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‘A Normal Delivery Takes Place at Home’: A Qualitative Study of the Location of Childbirth in Rural Ethiopia

Abstract

To identify reasons why women who access health facilities and utilise maternal newborn and child health services at other times, do not necessarily deliver at health facilities. Forty-six semi-structured interviews were conducted with mothers who had recently delivered (n = 30) or were pregnant (n = 16). Thematic analysis of the interview data resulted in emerging trends that were critically addressed according to the research objective. Of the 30 delivered cases, 14 had given birth at a health facility, but only 3 of those had planned to do so. The remaining 11 had attended due to long or complicated labours. Five dominant themes influencing location of delivery were identified: perceptions of a normal delivery; motivations encouraging health facility delivery; deterrents preventing health facility deliveries; decision-making processes; and level of knowledge and health education. Understanding the socio-cultural determinants that influence the location of delivery has implications for service provision. Alongside timely health education and maximising the contact between women and healthcare professionals, these determinants should be actively incorporated into maternal newborn and child health policy and programming in ways that encourage the utilisation of health facilities, even for routine deliveries.

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Acknowledgments

We would like to thank the Ministry of Health in Ethiopia, and the Regional and Zonal Health Bureaus for supporting this research, and for assistance given by health professionals in South Wollo. The study was funded by the Stavros Niarchos Foundation. Particular gratitude is extended to the mothers and families who participated in the study.

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Correspondence to Juliet Bedford.

Appendix

Appendix

Background

  • What is your name?

  • How old are you?

  • Do you have brothers and sisters?

  • How many children do you have?

  • Are they boys/girls?

  • How old are they?

  • Where is your family from?

  • Are you Christian or Muslim?

  • Do you work? What kind of work do you do?

  • Did you go to school? What class did you achieve?

  • Do your children go to school? What class are they in?

  • Are you part of any community organisations?

  • Are you married?

  • How long have you been married?

  • How old were you when you got married?

  • How old is your husband now?

  • Where is his family from?

  • Does he work? What kind of work does he do?

General healthcare

  • When somebody is ill, what do you do?

  • Normally, where do you go for treatment?

  • Do you go to the health post or health centre? When and why?

  • Do you go to a traditional or spiritual healer? When and why? What treatment do they give you?

  • Where is the nearest health centre/health post?

  • How do you get there?

  • How long does it take to get there?

  • Do you have to pay for treatment? If so, is it difficult to pay for treatment?

  • What kind of treatment do you like? What do you think works?

  • Is the health centre/health post good? Does it give good treatment?

  • What conditions does the health centre/health post treat best?

Maternal healthcare

  • Where were you born? Why were you born there?

  • Where were your brothers and sisters born?

  • Where do most women you know give birth? Why?

  • Where do you think it is better to give birth? Why?

  • Why do women go/not go to a health centre to give birth?

  • What do you think about giving birth at home?

  • What do you think about giving birth at a health centre?

  • Is there a traditional birth attendant here?

  • Do many women use her?

  • What happens when she comes to your house?

  • Do you pay here?

  • What do you think of using a traditional birth attendant?

  • Do you use family planning now and/or in the past?

  • Have you ever used contraceptives? If so, what kind? Where did you get them from?

  • Did your husband know you use(d) contraceptives? If so, what does/did he think?

Pregnancy/ante-natal

  • How did you find out you were pregnant?

  • When did you find out you were pregnant?

  • Did you do any test to confirm your were pregnant?

  • What did you think when you found out you were pregnant? How did you feel?

  • Were you surprised?

  • Was it a planned pregnancy?

  • What did your husband/family think?

  • How did you feel whilst you were pregnant? Did you feel healthy?

  • Were you ill whilst you were pregnant? If so, what was wrong? What did you do about it?

  • Were there any problems whilst you were pregnant?

  • When you were pregnant, were you concerned? What were you concerned about?

  • Did you go to the health centre/health post whilst you were pregnant?

  • If so, what did you go for?

  • How many times did you go?

  • When during the pregnancy did you go?

  • Did it help/was it useful?

  • What did your husband/family think when you went to the health centre/health post?

  • Did anybody from the health post/health extension worker/community volunteer come to see you?

  • What did they tell you?

  • Was it useful?

  • How many times did they visit you and when?

  • What did your husband/family think?

  • Did you have any health education whilst you were pregnant?

