INTRODUCTION:

Among many measures needed to reduce the high maternal and infant mortality in India and other low- and middle-income countries to attain millennium development goals 4 and 5¹, shifting place of delivery from home to hospital is a primary target, as many studies have clearly showed adverse outcomes because of delivery at home by traditional birth attendants unable to offer the best obstetrical practices.^2,3 Such change is inevitablebut needs to be managed effectively for benefitting the client and efficiently to conserve resources.⁴

Shifting deliveries from home to hospital is the first step, but without competent maternity staff this will be a disaster.⁵ Adequate resources and well trained midwives is one side of the equation, but education of mothers and their cooperation is the other side to be ensured by the continuing professional education of the staff based on realities.⁶The International Confederation of Midwives and World Health Organization as well as the Government of India had made several recommendation on properly equipping the midwives^7,8, but deficiencies still exist especially among those employed in hospitals. This paper outlines some guidelines based on research done in the labour wards of an urban multispecialty hospital.

MATERIAL AND METHODS:

The research setting was the labour wards of the Bangalore Baptist Hospital in Bangalore, Karnataka state, a multispecialty hospital established about four decades ago and attracting a large clientele from all socioeconomic strata of the population. The labour ward is well equipped with adequate midwifery and nursing staff and supervised by the Dept of Obstetricsand Gynaecology. It was proposed to interview prospectively all mothers admitted into the labour ward for delivery using a well-designed schedule which was validated and field tested. The research was approved by the Ethics Committee of the Hospital and informed consent was obtained from each mother before interview. There were seven statements of expectations and 16 statements of experiences of the mother concerning her childbirth, the behaviour, competency, courtesy and cooperativeness of the midwives and nursing staff. For each statement, the agreement was recorded in a 5-point scale, Strongly Agree scores 1, Agree as 2, Not sure as 3, Disagree as 4 and Strongly disagree as 5. Means with Standard Deviations and 95% Confidence intervals were computed for each statement for all mothers as well as in subgroups based on age, gravida, education and occupational status of the mother. Pearson’s correlation was calculated between expectations and experiences. Data were computerized and analysed using SPSS. The mothers fully cooperated and gave considered replies to all the statements.

RESULTS:

The summary of expectations is presented in Table 1, showing the mean (SD) scores as well Proportions on agreements.

Since strongly agreed is scored 1, and agreed as 2, the mean scores reflect a relatively high agreement for all the seven statements on expectations of mothers. The proportions agreed also confirm these observations. About 20% seem unsure and about 10% disagree. It is possible that there are specific reasons such as some neglect or inability to manage complications in these mothers which need careful scrutiny. The higher scores for greater emotional support seem necessary. These expectations were analysed according to age, gravida, education and professional status of the mother and the differences were not statistically significant.

The experiences of the mothers are given in Tables 2 and 3.

Table 1 Expectation of Mothers: Mean, SD, 95% CI, and Agreements

Expectations	Mean score	Standard Deviation	95% confidence interval	Agree	Not sure	Disagree
Allowing my husband during labour to support me physically and emotionally	2.27	1.06	2.15-2.39	65.0	21.7	13.3
Checking my baby’s health properly	2.04	0.94	1.93-2.15	77.0	14.7	8.3
Offering for the choices of where to have the baby	2.14	1.02	2.02-2.26	70.7	20.2	9.1
Offering the choice to use the pain relief that I had already planned	2.14	0.94	2.03-2.25	70.3	20.3	9.4
Expected emotional support from midwife care	2.27	1.03	2.15-2.39	64.0	24.0	12.0
Expected to have the same midwife care during the whole time	2.10	0.94	1.99-2.21	71.3	21.7	7.0
Hospital room or ward to be properly cleaned	2.08	0.98	1.97-2.19	75.0	16.3	8.7

Table 2: Experiences of the mothers: I: Mean score. SD, 95% CI and Agreements

Experiences	Mean	Standard deviation	95% CI	Agree	Not sure	Disagree
Midwives gave meencouragement and emotional support	2.04	1.00	1.93 - 2.15	74..0	16.8	9.2
Same midwife care was there for the labour	2.23	0.94	2.12 - 2.34	68.0	21.0	11.0
Never Left alone during the early labour by midwives and doctor	2.45	1.09	2.32 - 2.57	58.0	25.0	17.0
During your antenatal check-ups midwife asked about emotional status	2.35	1.00	2.24 -- 2.46	61.7	26.3	12.0
I used my choice of pain relief that I had planned earlier	2.32	0.99	2.21..—2.43	63.4	24.0	12.6
Doctor and midwife care were cooperative	2.24	0.96	2.13 -- 2.35	70.0	18.7	11.3
Midwives who cared during labour andbirth were involved in antenatal care also	2.30	1.03	2.18 - 2.42	68.0	19.3	12.7

