TABLE OF CONTENTS
Title
page i
Approval
page ii
Certification iii
Dedication iv
Acknowledgments v
Table of contents vi
List
of tables viii
Abstract ix
CHAPTER
ONE: INTRODUCTION
Background to the Study 1
Statement of the Problem 6
Purpose of the Study 7
Specific Objectives of the Study 8
Research Questions 8
Significance of the Study 8
Scope of the Study 9
Operational Definition of terms 9
CHAPTER
TWO: LITERATURE REVIEW
Concept
of Pregnancy and Child birth 11
Theoretical Review 23
The Health Belief Model 23
Empirical Review 27
Summary of Literature Review 35
CHAPTER
THREE: RESEARCH METHODOLOGY
Research
Design 37
Study
Area 37
Population of
study 38
Sample Size 38
Sampling procedure 39
Inclusion Criteria 39
Instrument
for Data Collection 39
Validity
of instrument 40
Reliability
of instrument 40
Ethical
Considerations 41
Procedure
for Data Collection 41
Method
of Data Analysis 42
CHAPTER FOUR: PRESENTATION OF RESULTS
Presentation
of results and Summary of major findings 44
CHAPTER FIVE: DISCUSSION OF FINDINGS
Discussion of
Findings 58
Limitation of
the study 66
Implication for
Nursing 66
Suggestions for
Further Studies 67
Summary 67
Conclusion 68
Recommendations 69
References 73
Appendices 87
LIST OF TABLES
Table 1. Socio-demographic characteristics 45
Table 2. Personal factors that informed decision
to deliver
outside the health facility of booking 47
Table 3. Family factors that informed decision
to deliver
outside the health facility of booking 50
Table 4. Institutional factors that influence
delivery outside health facility of booking 52
Table 5. Health care provider factors that
inform out-of-hospital delivery by pregnant mothers 55
Box 1. Code I: Personal factors 48
Box 2. Code II: Family factors 51
Box 3. Code III: Institutional factors 53
Box 4. Code IV: Health care provider factors 56
Figure 1. Adapted from health believe model 24
Figure 2. Conceptual model for the study 26
ABSTRACT
Out of health
facility delivery is highly challenging and competitive to health facility
delivery in many communities in Bayelsa State, as most women continue to engage
in the practice. Therefore, the study is to explore in-depth, the factors that
influence mothers’ decision to deliver outside health facility where they
booked in Bayelsa State. Objectives were to (1) determine personal factors that
inform pregnant mother’s decision to deliver outside the health facility of
booking, (2) identify family factors influencing out-of health facility
delivery, (3) determine institutional factors responsible for their decision to
deliver outside the health facility and (4) determine
health care providers factors that inform out-of-health facility delivery by
pregnant mothers. Transcendental
phenomenological research design was adopted, using non-probability sampling
technique and purposive sampling methods to obtain data from 15 participants. Validity
and reliability was based on criteria for trustworthiness in a qualitative
research. Instrument for data collection was semi-structured in-depth interview
guide and tape recorder, with an in-depth face-to-face interview that lasted
between 10-35minutes (each participant). Data were analyzed using Colaizzi’s
seven steps of data analysis, presented in themes, codes and subcodes (Nvivo).
Findings revealed interplay of health institutional factors such as attitude of
health staff, previous experience of the women, lack of care and support during
labour by health care provider, availability of TBA’s and the high cost of
delivery services in health facilities. Other findings include socio factors
such as distance to health facility, low educational level of respondent and
religious beliefs. Significant finding was the women’s expression of fear of
Caesarean Section. However, mothers expressed confidence in the antenatal care
services where they receive information that both mother and baby is well and
safe. Hence, better to deliver at home. Thus, the following recommendations:
(i) Raised awareness on danger signs of pregnancy, labour and delivery, (ii)
Improve relationship of health care providers and the women (iii) Proper and
adequate management system, (iv) Quality assurance policy system and (v) Improving
physical access (road access).
CHAPTER ONE
INTRODUCTION
Background
to the Study
A
pregnant woman needs regular check-ups in a health facility where a midwife or
a doctor will be in attendance. These check-ups are called antenatal care or
antenatal visit (Iyaniwura & Yussuf, 2009). These check-ups end at delivery
of the baby or babies, with post-natal care inclusive. More so, WHO, UNICEF,
UNFPA and World Bank (2008), stated that each year about 6 million women become
pregnant and 5 million of these pregnancies result in child birth. WHO
(2014), reported that about 16 million
girls aged 15-19 and some one million girls under 15 give birth every year, most
in low and middle income countries. According to the US Government poster on
teen pregnancy, over 1100 teenagers mostly aged 18-19 give birth every day in
the United State alone (Hamilton, Brady, Ventura & Stephanie, 2012).
