Childbirth Services Research Articles

Readiness, access, and use of facility childbirth care in Ethiopia: results from nationally representative linked household and health facility surveys

Background Facility readiness is an important prerequisite for providing safe, effective childbirth care. This study assesses the readiness of health facilities in Ethiopia to provide childbirth services, describes variations in geographic access to service-ready facilities, and evaluates how facility readiness relates to childbirth service usage with a lens on equity. Methods The study used cross-sectional data from a nationally representative sample of households in Ethiopia linked with data from health facilities serving the same areas. We explored variation in childbirth service readiness across facilities and classified facilities as “service-ready” if they had a readiness score of 0.75 or higher on a 0-1 scale. We used logistic regression modeling to examine the odds of residing within 10 kilometers of a service-ready facility by socioeconomic and geographic characteristics, and the odds of a facility delivery given the readiness of nearby facilities. Results Childbirth service readiness was generally high for hospitals (median score: 0.92) with minimal variation (interquartile range, IQR: 0.88 to 0.96). Health centers and clinics displayed lower and more variable readiness (median: 0.75, IQR: 0.66 to 0.84). In both crude and adjusted regression analyses, odds of residing within 10 kilometers of a service-ready facility were significantly greater for women with higher education levels, greater wealth, and urban residence. We found the adjusted odds of using facility childbirth services were 1.23 (95% CI: 1.03, 1.48) times greater for each 0.10-unit increase in the readiness level of nearby facilities. Conclusions Access to childbirth care is not equal for Ethiopian women. Those living in rural areas and the poor must travel farther to reach facility childbirth services, and the nearest facilities serving these women were less prepared to provide quality care. This may contribute to lower service utilization by such disadvantaged groups of women.

Navigating and manipulating childbirth services in Afar, Ethiopia: A qualitative study of cultural safety in the birthing room

Access to maternal health services has increased in Ethiopia during the past decades. However, increasing the demand for government birthing facility use remains challenging. In Ethiopia's Afar Region, these challenges are amplified given the poorly developed infrastructure, pastoral nature of communities, distinct cultural traditions, and the more nascent health system. This paper features semi-structured interviews with 22 women who were purposively sampled to explore their experiences giving birth in government health facilities in Afar. We used thematic analysis informed by a cultural safety framework to interpret findings. Our findings highlight how women understand, wield, and relinquish power and agency in the delivery room in government health facilities in Afar, Ethiopia. We found that Afari women are treated as ‘others’, that they manipulate their care as they negotiate ‘cultural safety’ in the health system, and that they use trust as a pathway towards more cultural safety. As the cultural safety framework calls for recognizing and navigating the diverse and fluid power dynamics of healthcare settings, the onus of negotiating power dynamics cannot be placed on Afari women, who are already multiply marginalized due to their ethnicity and gender. Health systems must adopt cultural safety in order to ensure health quality. Providers, particularly in regions with rich cultural diversity, must be trained in the cultural safety framework in order to be aware of and challenge the multidimensional power dynamics present in health encounters.

Accessibility Analysis of Childbirth Service Centers Using Geospatial Techniques in Rural Magadi, Kenya

Accessibility to childbirth services is a necessity despite geographic, demographic and socio-economic origin. The distribution pattern between health facilities and households in rural areas is not as extensively researched as those of urban areas, especially pastoral communities. Challenges in accessing social amenities including childbirth service centres are dominant. This study aims to assess the spatial accessibility between the location of households and the location of the childbirth health facility in Magadi Ward. The study employed geospatial techniques to visualize the spatial distribution of households and health facilities; and the road connectivity between them. To represent the variation, accessibility zones were modelled using the Euclidean distance tool. Buffer analysis was also conducted to indicate the relationship between the served and unserved areas in regard to the five kilometres Ministry of Health recommended radius. Coordinates of 246 households were randomly picked from the eight community unit clusters in the Magadi ward. The findings revealed the number of women who delivered at health facilities to be 38.2%, while those who delivered at home were 61.8% contrary to the majority being within the service area of the buffer. The most accessible zones were located in the central and upper western parts of Magadi Ward. The utilization of antenatal and postnatal care services and health facilities for the place of delivery differed significantly. The results indicate the poor use of health facilities as a place of delivery for women who utilized childbirth services in the last year, prior to data collection. This provides valuable information and location-based evidence of low access to health facilities for childbirth services, and therefore, offers guidance on sound decision making and strategies to improve on the accessibility of childbirth services.