Table 3: Experiences of the Mothers-II: Mean score. SD, 95% CI and Agreements

Experiences	Mean	Standard Deviation	95% CI	Agree	Not sure	Disagree
Medicines were given timely	2.00	1.04	1.88 – 2.12	65.6	15.3	9.1
Check-ups done on a regular basis	2.09	0.98	1.97 – 2.21	74.3	16.0	9.7
Test results were timely shown after birth of baby	2.17	1.00	2.05 – 2.29	68.0	22.0	10.0
I was properly taken care of after birth of baby	2.18	1.02	2.06 – 2.30	67.7	22.0	10.3
Hospital room or ward was clean	2.05	0.90	1.95 – 2.15	74.3	19.7	6.0
Assisted in breastfeeding	2.17	0.94	2.07 – 2.27	68.4	23.3	8.3
There was no delay in discharge	2.09	0.90	1.99 – 2.19	72.0	21.3	6.7
Timely healthcare facilities were provided to me and to the child	2.12	0.93	2.02 – 2.22	68.6	25.0	6.3
The health of the child was properly taken care of	2.01	0.89	1.91 – 2.11	74.3	20.0	5.7

In general, the mothers seem satisfied with the care they received from the staff in the Labour ward, with uniformly high agreements, confirmed by nearly two-thirds or 70% agreeing to the 16 statements relating to medical and emotional aspects and attention given to mother and child. It is disappointing to note that the scores could have been better and more women satisfied. It is even more disconcerting that about 10% have disagreed and another 20-25% neutral. Further research will be needed to follow-up these mothers for their feedback that could be used to improve the training of the maternity staff and upgrading the facilities. Detailed analyses by characteristics of the mothers did not show statistically significant variations. There was a highly significant correlation, r= 0.678 (p<0.01) between expectations and experiences. Indicating that mothers expressed satisfaction that their expectations were met to a large extent.

DISCUSSION:

The main expectations of the mothers was towards being allowed individual freedom,having cooperative and competent midwives to care during her labour and childbirth, be supportive to her emotional needs and ensuring a clean environment. Similarobservations were noted in other studies.^9,10 It was gratifying to note that the mothers were happy with their interaction with staff and care, both medical and psychological. However this was true for only two-thirds of mothers, and about 20% undecided and 10% having some disagreements. This implies that the services were not optimal or there were deficiencies as well as neglect from the point of view of some mothers.^11,12 This must be seriously considered and suitable action taken to make hospital deliveries more attractive and friendly. No doubt the hospital took care of the medical and critical care aspects well safeguarding mother and child but the mothers probably expect more emotional support, assurances and information that will make the hospital environment as their home, which is the main focus for safe deliveries.^13,14 Those mothers who disagreed and perhaps even among those agreeing to the various statements on experiences, would have welcomed better education and information as needed for their maternal and infant needs.¹⁵ It was not possible in this research to observe more closely the handling of emergencies or complications in the intrapartum and early postpartum phases, and it might of revealed some weaknesses in the staff or resources. Logistically it may not have been possible to assign the same midwife throughout as expected by the mothers, and this could have resulted in some dissatisfactions. While minimum standards are maintained in recruitment and training of midwives, there is likely to be variations in the approach or competence in handling emergencies by different staff. ^16,17 Supervision of midwives, continuing education and quality control are essential managerial requirements for ideal organizations, especially in critical areas such as the labour wards and intensive care units.^18,19 If the trend towards more women opting for hospital deliveries is to be accelerated, then better staff and better management of labour wards become paramount.^20,21

CONCLUSION:

More than two-thirds of mothers were satisfied with their experiences in hospital deliveries matching their expectations. Continuing professional education of midwives and nursing staff in maternity wards will yield better and more positive responses from mothers and their families.

ACKNOWLEDGEMENT:

I thank the Director and Administration of the Bangalore Baptist Hospital for permission and encouragement to do this study. I am grateful to the staff of the Labour wards for their help and guidance. This research would not have been possible without the full cooperation of the mothers and their families who have provided the necessary information and feedback; I am deeply indebted to them.

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Received on 17.12.2020 Modified on 30.01.2021

Asian J. Nursing Education and Research. 2021; 11(2):267-270.

DOI: 10.5958/2349-2996.2021.00064.1