  • If so, what did you learn?

  • Was it at the health centre/health post/health extension worker/community volunteer?

  • Did you receive any education materials?

  • If so, what? (birth prepardness plan/family health card)

  • Was the health education useful? Why?

  • Did it tell you new information you didn’t know before? What did it tell you?

  • Did your husband/family receive any health education? (above details).

  • Whilst you were pregnant what did your husband/family do?

  • Were they helpful?

Childbirth and immediate newborn care

  • Whilst you were pregnant, did you think about giving birth? What did you think?

  • What did people (friends/family/community) tell you about having a baby?

  • Did you talk about giving birth with anybody? Who? What did they say?

  • Did you think there would be much pain?

  • Were you worried? What were you worried about?

  • Did you feel prepared about giving birth?

Interviewees who had given birth

  • When did you go into labour? What did you first notice?

  • How did you feel?

  • Who was with you?

  • What did they do?

  • Where did you give birth?

  • Why did you give birth there?

  • Tell me what happened (narrative of childbirth)

  • Was the delivery the same as/different to what you had thought/expected? If so in what ways?

For home deliveries

  • How was with you during the labour/birth? What did they do?

  • What position did you deliver in?

  • Who cut the umbilical cord?

  • What did you do with the placenta?

  • After the baby was born, what happened to the baby/to you?

  • What did you do with/give to the newborn baby? Who told you to do that?

  • Did you consider giving birth at the health centre? Why/why not?

For health centre deliveries

  • When did you go to the health centre?

  • Why did you go to the health centre?

  • Who made the decision to go the health centre? What happened?

  • How did you get to the health centre? Was it difficult to go?

  • What happened on the way to the health centre? Who was with you during the journey? How long did it take?

  • When you arrived at the health centre, what happened?

  • When you were taken into the delivery room, was anybody with you? Who?

  • What position did you deliver in?

  • After the baby was born, what happened to the baby/to you?

  • What did you do with/give to the newborn baby? Who told you to do that?

  • When did you go home? How did you go home?

  • Did you have to pay to get to the health centre? How much?

  • Did you have to pay at the health centre to give birth there? How much? Did you have the money with you?

  • Did you consider giving birth at home? Why/why not?

Interviewees who were pregnant

  • Where do you think/where are you planning to give birth? Why?

Post-natal

  • After you had given birth, what happened? What did you do? Where did you go?

  • How were you/your child? Were you healthy?

  • Were there any problems? If so, what problems, what happened, what did you do?

  • Did you breastfeed your child?

  • When did you start breastfeeding?

  • Did you give the baby the colostrum?

  • How long did you breastfeed for?

  • Did you give the baby butter/water/food?

  • Did you have a confinement period? For how long? What happened?

  • Did you go to the health centre/health post after the baby was born?

  • Why/why not?

  • Did anybody from the health centre/health post/health extension worker/community volunteer visit you after the birth?

  • If so, what did they say/do? Was it helpful?

  • How is the baby now?

  • Has it received its immunisations? If so, where and when? If not, why not?

General conclusions

  • Overall, how was your experience of pregnancy/childbirth/afterwards?

  • Would you have done/liked to have done anything differently? If so, what and why?

  • Will you have/like to have more children in the future? How many children would you like?

  • Will you do anything differently in the future? If so what and why?

  • If you went to a health centre/health post for the birth, did you tell your friends/family/community about it? What did they think?

  • What has been the experiences of your friends/family about maternal healthcare?

  • Do you know women who have had complications during pregnancy/childbirth? What happened? What caused the complications?

  • Do you think that it is dangerous/risky to give birth?

  • What do you think the dangers/risks are?

  • Do you think it is a problem if a woman does not have children?

  • What do you think about maternal healthcare in your community?

  • What are the main problems/challenges women face?

  • How can these problems be solved?

  • What can be done to help improve the situation?

  • Is there anything else you think we should know or would like to tell us?

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Bedford, J., Gandhi, M., Admassu, M. et al. ‘A Normal Delivery Takes Place at Home’: A Qualitative Study of the Location of Childbirth in Rural Ethiopia. Matern Child Health J 17, 230–239 (2013). https://doi.org/10.1007/s10995-012-0965-3

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Keywords

  • Maternal health
  • Care-seeking behaviour
  • Facility delivery
  • Childbirth
  • Ethiopia
  • Qualitative methods