The role of midwives in implementing reproductive health services in Islamic Republic of Iran.

It is essential to study the availability of reproductive health services and the capacities of providers, to provide evidence for improving service quality. To identify the role of midwives in the provision of reproductive health services and recommend improvements. A national review of government health resources in the Islamic Republic of Iran was conducted to explore available reproductive health services. Through semi-structured interviews with 30 midwives, information was collected about the compatibility of services with the capacity and scope of the activities of midwives. A panel of 12 experts was assembled to develop a proposed service package. The content analysis method was applied to data analysis and interpretation. The service package developed covered 82 services that midwives can offer at the 8 healthcare facility groups. Although midwives were trained to manage a range of primary and gynaecological care services, certain essential aspects of reproductive health services were not being delivered on the frontline. These include sexually transmitted diseases and human papilloma virus management, diagnosis and treatment of common gynaecological problems, sexual education and counselling, and childbirth services. Midwives were not adequately engaged to provide reproductive health care at the secondary level. There are drawbacks to the current reproductive health service delivery in the Islamic Republic of Iran. The service package designed and proposed in this study aims to strengthen reproductive health care services and planning and better integration of midwife-led programmes.

Access to childbirth care services in the interior of Pernambuco, Northeast region of Brazil.

To analyze the access of women to the public health system network to childbirth care, highlighting the barriers related to the "availability and accommodation" dimension in a health macroregion of Pernambuco. Ecological study, conducted based on hospital birth records from the Hospital Information System of the Brazilian Unified Health System (SUS), and information from the state's Hospital Beds Regulation Center, about women residing in health macroregion II, in 2018. Displacements were reviewed considering the geographic distance between the municipality of residence and that of the childbirth; estimated time of displacement of pregnant women; ratio of shifts blocked for admission of pregnant women for delivery; and the reason for unavailability. In 2018, health macroregion II performed 84% of usual risk childbirths, and 46.9% of high-risk childbirths. The remaining high-risk childbirths (51.1%) occurred in macroregion I, especially in Recife. The reference maternity for high-risk childbirths in that macroregion had 30.4% of the days of day shifts and 38.9% of the night shifts blocked for admission of childbirths; the main reason was the difficulty in maintaining the full team in service. Women residing in the health macroregion II of Pernambuco face great barriers of access in search of hospital care for childbirth, traveling great distances even when pregnant women of usual risk, leading to pilgrimage in search of this care. There is difficulty regarding availability and accommodation in high-risk services and obstetric emergencies, with shortage of physical and human resources. The obstetric care network in macroregion II of Pernambuco is not structured to ensure equitable access to care for pregnant women at the time of childbirth. This highlights the need for restructuring this healthcare services pursuant to what is recommended by the Cegonha Network.

Maternal satisfaction with childbirth services among postnatal mothers at a primary health center

Background: Primary health centers (PHC) are the first point of contact among the public and structured health services. Maternal satisfaction is an indicator of the quality of services received by the mother during their childbirth experience at the primary health centers. This study aimed to assess the maternal satisfaction of postnatal mothers with childbirth services at a primary health center. Methods: A descriptive study was undertaken at a conveniently selected 24-hour functional primary health center. Maternal satisfaction of mothers delivering at the selected PHC was assessed by using the standardized SMMS tool. 36 mothers selected by convenience sampling were interviewed. Results: All (100%) mothers were satisfied with their childbirth experience (overall mean score 143.3 and SD 5.68). Mothers expressed their highest level of satisfaction with the childbirth experience as one of their best experiences (4.9±.3), they agreed that doctors did all interventions they could do (4.8±0.4) and also, they said that doctors and nurses explained them about all new situations related to labor (4.4±0.5). Mothers were least satisfied with the management of labor pain (1.9±1), nurses could have given them a little more time to start their breast feed (3.1±0.8) and if they could have started breast-feeding a little early (3.2±1.2). Conclusions: Maternal satisfaction is an important indicator of maternal and newborn services provided at any health care facility. Assessing the mother’s perspective is a good determinant of their expectations and can help improve the quality of services at the primary health centers.

