.8
|
Diarrhoea
|
1
|
1.8
|
Measles
|
1
|
1.8
|
Fever
|
5
|
8.9
|
Sepsis
|
5
|
8.9
|
Unknown cause
|
5
|
8.9
|
Haemorrhage
|
6
|
10.8
|
Hypoxia
|
6
|
10.8
|
Prolonged labour
|
24
|
42.8
|
Experienced Fistula after Home Delivery [N=94]
|
|
|
Yes
|
5
|
5.3
|
No
|
89
|
94.7
|
Bivariate analysis: factors associated with home delivery
As part of the study objectives, possible factors associated with home delivery was determined using the Chi-square. The results are shown in Table 4. Results showed that there was significant association between home delivery among the women and parity (X2 =13.66 ,p = 0.003), women’s level of education (X2 =11.06,,p = 0.001), occupation of the women (X2 =9.56, p = 0.002), marital status (X2 =9.56, p = 0.031), and person who decides where to deliver (X2 =34.05, p < 0.001).Women with 4-6 children had the highest proportion of those who delivered at home while the least was among those with 1-3 children (X2 = ..; p = 0.003). More than half of the women with non-formal education had delivered at least a child at home, while not more than 30% of those with formal education had a home delivery (X2 = 11.06.; p = 0.001).. About 52%) of the women in the unemployed group had a home delivery, while 32% of those in the employed group had a home delivery (X2 =9.56; p = 0.002). . ..46% of women in the married group have had a home delivery, while 31% from the unmarried category – single, divorced, or widowed – had a home delivery (X2 = 4.66.; p = 0.031).. The highest occurrence of home delivery was among those who had their mothers decide where to deliver for them (81%), 38% of those who decided themselves had a home delivery, while 20% of those whose husbands decided for them had a home delivery (X2 =34.05; p < 0.001).
Other factors found not to be significantly associated with home delivery were: age of the women, educational level of their partners, monthly income of the women’s household, proximity of the women to a health facility, belief that home delivery can lead to maternal death and traditional custom that pregnant women should deliver at home.
Table 4.1.6… Factors associated with home delivery among respondents
|
Home delivery
|
|
|
No
N= 134
n (%)
|
Yes
N= 94
n (%)
|
(p-value=0.05 significant)
|
Age Group (Years)
|
|
|
|
15 – 25
|
34 (68%)
|
16 (32%)
|
2.48
(0.480)
|
26 – 35
|
46 (57.5%)
|
34 (42.5%)
|
36 – 45
|
49 (55.7%)
|
39 (44.3%)
|
> 45
|
5 (50%)
|
5 (50%)
|
Parity
|
|
|
|
1 – 3
|
59 (73.8%)
|
21 (26.2%)
|
13.66
(0.003)
|
4 – 6
|
33 (45.8%)
|
39 (54.2%)
|
7 – 9
|
24 (51.1%)
|
23 (48.9%)
|
≥10
|
18 (62.1%)
|
11 (37.9%)
|
Mother’s Educational Level
|
|
|
|
Non-formal education
|
57 (48.3%)
|
61 (51.7%)
|
11.06
(0.001)
|
Formal education
|
77 (70.0%)
|
33 (30.0%)
|
Partner’s Educational Level
|
|
|
|
Non-formal education
|
65 (57.5%)
|
48 (42.5%)
|
0.14
(0.704)
|
Formal education
|
69 (60.0%)
|
46 (40.0%)
|
Monthly Income ($)
|
|
|
|
50 – 150
|
51 (60.7%)
|
33 (39.3%)
|
1.71
(0.635)
|
160 – 250
|
44 (55.0%)
|
36 (45.0%)
|
260 – 350
|
20 (55.6%)
|
16 (44.4%)
|
>350
|
19 (67.9%)
|
9 (32.1%)
|
Occupation
|
|
|
|
Unemployed
|
52 (48.1%)
|
56 (51.9%)
|
9.56
(0.002)
|
Employed
|
82 (68.3%)
|
38 (31.7%)
|
Marital Status
|
|
|
|
Married
|
83 (53.9%)
|
71 (46.1%)
|
4.66
(0.031)
|
Unmarried
|
51 (68.9%)
|
23 (31.1%)
|
Decision maker on where to deliver
|
|
|
|
Self
|
87 (61.7%)
|
54 (38.3%)
|
34.05
(< 0.001)
|
Husband
|
40 (80%)
|
