Home birth without skilled attendants despite millennium villages project intervention in Ghana: insight from a survey of women’s perceptions of skilled obstetric care

BACKGROUNDThe purpose of this metasynthesis is to analyze women's lived experiences of giving birth in Ghana during and after the Millennium Development Goals (MDGs), when health policy in Ghana was changed to urge women to birth in health services with skilled attendants.METHODAn interpretive phenomenological framework guided the review of the literature. Three electronic databases were searched as well as reference lists and author searches. Articles that met the screening criteria for inclusion were coded and thematically analyzed, then drawn together to construct the essence of women's experiences of giving birth in Ghana.RESULTSSeven themes were constructed from the data and these were poor quality health services, maltreatment by midwives, mixed emotions about pregnancy and childbirth, supernatural fears, women wanting safe births with skilled birth attendants, uncertainty about reaching a health facility, and decision-making hierarchy. There were three counter themes and these were women wanting a home birth with a traditional midwife, defiance against dominant decision-makers by some women, and a belief that “not all nurses are bad.”CONCLUSIONGhanaian women have heeded the MDGs and health policy messages to birth with skilled attendants, but in reality, they are not always accessible, available, appropriate, or of high quality. Maternal health services still need much improvement including more resources such as staff, essential services, medicines, and quality assurance standards.

Download Full-text

Safety of non-medically led primary maternity care models: a critical review of the international literature

Australian Health Review ◽

10.1071/ah11039 ◽

2012 ◽

Vol 36 (2) ◽

pp. 140 ◽

Cited By ~ 16

Author(s):

Meredith J. McIntyre

Keyword(s):

Perinatal Mortality ◽

Critical Review ◽

Maternity Care ◽

Home Birth ◽

Obstetric Care ◽

Low Risk ◽

International Studies ◽

Birth Centre ◽

Increased Risk ◽

Low Risk Women

The Australian government has announced major reforms with the move to a primary maternity care model. The direction of the reforms remains contentious; with the Australian Medical Association warning that the introduction of non-medically led services will compromise current high standards in maternity services and threaten the safety of mothers and babies. The purpose of this paper is to conduct a critical review of the literature to determine whether there is convincing evidence to support the safety of non-medically led models of primary maternity care. Twenty-two non-randomised international studies were included representing midwifery-led care, birth centre care and home birth. Comparative outcome measurements included: perinatal mortality; perinatal morbidity; rates of medical intervention in labour; and antenatal and intrapartum referral and transfer rates. Findings support those of the three Cochrane reviews, that there is sufficient international evidence to support the conclusion of no difference in outcomes associated with low risk women in midwifery-led, birth centre and home birth models compared with standard hospital or obstetric care. These findings are limited to services involving qualified midwives working within rigorous exclusion, assessment and referral guidelines, limiting the number of urgent intrapartum transfers that come with increased risk of perinatal mortality. What is known about the topic? Systematic reviews of maternal and perinatal outcomes associated with midwifery-led care when compared to conventional intrapartum hospital care concluded that these non-medically led models of care are associated with several benefits for low risk women and their babies with no identified adverse effects. What does this paper add? The finding of no difference in outcomes associated with midwifery-led, birth centre and home birth compared with standard hospital or obstetric care is limited to international studies involving women in the care of qualified midwives working within rigorous guidelines for practice involving inter-professionally agreed exclusion, assessment and referral criteria. What are the implications for practitioners? Midwives caring for women in non-medically led models are urged to be vigilant to the need for early detection and prompt action in the event of unforseen complications to avoid an over emphasis on normality. This decreases the likelihood of urgent intrapartum transfers that come with an increased risk of perinatal mortality.

Download Full-text

Access to Skilled Care at Home during Pregnancy and Childbirth: Dhaka Bangladesh

International Quarterly of Community Health Education ◽

10.2190/iq.30.1.g ◽

2010 ◽

Vol 30 (1) ◽

pp. 81-87 ◽

Cited By ~ 1

Author(s):

Saria Tasnim ◽

Aminur Rahman ◽

A. K. M. Shahabuddin

Keyword(s):

Health Care Providers ◽

Home Birth ◽

Obstetric Care ◽

Community Analysis ◽

Care Providers ◽

Pregnancy And Childbirth ◽

Birth Attendants ◽

Care Services ◽

Quasi Experimental ◽

At Home

In Bangladesh the majority of childbirth takes place at home by unskilled persons. The objective of this study was to strengthen maternity care services through provision of skilled midwives and to explore people's perception of skilled birth attendants. As part of a quasi-experimental community trial conducted among selected urban area of Dhaka city, a group of skilled midwives were posted in selected urban centers between January to December 2002 to provide obstetric care services and some social mobilization activity in the community. Analysis of skilled midwives self-reported case records and monitory reports of the researchers was done on selected themes. The perception of the skilled midwife was not clear to people. They thought traditional birth attendants who conducts delivery over years were skilled midwives. Preparedness for obstetric emergency and birth planning was non-existent in the families. The skilled midwives were well accepted in the community but discouraged by center authority for home birth, apprehending that it will reduce their client flow and earning. Non-cooperation by other health care providers was common.

Download Full-text

‘I didn’t think you were allowed that, they didn’t mention that.’ A qualitative study exploring women’s perceptions of home birth

BMC Pregnancy and Childbirth ◽

10.1186/s12884-018-1733-1 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 5

Author(s):

Jo Naylor Smith ◽

Beck Taylor ◽

Karen Shaw ◽

Alistair Hewison ◽

Sara Kenyon

Keyword(s):

Qualitative Study ◽

Home Birth ◽

Women’S Perceptions

Download Full-text

Legislative Gaps in Addressing Rural Women’s Access to Obstetric Care in the United States: A Case Study of the North Carolina Home Birth Freedom Act

Policy Perspectives ◽

10.4079/pp.v26i0.19290 ◽

2019 ◽

pp. 27-37

Author(s):

Isabella Higgins

Keyword(s):

United States ◽

North Carolina ◽

Access To Care ◽

Rural Areas ◽

Home Birth ◽

Obstetric Care ◽

The United States ◽

Care Providers ◽

The North ◽

Obstetric Care Providers

Rural women in the United States face numerous barriers to accessing obstetric care. Hospitals and obstetric wards in rural areas are closing, and there is a shortage of rurally-located obstetric care providers. Recent experience in North Carolina provides insight into current legislative barriers to improving rural women’s access to obstetric care. In 2015, legislators in the North Carolina General Assembly unsuccessfully advocated for the Home Birth Freedom Act, which would have allowed certified professional midwives to practice in the state.While the Home Birth Freedom Act would have helped to address rural women’s access to care, it would not have been sufficient. This analysis describes why rural women’s access to obstetric care is limited and offers recommendations to expand access to care by providing certified nurse-midwives with more autonomy, appropriating funds to place obstetric care providers in rural areas, and improving Medicaid reimbursement rates.

Download Full-text