Data Science Application for Creation of Maternal Morbidity and Mortality Predictive Software

In Mexico, the estimated Maternal Mortality Ratio is 34.6 deaths per 100,000 estimated births. Consequently, healthcare facilities and services have given precedence to prenatal care, childbirth services, and postpartum care. In Mexico, the Ministry of Health maintains an open database concerning maternal deaths, encompassing 58 variables. Among these variables is the CIE (International Statistical Classification of Diseases and Related Health Problems), which covers a total of 248 diseases linked to maternal deaths. Currently, there is no software that classifies women undergoing pregnancy check-ups (according to their socio-clinical risk of mortality), using variables selected with data science. This project is rooted in the methodology advanced by International Business Machines (IBM) for the implementation of data science. The software's utilized model was constructed through the Naïve Bayes supervised learning algorithm, yielding an accuracy of 0.7236. The overall precision stood at 0.75, with an overall recall of 0.74, and an overall F1-score of 0.71. For the eclampsia during labor class, precision reached 0.71, recall was 0.94, and the F1- score attained 0.81. As for secondary or late postpartum hemorrhage, precision scored 0.81, recall measured 0.43, and the F1-score was 0.56.

Methods of induction and augmentation of labor in a freestanding birth center: a cross-sectional study.

To describe and analyze the use of methods of induction and augmentation of labor in a freestanding birth center (FBC). Cross-sectional study carried out at a FBC located in São Paulo (SP), with all women booked from 2011 to 2021 (n = 3,397). The majority of women (61.3%) did not receive any method. The methods were used alone or in combination (traditional Chinese medicine, massage, castor oil, stimulating tea, amniotomy, and oxytocin). Traditional Chinese medicine (acupuncture, acupressure, and moxa) was the most used method (14.7%) and oxytocin was the least frequent (5.1%). The longer the water breaking time, the greater the number of methods used (p < 0.001). Amniotomy was associated with maternal transfers (p < 0.001). Induction and augmentation of labor were strictly adopted. The use of natural or non-pharmacological methods prevailed. Robust clinical studies are needed to prove the effectiveness of non-pharmacological methods of stimulation of childbirth, in addition to strategies for their implementation in other childbirth care services, to really prove the effectiveness of non-pharmacological methods in the parturition process, that is, in labor and birth.

Assessment on Quality of Healthcare Services during Childbirth: A Community-based Mixed-method Study in the Women of Puducherry.

A women's right to a positive childbirth experience should be the heart of any care provided. To assess the quality of childbirth services and mistreatment by healthcare providers among reproductive age group women and to explore factors influencing the same between women and stakeholders. A community-based, mixed-method study was conducted from April to September 2021 in field practice areas of a medical college in Puducherry district. The sample size for the quantitative study was 348 and the women were chosen using a multi-stage sampling technique. Women were interviewed with a semi-structured questionnaire. In-depth and key informant interviews between women and stakeholders were done for the qualitative data collection. Three-fourths (77.0%) of women preferred government tertiary healthcare facilities for obstetric care. Although 69.0% and 75.6% of the participants did not experience any verbal and physical abuse, respectively, the qualitative study results were quite the opposite. While 92.8% of the women complained that no birth companion was allowed during their delivery. Moreover, 79.9% of the women did not have the freedom to choose their comfortable birthing position. The levels of mistreatment in the rural areas were slightly higher than that of the urban areas. Quality care is a fundamental approach to maternity care. A fair bit of women experiences mistreatment during childbirth in healthcare setups. However, the chief concern here is the perception of such abuse by the mothers as normal due to their lack of knowledge regarding women's rights.

Effectiveness of measures to preserve labour and childbirth companionship at the times of COVID-19 outbreak

IntroductionAlthough childbirth services were accessible after COVID-19 outbreak, the measures taken by the Italian Government for contagion containment required some restrictions on the presence of trusted persons for mothers, forcing them to isolation during hospitalization. To preserve companionship, the Regional Health Authority of Tuscany issued a resolution providing partners with the possibility to be present during labour and childbirth for non-asymptomatic women. ObjectivesIn this study, we: 1) analyse the impact of pandemic on companionship in terms of significant reduction of the possibility for women to be accompanied by a trusted person during labour and childbirth; and 2) ascertain if the regional resolution issued was effective in containing the reduction of companionship. MethodsWe performed an interrupted time series analysis to measure the variation of the possibility for women to be accompanied by a trusted person during labour and childbirth, in response to formalization of lock-down due to COVID-19 outbreak and the introduction of the regional resolution aimed at contrasting negative effects on companionship. Results and conclusionsThe ITS analysis showed that there was a significant decrease in the women-reported experience of companionship in the month of the formalization of lock-down, namely March 2020, followed by a slight increase in the upcoming months. A trend reversal was observed after May 2020, when the regional resolution was fully operational.