10 (20%)
|
Mother
|
7 (18.9%)
|
30 (81.1%)
|
|
No home delivery
|
Home delivery
|
(p-value)
|
Residential Area near or within 5-km to Health Facilities
|
|
|
|
Yes
|
58 (65.2%)
|
31 (34.8%)
|
2.47
(0.116)
|
No
|
76 (54.7%)
|
63 (45.3%)
|
Believes that home delivery can lead to maternal death
|
|
|
|
Yes
|
43 (60.6%)
|
28 (39.4%)
|
0.14
(0.712)
|
No
|
91 (58%)
|
66 (42%)
|
Has traditional custom that require pregnant women to deliver at home
|
|
|
|
Yes
|
70 (57.4%)
|
52 (42.6%)
|
0.21
(0.646)
|
No
|
64 (60.4%)
|
42 (36.9%)
|
Factors associated with home delivery among respondents using binary logistic regression
The unadjusted odds-ratio estimate from the binary logistic regression gave result showing that women with 4 – 6 children were three times more likely than those with 1 – 3 children to have had a home delivery (OR = 3.32, p = 0.001); those with 7 – 9 children were about 2.7 times more likely to have had a home delivery as compared to those with 1 – 3 children (OR = 2.69, p = 0.010); lastly, women with 10 or more children born were 1.7 times more likely to have had a home delivery than those with 1 – 3 children born (OR = 1.72, p = 0.239). [Table….]
Women with formal education (primary – tertiary) were 60% less probable to have had a home delivery, when compared with those who had no formal education (OR = 0.40, p = 0.001). Women who were employed had 57% less chances of having a home delivery, in comparison with those who were unemployed (OR = 0.43, p = 0.002). Married women were almost twice likely as the unmarried women to have a home delivery (OR = 1.90, p = 0.032). Women who had their husbands decide where they delivered were 60% less probable to have delivered at home than those who decided themselves (OR = 0.40, p = 0.021); women who had decision on where they deliver taken by their mothers were almost seven times likely to deliver at home than those who decided themselves (OR = 6.91, p < 0.001).
Table: 4.1.7 Factors associated with home delivery among respondents using binary logistic regression
|
|
|
OR (95%CI)
|
p-value
|
Parity
|
|
|
1 – 3 (Ref)
|
1
|
|
4 – 6
|
3.32 (1.68 – 6.56)
|
0.001
|
7 – 9
|
2.69 (1.26 – 5.75)
|
0.010
|
≥10
|
1.72 (0.70 – 4.23)
|
0.239
|
Mother’s Educational Level
|
|
|
Non-formal education (Ref)
|
1
|
|
Formal education
|
0.40 (0.23 – 0.69)
|
0.001
|
Occupation
|
|
|
Unemployed (Ref)
|
1
|
|
Employed
|
0.43 (0.25 – 0.74)
|
0.002
|
Marital Status
|
|
|
Unmarried (Ref)
|
1
|
|
Married
|
1.90 (1.06 – 3.41)
|
0.032
|
Decision on where to deliver
|
|
|
Self (Ref)
|
1
|
|
Husband
|
0.40 (0.19 – 0.87)
|
0.021
|
Mother
|
6.91 (2.84 – 16.81)
|
< 0.001
|
Ref: Reference category
Predictors of home delivery among respondents
Result from the multivariate logistic regression is as presented in Table ….. This showed that, despite controlling for confounders, women with 4 – 6 children were four times more likely to have a home delivery (OR = 3.65, p = 0.002), those with 7 – 9 children were almost two and half times more likely to have a home delivery (OR = 2.38, p = 0.056); women with employment were 59% less likely to have a home delivery (OR = 0.41, p = 0.009); women whose husbands decided their place of delivery for them were 58% less likely to deliver their child at home (OR = 0.42, p = 0.038); women who had their mothers decided for them were ten times more likely to deliver their babies at home (OR = 10.02, p < 0.001).
