Abstract
BackgroundEvery pregnant woman faces risk of life-threatening obstetric complications. A birth-preparedness package promotes active preparation and assists in decision-making for healthcare seeking in case of such complications. The aim was to assess factors associated with birth preparedness and complication-readiness as well as the level of male participation in the birth plan among emergency obstetric referrals in rural Uganda.MethodsThis was a cross-sectional study conducted at Kabale regional hospital maternity ward among 140 women admitted as emergency obstetric referrals in antenatal, labor or the postpartum period. Data was collected on socio-demographics and birth preparedness and what roles spouses were involved in during developing the birth plan. Any woman who attended antenatal care at least 4 times, received health education on pregnancy and childbirth danger signs, saved money for emergencies, made a plan of where to deliver from and made preparations for a birth companion, was deemed as having made a birth plan. Multivariate logistic regression analysis was conducted to analyze factors that were independently associated with having a birth plan.ResultsThe mean age was 26.8 ± 6.6 years, while mean age of the spouse was 32.8 ± 8.3 years. Over 100 (73.8%) women and 75 (55.2%) of their spouses had no formal education or only primary level of education respectively. On multivariable analysis, Primigravidae compared to multigravidae, OR 1.8 95%CI (1.0-3.0), education level of spouse of secondary or higher versus primary level or none, OR 3.8 95%CI (1.2-11.0), formal occupation versus informal occupation of spouse, OR 1.6 95%CI (1.1-2.5), presence of pregnancy complications OR 1.4 95%CI (1.1-2.0) and the anticipated mode of delivery of caesarean section versus vaginal delivery, OR 1.6 95%CI (1.0-2.4) were associated with having a birth plan.ConclusionIndividual women, families and communities need to be empowered to contribute positively to making pregnancy safer by making a birth plan.
Highlights
Maternal mortality remains a public health challenge worldwide, and the global maternal mortality ratio of 342, 900/100,000 live births annually is still unacceptably high [1]
Age group of adolescents versus older women (Odds ratio (OR) 1.04 (95% confidence limits (CI) 1.0-1.17), Primigravidae compared to multigravidae OR 1.3, education level secondary or higher versus primary level or none (OR 2.2 95%CI (1.3-3.6), formal occupation versus informal occupations OR 1.5 95%CI (1.12.0) and age of spouse above 25 years compared to 24 years or younger (OR 1.1 95% CI(1.0-1.2), education level of spouse of secondary or higher versus primary level or none, OR 2.0 95% CI (1.3-3.2), and formal occupation versus informal occupation of spouse, OR 1.5 95%CI (1.1-2.0) were associated with having a birth plan
Primigravidae compared to multigravidae, OR 1.8 95%CI (1.0-3.0), education level of spouse of secondary or higher versus primary level or none, OR 3.8 95%CI (1.2-11.0), formal occupation versus informal occupation of spouse, OR 1.6 95%CI (1.1-2.5), presence of pregnancy complications OR 1.4 95%CI (1.1-2.0) and the anticipated mode of delivery of caesarean section versus vaginal delivery, OR 1.6 95%CI (1.0-2.4) were associated with having a birth plan
Summary
Maternal mortality remains a public health challenge worldwide, and the global maternal mortality ratio of 342, 900/100,000 live births annually is still unacceptably high [1]. A disproportionately high burden of these maternal deaths is borne by developing countries such as Uganda, with a maternal mortality ratio of 432 per 100,000 live births [2]. These deaths arise from pregnancy, childbirth or postpartum complications. For birth preparedness, a potential blood donor and a decision-maker (in case of emergencies) need to be identified [5] This is because complications such as hemorrhage are unpredictable and highly fatal if timely treatment is not obtained. This makes this package a very important strategy in developing countries, where obstetric services are poor.
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