Readiness of health facilities to provide safe childbirth in Liberia: a cross-sectional analysis of population surveys, facility censuses and facility birth records

BackgroundThe provision of quality obstetric care in health facilities is central to reducing maternal mortality, but simply increasing childbirth in facilities not enough, with evidence that many facilities in sub-Saharan Africa do not fulfil even basic requirements for safe childbirth care. There is ongoing debate on whether to recommend a policy of birth in hospitals, where staffing and capacity may be better, over lower level facilities, which are closer to women’s homes and more accessible. Little is known about the quality of childbirth care in Liberia, where facility births have increased in recent decades, but maternal mortality remains among the highest in the world. We will analyse quality in terms of readiness for emergency care and referral, staffing, and volume of births.MethodsWe assessed the readiness of the Liberian health system to provide safe care during childbirth use using three data sources: Demographic and Health Surveys (DHS), Service Availability and Readiness Assessments (SARA), and the Health Management Information System (HMIS). We estimated trends in the percentage of births by location and population caesarean-section coverage from 3 DHS surveys (2007, 2013 and 2019–20). We examined readiness for safe childbirth care among all Liberian health facilities by analysing reported emergency obstetric and neonatal care signal functions (EmONC) and staffing from SARA 2018, and linking with volume of births reported in HMIS 2019.ResultsThe percentage of births in facilities increased from 37 to 80% between 2004 and 2017, while the caesarean section rate increased from 3.3 to 5.0%. 18% of facilities could carry out basic EmONC signal functions, and 8% could provide blood transfusion and caesarean section. Overall, 63% of facility births were in places without full basic emergency readiness. 60% of facilities could not make emergency referrals, and 54% had fewer than one birth every two days.ConclusionsThe increase in proportions of facility births over time occurred because women gave birth in lower-level facilities. However, most facilities are very low volume, and cannot provide safe EmONC, even at the basic level. This presents the health system with a serious challenge for assuring safe, good-quality childbirth services.

Determinants of Maternal Satisfaction with the Quality of Childbirth Services in a University Hospital in Kumasi, Ghana: A Cross-Sectional Study

Introduction. Rendering quality childbirth services that lead to higher levels of maternal satisfaction is an important goal of every health institution. Despite efforts at enhanced client satisfaction over the years, there are still some quality concerns for health policymakers and managers to address. This study sought to assess maternal satisfaction with childbirth services at a university hospital in Kumasi, Ghana. Methods. We conducted a facility-based cross-sectional study among women in postnatal wards after delivery at the University Hospital, Kwame Nkrumah University of Science and Technology. They were recruited using a systematic sampling method, and their perspective about the quality of childbirth services was assessed using a service quality (SERVQUAL) tool. Linear regression analysis was performed to identify the relationship between SERVQUAL attributes and maternal satisfaction. Statistical significance was set atpvalue &lt; 0.05 at a 95% confidence interval. Results. Of the 277 participants interviewed, 79.8% (221) were satisfied with the childbirth services. Delays (49.5%), unprofessional conduct from health workers (7.2%), poor facilities (10.8%), and an inadequate number of skilled staff (15.5%) were identified as the challenges mothers encountered at the facility. After adjusting for all the components of the SERVQUAL model, reliability (adjustedβ=−3.28,p=0.001) and empathy (adjustedβ=2.21,p=0.028) were the most significant predictors of maternal satisfaction with childbirth services. Conclusion. Majority of postnatal women were generally satisfied with the overall childbirth services they received at the University Hospital. The service quality components that significantly predicted maternal satisfaction with childbirth services were “reliability” and “empathy.”