Table: 4.1.8 Predictors of home delivery among respondents
|
|
|
Adjusted Odds Ratio (AOR) (95%CI)
|
p-value
|
Parity
|
|
|
4 – 6
|
3.65 (1.64 – 8.14)
|
0.002
|
7 – 9
|
2.38 (0.98 – 5.79)
|
0.056
|
≥10
|
2.16 (0.76 – 6.19)
|
0.150
|
Mother’s Educational Level
|
|
|
Formal education
|
0.62 (0.32 – 1.18)
|
0.144
|
Occupation
|
|
|
Employed
|
0.41 (0.21 – 0.80)
|
0.009
|
Marital Status
|
|
|
Married
|
1.83 (0.87 – 3.85)
|
0.114
|
Decision on where to deliver
|
|
|
My husband
|
0.42 (0.18 – 0.95)
|
0.038
|
My mother
|
10.02 (3.71 – 27.05)
|
< 0.001
|
Results on focus group discussion (B)
Among the 20 participants interviewed factors influencing obstetric home delivery and outcome, were split among mothers (home delivery–10 and facility delivery–10) from the five different villages of Dusmareb district (Dayax, Horseed, wabari, Wahar Ade and Bulo’oog). Each village was selected of 4 participants comprising two home delivery and two with institutional delivery gathering at center of the town. For each group category,
The definition of home delivery were asked. Followed by their perceived on difference between hospital delivery and home delivery. Then, the reasons behind home delivery practices and the impact of home delivery to mothers, infants, and the community were questioned. Finally, the participant’s experiences in pregnancy, labor and subsequent birth outcomes were discussed.
Definition of home delivery
Various descriptions of home delivery practices were presented by the participants which, could be summarised into three categories. Category one, believed that home delivery practices means the delivery that take place at home. Category two, describe it as a delivery assisted by non- hospital staff worker while the last category, assisted by non- professional staff rather than skilled professional staff like midwives, nurses or doctors.
Category one: (Home delivery is delivery occur in my home without going outside).
Category two: (Home delivery is delivery assisted non-hospital staff worker)).
Category three: (home delivery is the delivery assisted by non-professional staff rather than skilled professional staff, like midwife, nurse doctor.
Difference between hospital and home delivery
On the perception of the home delivery versus hospital delivery according to the women in the focus group. There has been variation on the ideas of the respondents. Three of home delivery mothers perceived that the hospital delivery may be assist by hospital workers using equipment to assist their delivery in case encountered by a complication, in which TBAs does not have. They also believed that home delivery is more hygienic than the hospital delivery.
The other three from the hospital delivery group said that there is no a trained person who can assist the mother at home, that is why most of the TBAs are assisting the mother at home. The TBAs waits the baby until the baby comes out, on the other hand, hospitals has trained personnel with a good experience, equipment and drugs for the use to be assisted to mothers in labour. Also other parts of the participants presented that injections, pain killers, and blood transfusion are available at hospitals while the home doesn’t have. A mothers with a good experience to home delivery assumes that the TBAs who helped the mother at home is more experienced than the girls work at the hospital.
Three mothers from home delivery parts were said: (The hospital delivery may assist equipment if the complication will occur, while the home does not. Also, the home delivery has more hygiene then the hospital.)
The majority of mother had hospital delivery were said: (in the home mostly there is no trained person who assists the mother, so that TBAs will help her, and the TBAs mother will wait until the baby will come out, while in the hospital there is a training person with good service so that the trained person can give me a drug to help the labor process)
While the group majority of participants said: (The mother can get the hospital what she cannot get at home like injection, ant pain, bleed transfusion if needed).
The mother with good experience of home delivery said (In the home there is a mother with a good experience while the hospital have little girls with no experience, and they don’t know how to manage the mother in labour)
Why do women deliver at home?
