Knowledge And Utilization Of Birth Preparedness And Complication Readiness Among Pregnant Women

1.1 BACKGROUND OF THE STUDY

It is true that birth of baby precedes celebration but it equally poses source of concern as pregnancy and childbirth is sometimes a perilous journey especially in the developing countries, where the risk of a woman dying from pregnancy and related complications is almost 40 times greater than that of her counterparts in developed countries (Benson & Yinger, 2002). Maternal mortality remains a public health challenge world wide, and the global maternal mortality ratio of 525 per 100,000 live births annually is still unacceptably high (Hogan, 2010). A disproportionately high burden of these maternal deaths is borne by developing countries including Nigeria, with a maternal mortality ratio of 500– 1,000 per 100,000 live births (World Bank, 2013). These deaths arise from pregnancy, childbirth or postpartum complications. According to WHO (2009), maternal deaths are thought to occur in developing countries due to delay in deciding to seek appropriate care, delay in reaching an appropriate health facility, and delay in receiving adequate emergency care once at a facility. These delays may be reduced if pregnant women and their families are prepared for birth and its complications. Birth preparedness and complication readiness strategy is therefore, very relevant in this regard.This strategy can reduce the number of women dying from complications due to such delays by making a birth plan that constitutes birth-preparedness and complication-readiness measures for pregnant women, their spouses and their families (McPherson, Khadka, Moore & Sharma, 2006).

Birth-preparedness and complication-readiness is a comprehensive package aimed at promoting timely access to skilled maternal and neonatal services. It is a safe motherhood strategy whose objective is to promote the timely use of skilled maternal and neonatal care during childbirth or obstetric emergencies by reducing delays at the first, second and third levels (Maternal and Neonatal Health Program, 2007). It entails making plans prior to birth to ensure that a pregnant woman is prepared for normal birth and complications. The birth-preparedness package promotes active preparation and decision- making for delivery by pregnant women and their families. (McPherson, et al, 2006). Decision are made and documented on such issues as desired place for birth, the preferred skilled birth attendant, items required for birth, birth companion, getting a compatible blood donor and arranging in advance for transport. This stems from the fact that every pregnant woman faces risk of sudden and unpredictable life threatening complications that could end in death or injury to herself or to her baby (JHPIEGO, 2006).

Other elements of birth preparedness include knowledge of expected date of delivery, signs of labour, dangers signs, HIV testing, mobilising resources to pay for services, arranging for someone to take care of the family during delivery. Importance of post- natal care, importance of exclusive breast feeding and contraception (Maternal and Neonatal Health Program 2003). In addition, a potential blood donor and a decision maker (in case of emergencies) need to be identified (Kaye, Mirembe, Azigy, Namuelema, 2003).

Approximately 15% of pregnant women develop life-threatening complications hence need for emergency obstetric care. These complications are unpredictable and may progress rapidly to a fatal outcome (Rogo & Aloo, 2011). Knowledge of danger signs of obstetric emergencies and appreciation of the need for rapid and appropriate response when emergencies occur may reduce delay in decision making and in reaching health facilities. Such signs in pregnancy are vaginal bleeding, severe headache, severe vomiting, swelling of hands and face, difficulty in breathing, fits, fever, reduction or absent fetal movement and drainage of liquor (WHO, 2009). Therefore, this package is a very important strategy in developing countries, where obstetric services are poor. Birth plan should be discussed on the first clinic visit, reviewed in subsequent visits and finalized by 32 weeks (Barbara & Gomez, 2007).

One of the key roles of antenatal care is to provide health education on danger signs of pregnancy and delivery, preparation of a birth plan and to encourage delivery under a skilled attendant. WHO (2009) now recommends that pregnant women should receive focused antenatal care in which birth preparedness and complication readiness is a key component (WHO, 2009), Ministry of Health, Kenya, (2012). In order to address this disturbing trend, the International Conference on Population and Development (ICPD) urged that special efforts should be made to emphasise men’s shared responsibility and promote their active involvement in maternity care (JHPIEGO, 2006). In spite of this, pregnancy and childbirth continue to be regarded as exclusively women’s affairs in most African countries, especially in the rural settings (Mullick, Kunene, & Wanjiru, 2005).