Sistem Pendukung Keputusan Dalam Pemilihan Bidan Terbaik Untuk Wilayah Medan Menerapkan Metode MOORA dengan Pembobotan ROC

Midwives are professional health workers who have graduated from midwifery education and are registered in accordance with statutory provisions. In practice midwives have attended special training to be able to provide services in the form of midwife care in the form of caring for childbirth and other services. However, the selection of the best midwife, especially at STIKES Indah Medan, is done manually where internal parties make random choices so that complaints are received by patients in their services. In solving this problem, it is better to use a system where selectors can choose the best midwife according to the desired requirements. The system is SPK with Rank Order Centroid weighting through the MOORA (Multi Optimization On The Basis Of Ratio Analysis) method which will produce a solution on the part of STIKES Indah Medan to choose one of the desired midwives

Determinants of facility-based childbirth among adolescents and young women in Guinea: A secondary analysis of the 2018 Demographic and Health Survey.

Maternal mortality remains very high in Sub-Saharan African countries and the risk is higher among adolescent girls. Maternal mortality occurs in these settings mainly around the time of childbirth and the first 24 hours after birth. Therefore, skilled attendance in an enabling environment is essential to reduce the occurrence of adverse outcomes for both women and their children. This study aims to analyze the determinants of facility childbirth among adolescents and young women in Guinea. We used the Guinea Demographic and Health Survey (DHS) conducted in 2018. All females who were adolescents (15-19) or young women (20-24 years) at the time of their most recent live birth in the five years before the survey were included. We examined the use of health facilities for childbirth and its determinants selected through the Andersen health-seeking model using descriptive analysis and multilevel multivariable logistic regression. All descriptive and analytical estimated were produced by adjusting for the survey sampling using the svy option, including adjustment for clustering, stratification and unequal probability of selection and non-response (individual sample weights). The subpopulation option was also used to account for the variance of estimations. Overall, 58% of adolescents and 57% of young women gave birth in a health facility. Young women were more likely to have used private sector facilities compared to adolescents (p<0.001). Factors significantly associated with a facility birth in multivariable regression included: secondary or higher educational level (aOR = 1.86; 95%CI:1.24-2.78) compared to no formal education; receipt of 1-3 antenatal visits (aOR = 9.33; 95%CI: 5.07-17.16) and 4+ visits (aOR = 16.67; 95%CI: 8.82-31.48) compared to none; living in urban (aOR = 2.50; 95%CI: 1.57-3,98) compared to rural areas. Women from poorest households had lower odds of facility-based childbirth. There was substantial variation in the likelihood of birth in a health facility by region, with highest odds in N'Zérékoré and lowest in Labé. The percentage of births in health facilities among adolescents and young women in Guinea was 58%. This remains suboptimal regarding the challenges associated maternal mortality and morbidity issues in Guinea. Socio-economic characteristics, region of residence and antenatal care use were the main determinants of its use. Efforts to improve maternal health among this group should target care discontinuation between antenatal care and childbirth (primarily by removing financial barriers) and increasing the demand for facility-based childbirth services in communities, while paying attention to the quality and respectful nature of healthcare services provided there.

Non-compliance Analysis of Independent Participants Paying BPJS Health Contributions After Utilization of Delivery Services

Losses experienced by BPJS Health due to payment of contributions that have been stopped for participants who have used maternity services of more than 200 billion in a span of 2 years. It was recorded that 64.7% of mothers who were about to give birth registered as participants a month before giving birth and then quit (43%) or did not comply with the payment after delivery. The largest percentage comes from independent participants or non-wage recipients (PBPU). In Jambi Province, non-compliance in paying BPJS Health contributions is the highest in Jambi City. There were 77,489 participants in arrears in 2021 which resulted in a loss of 60.1 billion. Non-compliance in paying dues comes from multiple factors. The purpose of this study is to analyze the factors causing the non-compliance of independent participants in paying BPJS Health contributions after utilizing childbirth services in Jambi City. A quantitative study approach with a cross-sectional design conducted in Jambi City in 2022. There were 96 respondents who were selected based on the accidental sampling technique. The study instrument was a questionnaire. Quantitative data processing through the stages of editing, coding, entry and cleaning with SPSS. Data analysis consisted of univariate analysis and bivariate analysis using chi-square test. The results of the study found that as many as 33.3% of independent participants did not comply in paying BPJS Health contributions after using childbirth services. There is a significant relationship between the number of family members (p = 0.001), knowledge (0.000), perception of illness (p = 0.001), clinical assessment (p = 0.000), and willingness to pay (WTP) with the non-compliance of independent participants in paying BPJS Health contributions. after the use of maternity services. It is recommended for BPJS Health to consider the application of the waiting period method for participants who will take advantage of maternity services. As well as increasing promotive activities for the Jambi City Government in educating and increasing public awareness about the importance of health insurance in protecting household financing.