However,
pregnancy is complete with three trimester except otherwise. The 1st trimesteris the first 13 weeks or 3 months of
the pregnancy in which the baby develops at a very fast rate and becomes almost
fully formed by the end of it. While the 2nd trimester, is from 4 – 6 months of pregnancy during which it becomes obvious
that the mother is pregnant. And the 3rd trimesteris from 7 – 9 months until the baby is born. During this period,
the baby will build up fat stores, and continue growing rapidly (American
Journal of Obstetrics and Gynecology, 2015).
Health
Direct Australia (2013), defined antenatal care as the care received from
healthcare professional during pregnancy. In light to this, antenatal care
(ANC) attendance provides a unique opportunity to improve the health of women
and infants. Also, the utilization of ANC provides opportunities of promoting
services that may include weight and blood pressure measurement (WHO, 2010).
However, distance to health facilities, inadequate Transportation,
socio-cultural beliefs and the need for immediate and specialized services have
hampered women’s ability to access these services in many less developed
countries and northern Nigeria in particular (WHO, 2010).
Antenatal
care includes early booking, regular clinic visits as structured and decision
to deliver in a health facility at term or otherwise, while Booking is the term
used to describe the first visit by the pregnant woman to the antenatal clinic.
This first visit which is best during the first trimester provides the
opportunity for detailed investigation on the status of both mother and baby.
If the mother is expecting her first baby, she will have up to 10 antenatal
appointments. If she has a baby before, she will have up to 7 antenatal
appointments. Under certain circumstances for example, if you develop a medical
condition, you have more visits, (NHS, 2015). Based on the results of a WHO antenatal care
randomized trial, the standard measure of adequate antenatal care delivery is a
minimum of four (4) antenatal visits (with the first occurring during the first
trimester) for a woman and her fetus, if they are judged to be healthy
following a standard risk assessment (NHS, 2015). This minimum of 4 antenatal
clinic visits throughout full term pregnancy is the package explained in birth
preparedness and complication readiness plan.
Birth
preparedness and complication readiness plan according to WHO (2005), posited
that prenatal care includes attention to a woman’s preparation for child birth
such as getting the support she will need from her provider, family and
community and making arrangement for her new born. Consequently, the skilled
care provider and the woman should plan the following: a skilled provider to be
at the birth and how to get there, items needed for the birth and money to pay
for the skilled attendance and any needed medications, support after the birth,
including someone to accompany the woman to the delivery facility during labour
and someone to take care of her family while she’s away. Also an individual
birth plan should answer the following questions: Does patient know when baby
is due? Has she chosen a skilled health provider? Has she chosen a health
facility for delivery? Does she know danger signs in pregnancy? Has she chosen
a decision maker? Does she have a transport plan? Has she collected basic birth
supplies and does she have a birth partner? If all these answered yes, then the
individual is ready for delivery.
Child
birth includes both labor and delivery; ie, it refers to the entire process as
the baby makes its way from the womb down the birth canal to the outside world
(Farlex, 2012). Although, vaginal delivery is the most common and safest type
of childbirth, when necessary in certain circumstances, forceps (instruments
resembling large spoons) may be used to cup the baby’s head and help guide the
baby through the birth canal. Vacuum delivery is another way to assist delivery
and is similar to forceps delivery. In vacuum delivery, a plastic cup is
applied to the baby’s head by suction and the health care provider gently pulls
the baby through the birth canal. However, vaginal delivery may not always be
possible, hence Cesarean delivery (C-section) may be necessary for the safety
of the mother and baby, especially if one of these complications is present
such as big baby, transverse or oblique lie and breech presentation where there
will be difficulties for the baby to pass through the pelvis or there is foetal
distress. Most often, the need for a cesarean delivery is not determined until
after labor begins. Once a woman has had a cesarean delivery, future deliveries
may be done by cesarean section. That’s because surgery done on the uterus
increases the risk of it rupturing during a future vaginal delivery (Kecia Gaither,
2014). The birth environment has a profound effect on how labour progresses and
on how women remember their birth experiences and that the place of birth
should provide a distraction-free, comfortable, supportive and reassuring
environment for mothers and their families. Women need to remain confident,
have freedom to respond to their contractions in any way that works for them
and have continuous emotional, psychological, and physical support throughout
labour (Lamaze, 2007).
Consequently, a significant
proportion of mothers in developing countries still deliver at home unattended
by skilled health workers (Montagu, Yamey, Visconti, Harding & Yoong,
2011). In diverse contexts, individual factors including maternal age, parity,
education and marital status, household factors including family size,
household wealth, and community factors including socioeconomic status,
community health infrastructure, region, rural/u