1.2 STATEMENT OF THE STUDY

In sub-Saharan Africa, pregnancy and childbirth continues to be viewed as solely women’s issues (JHIPIEGO, 2006). A male companion at antenatal care is rare and in many rural communities, it is unthinkable to find male companions accompany a woman to the labour room during delivery (Mullick, Kunene & Wanjiru, 2005; Babalola & Fatusi, 2009). This posture of men towards BP/CR depicts lack of knowledge of their role in pregnancy and child birth. Yet, men have social and economic power, especially in Africa including Enugu State. They also, have tremendous control over their partners, so they decide the timing and conditions of sexual relations, family size and whether their spouse will utilize available health care services (Iliyasu, 2010). This situation makes male partner involvement critical if improvement in maternal health and reduction of maternal morbidity and mortality is to be realized. His engagement in maternity care seems to be lacking in developing countries especially rural communities. Male involvements will enable men to support their spouses to utilize emergency obstetric services early and the couple would adequately prepare for birth and get themselves ready for complications. This does not seem to be the case in developing countries including Nigeria and Enugu state. Birth preparedness and complication readiness is an issue that concerns both male and female (couples) for better outcome of pregnancy and delivery, but it seems to be viewed as women’s responsibility. This poses a big problem. There is therefore the need to assess the knowledge, practice and factors that influence birth preparedness and complication readiness among couples in selected rural communities in Enugu State since there are documented evidence that maternal mortality is higher in rural communities than in the urban settings (WHO, 2014).

1.3 OBJECTIVES OF THE STUDY

The primary aim of this study is to examine the knowledge and utilization of birth preparedness and complication readiness among pregnant women in Sapele, Delta State. Other aims of this study are:

1. Determine the level of pregnant women knowledge of birth preparedness and complication readiness.
2. Find out the acceptably practices of birth preparedness and complication readiness.
3. Find out the extent pregnant women utilizes birth preparedness and complication readiness in Sapele, Delta State.
4. Ascertain the factors affecting pregnant women practice and utilization of birth preparedness and complication readiness in Sapele, Delta State.

1.4 RESEARCH QUESTIONS

The following research questions will be answered in this study:

1. What is the level of pregnant women knowledge of birth preparedness and complication readiness?
2. What are the acceptably practices of birth preparedness and complication readiness?
3. What is the extent pregnant women utilizes birth preparedness and complication readiness in Sapele, Delta State?
4. What are the factors affecting pregnant women practice and utilization of birth preparedness and complication readiness in Sapele, Delta State?

1.5 RESEARCH HYPOTHESES

The following hypothesis will be tested in this study:

Ho: The level of knowledge of birth preparedness and complication readiness among pregnant women in Sapele, Delta State is low.

Ha: The level of knowledge of birth preparedness and complication readiness among pregnant women in Sapele, Delta State is high.

1.6 SIGNIFICANCE OF THE STUDY

This study has relevance to the general public, nurse practitioners, nurse administrators and nurse educators.   It will be significant to the general public as findings from this study will show the need for couples and the general public to be prepared for birth and any complications that may arise, thereby reducing the risk/incidences of maternal and infant mortality. Findings from the study will equip the couples with invaluable information on birth preparedness and complication readiness, which will go a long way, if applied to ensure better and safer maternal health for the mothers.

This study will also be relevant to the nurse practitioners as they will be equipped with the findings from this study, which will enable them adequately prepare the couples for birth and possibly avoid any complication that may arise.   Findings from this study can be utilized by nurse administrators who will ensure that the necessary environments are provided that will enable the nurse oversee the adoption of birth preparedness and complication readiness.

1.7 SCOPE OF THE STUDY

This study focuses on the knowledge and utilization of birth preparedness and complication readiness among pregnant women in Sapele, Delta State. The study will  by extension ascertain the factors affecting pregnant women practice and utilization of birth preparedness and complication readiness in Sapele, Delta State. The respondents for this study will comprise of pregnant women in Sapele, Delta State.

1.8 LIMITATIONS OF THE STUDY

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.

Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.

1.9 DEFINITION OF TERMS

Birth Preparedness and Complication Readiness: This is a comprehensive strategy that focuses on promoting the timely utilization of skilled maternal and neonatal health care and includes attending antenatal care at least four times during pregnancy, identifying a skilled provider and making a plan for reaching the facility during labour, setting aside personal funds to cover the costs of traveling to and delivering with a skilled provider and any required supplies, recognizing signs of complications, knowing what community resources (emergency transport, funds, communications, etc), are available in case of emergencies and having a plan for emergencies, obstetric care and referral system for Emergency Obstetric Case.

Knowledge: The information and understanding gained through education.

Practice: Action taken by couples towards BP/CR.

1.10 Organization of the Studies

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the  review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study,  sample size determination,  sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.