Women’s preferences in the low-risk pregnancy management: Discrete Choice Experiments from Tuscany

Abstract During the last years, organizational models to assist women during pregnancy have changed. The physiological management of low-risk pregnancy is gaining momentum thanks to increased available evidence. Therefore, a need to assess women’s acceptance of these new proposals is emerging. This study aims to explore women’s preferences during pregnancy and childbirth. We enrolled women from the continuously active survey on the maternity pathway in Tuscany, Italy. We designed Two Discrete Choice Experiments (DCE) and administered them through web-based surveys. We sought to catch women’s preferences on health professionals to be involved, team-based or exclusive assistance, the physical proximity of healthcare services, and cost per service. We also explored women’s decision-making autonomy and pain management during labour and childbirth. Additionally, we investigated women’s information needs on the physiological model of low-risk pregnancy management through qualitative methods. Mixed logit models on the DCEs results show that women prefer being assisted during pregnancy and childbirth by healthcare services that are free of charge, easily accessible from a geographic point of view, and provided by a gynaecologist. The interaction effects reveal statistically significant differences for some sociodemographic variables of respondents and maternity pathway attributes. Besides, qualitative analyses highlight that women are interested in the physiological management of low-risk pregnancy according to their level of knowledge, confidence and safety feelings, and beliefs concerning non-medicalization and autonomy. The main findings of this study point out several implications for policy and managerial practice to effectively implement the physiological model of low-risk pregnancy management. Key messages • This study proves that costs, travel distance, and type of health professional are the main determinants of women’s elicited preferences during pregnancy and childbirth. • Policymakers and healthcare managers should consider these findings in organizing and providing maternal and childbirth health services to foster the physiological management of low-risk pregnancies.

Midwives' Psychosocial Experiences in Pregnancy and Childbirth Services During The Covid-19 Pandemic

The safety aspect of health workers including midwives as the frontline in handling patients during the COVID-19 pandemic is at risk of being very vulnerable to being exposed to COVID-19 which threatens their lives and safety. Physical and mental fatigue in health workers during a pandemic increases the risk of burnout which can reduce the quality of service to patients. The purpose of this study was to review evidence related to the psychosocial experience of midwives in pregnancy and childbirth services during the COVID-19 pandemic. The method used was a scoping review beginning with the identification of scoping review questions using the PEO framework; identifying relevant articles to be determined based on inclusion and exclusion criteria; searching for articles using databases, namely Proquest, PubMed, Science Direct, and Wiley Online Library; selecting articles whose search flow is described through the PRISMA Flowchart; performing data charting and critical appraisal; compiling and reporting results. The results obtained based on 8 articles that had been critically appraised showed that 6 articles used qualitative studies, 1 article used mixed-method quantitative study, and 1 article used quantitative descriptive study. A total of 3 themes emerged, namely about the psychological impact, challenges and needs of midwives in pregnancy and childbirth services during the COVID-19 pandemic which affected the experience felt by midwives in pregnancy and childbirth services with psychological impacts such as fear and burnout. In addition, there were challenges faced by midwives and things that were needed by midwives in pregnancy and childbirth services during the COVID-19 pandemic. Abstrak: Aspek keselamatan tenaga kesehatan termasuk bidan sebagai garda terdepan dalam menangani pasien selama pandemic COVID-19 berisiko sangat rentan untuk terpapar COVID-19 yang mengancam jiwa dan keselamatannya. Kelelahan fisik dan mental pada tenaga kesehatan di masa pandemic meningkatkan resiko terjadinya burnout yang dapat mengurangi kualitas dalam pelayanan pada pasien . Tujuan penelitian ini untuk mereview evidence terkait dengan pengalaman psikososial bidan dalam pelayanan kehamilan dan persalinan di masa pandemic COVID-19. Metode yang digunakan ialah scoping review diawali dengan identifikasi pertanyaan scoping review menggunakan framework PEO; mengidentifikasi artikel yang relevan dengan ditentukan berdasarkan kriteria inklusi dan eksklusi; melakukan pencarian artikel menggunakan database yakni Proquest, PubMed, Science Direct, dan Wiley Online Library; melakukan seleksi artikel yang alur pencariannya digambarkan melalui PRISMA Flowchart; melakukan data charting dan critical appraisal; menyusun dan melaporkan hasil. Hasil yang diperoleh berdasarkan 8 artikel yang telah dilakukan critical appraisal , sebanyak 6 artikel menggunakan studi kualitatif, 1 artikel menggunakan kuantitatif mixed-method, dan 1 artikel menggunakan studi deskriptif kuantitatif. Sebanyak 3 tema yang muncul yakni tentang dampak psikologis, tantangan dan kebutuhan bidan dalam pelayanan kehamilan dan persalinan dimasa pandemic COVID-19 yang mempengaruhi pengalaman yang dirasakan oleh bidan dalam pelayanan kehamilan dan persalinan dengan adanya dampak psikologis seperti ketakutan dan burnout. Selain itu terdapat tantangan yang dihadapi oleh bidan dan hal-hal yang menjadi kebutuhan bidan dalam pelayanan kehamilan dan persalinan di masa pandemic COVID-19.