What makes women delivery at homes were asked for all members of the group discussion. Different reasons were outlined by the participants, this included, that mothers deliver at home have no relationship with staffs at the health facilities, which was believed by the majority of the participants. They further emphasised that they do not get any support from the health facilities staff.
Mothers deliver at home due to low awareness of the importance of hospital delivery while others are due to previous bad experience they had from the hospital and might be due to financial considerations as some of some of participants said.
The mother with previous home delivery shared that delivery is an urgent that it cannot be controlled till hospital delivery. Also some mother said that the mothers prefer home delivery due to long distances to hospital as well as less number of hospitals in the district.
While some of them said that they are not going to hospital due to fear of incision made in the perineum — the tissue between the vaginal opening and the anus — during childbirth), and also fear of episiotomy and Caesarean section (the use of surgery to deliver babies) while another mother tells that she does at home due to fear of vaccination at the hospital.
The majority of home delivery parts: (We don't have any relationship with health workers in health centers and health posts. They don't want us. And we don't get any support from them)
The majority of hospital delivery parts were said : (People may delivery at home due to low awareness on the importance of hospital, delivery, while other people may delivery at home due to previous bad experience met them at the institution. Some others are delivery due to financial consideration, because they don’t have money use for transport.)
The mother with previous home delivery was said: ( the vomiting will not wait for you, that mean when vomiting comes, will not wait until you reach the suitable place of it, and also the labour is like that, it occur mostly without prior planned. Thus it is mandatory to call my nearest mother, who can assist me.)
Some mother said: (we are refusing going long distance to hospital,)
While some of them said (She may also fear an episiotomy mostly the hospital people are not asking you if you accept the episiotomy or not and also due to fear of Caesarean section (he use of surgery to deliver babies)
The one mother said (I am not going to hospital due to fear of vaccination)
Impact of home delivery to mother
Mothers in the focus group were asked about the impact of home delivery to mothers and the most of them were said that the mode delivery may results vaginal bleeding, or dearth, also they said that TBAs may use unclean equipment that may results diseases like tetanus or HIV. The remaining parts told that home delivery may result in fistula or hysterectomy.
The most of mother said
(The mother of home delivery may experience, of vaginal bleeding, infection, or even death, also they may use non cleaned equipment that may result in a disease like tetanus or HIV).
The remaining parts said (If the mother at home may have prolonged labour then resulted fistula, or may have May the child may die inside the mother, them cause’s infection to the uterus that finally causes removal of the uterus.)
Impact of home delivery to infant
The impact of home delivery to an infant were also discussed among participants of the FGD. The most of the respondent were said that baby delivered at home may die due to hypoxia, while other parts of the group were said that the TBAs may cut the cord in an improper way that may cause bleeding or infection.
The last group of the study were said the condition of child is under god’s control
Whether delivered at home or hospitals.
Most of the respondent were said (Also the baby may die due to hypoxia, (last year, the mother was delivering at home with TBAs, and the baby was shoulder presentation the one hands of the baby first came out then the TBAs drag the baby’s hand and resulted to cut the baby’s hand, then the baby started bleeding, an finally die the baby also the mother developed infection)
The other parts of the group were said ( The child also may experience, improper cutting of cord, that can cause bleeding or infection to the baby, example the last months, a mother delivery at home, then the mother who assisted her, cut the cord below the normal place, then it resulted in excessive bleeding then dearth finally.)
The last parts of the study were said (first the child’s condition is under Allah control, but it does not depend on the home delivery or institutional delivery.)
Impact of home delivery to the community
Finally, we asked the group, the impact of home delivery to the community?
The most of them said they don’t know any impact of home delivery to society. While others said if the mother or child died it may affect the economic growth of the country, also if it resulted fistula it may cause divorce or end of the marriage.
The most of them were said (we don’t know I impact of home delivery to society)
While others said (If the mother died, or met the complication, she may affect economic growth of the country, also if the home delivery resulted the fistula, it may result from divorce or end of marriage,)