Maternal Satisfaction with Childbirth Services in Health Facilities in Nigeria: A Systematic Review of Literature and Recommendations

Maternal Satisfaction with Childbirth Services in Health Facilities in Nigeria: A Systematic Review of Literature and Recommendations

Effects of computed distances, and other determinant factors on place of child delivery in Magadi Ward, Kenya

The choice of place of delivery is still debatable in most sub-Saharan African societies’ especially pastoral communities. The decision on whether to deliver at a health facility or at home varies across households. This study sought to evaluate the effects of computed distance, demographic and socio-economic factors on the place of child delivery in rural Magadi, Kenya. The integration of both spatial and statistical techniques was adopted. Distances (straight-line distance, road network distance to the nearest health facility and primary facility) were computed using tools in the Network Analyst toolbox. Computed distances of 246 sampled households together with demographic and socioeconomic factors were further analysed using univariate and multivariate logistic regression. The findings showed that calculated road network distance to the primary facility was a determinant of access and use of place of delivery both for the adjusted and the unadjusted odds. Women aged 20 years or below, having more children, secondary education or above and those who are unmarried are more likely to deliver at health facility. Receiving 1 or 2 childbirth services from a health facility, being aware of a private actor who set up the health facility and involvement of the spouse in the decision-making of place of birth are also linked to the use of health facility for child delivery. Deliveries at home were related to family monthly income level, family occupation, opinion on health facility location and being aged between 21 – 30 years. It was found that though computed road distance to the primary facility was the dominant factor, other variables such as level of education, parity, awareness of local actors, other childbirth services received prior to child delivery and marital status determined whether a woman would access and use health facilities for child delivery.

Use of motorised transport and pathways to childbirth care in health facilities: Evidence from the 2018 Nigeria Demographic and Health Survey.

In Nigeria, 59% of pregnant women deliver at home, despite evidence about the benefits of childbirth in health facilities. While different modes of transport can be used to access childbirth care, motorised transport guarantees quicker transfer compared to non-motorised forms. Our study uses the 2018 Nigeria Demographic and Health Survey (NDHS) to describe the pathways to childbirth care and the determinants of using motorised transport to reach this care. The most recent live birth of women 15-49 years within the five years preceding the NDHS were included. The main outcome of the study was the use of motorised transport to childbirth. Explanatory variables were women's socio-demographic characteristics and pregnancy-related factors. Descriptive, crude, and adjusted logistic regression analyses were conducted to assess the determinants of use of motorised transport. Overall, 31% of all women in Nigeria used motorised transport to get to their place of childbirth. Among women who delivered in health facilities, 77% used motorised transport; among women referred during childbirth from one facility to another, this was 98%. Among all women, adjusted odds of using motorised transport increased with increasing wealth quintile and educational level. Among women who gave birth in a health facility, there was no difference in the adjusted odds of motorised transport across wealth quintiles or educational status, but higher for women who were referred between health facilities (aOR = 8.87, 95% CI 1.90-41.40). Women who experienced at least one complication of labour/childbirth had higher odds of motorised transport use (aOR = 3.01, 95% CI 2.55-3.55, all women sample). Our study shows that women with higher education and wealth and women travelling to health facilities because of pregnancy complications were more likely to use motorised transport. Obstetric transport interventions targeting particularly vulnerable, less educated, and less privileged pregnant women should bridge the equity gap in accessing childbirth services.