IFGH 2012: Perceptions and Care seeking for Obstructed Labor: Findings from the Qualitative Assessment of the Bangladesh Maternal Mortality Survey, 2010

Authors:Khan R., Sultana M., Blum LS., Nahar Q., Streatfield PK.


Author Affiliations: International Centre for Diarrheal Disease Research, Bangladesh (ICDDR, B)

Option 1– Scientific / Empirical Research Findings Presented as – Poster (unable to present)

Aims:

As part of a nationwide maternal mortality study, qualitative research was conducted between March 2010 and February 2011 with maternal deaths and near-miss who experienced obstructed labor. Deaths were sampled from the survey, while near-miss were identified in health facilities located in the same area. In-depth interviews included family members of women who died (2) or survived (4) obstructed labor, and in the case of near-miss, the women themselves.

Methods:

Qualitative research was carried out alongside with the national survey between March 2010 and January 2011. Maternal deaths were sampled from the survey; near-misses were identified from health facilities located in areas where the deaths occurred. Methods included in-depth interviews with people most familiar with maternal death (15) or near-miss (16) that had occurred due to hemorrhage and eclampsia within past 18 months.

Results:

Women who died experienced labor pain for 2-3 days before they sought care outside the home, while near-miss cases typically sought treatment within a few hours after the onset of contractions. Maternal deaths suffered from severe delivery pain which was not recognized as life-threatening by family members and formal and informal health care providers. In contrast, near-miss women experienced breech position, the baby’s head was stuck in the birth canal, or a hand came out first, which both family members and TBAs identified as danger signs. TBAs referred these women promptly to health facilities. However, once reaching the facility, near-miss women faced many delays obtaining appropriate care. Overall, five women eventually had c-sections, which family members initially objected to due to the costs involved. With the exception of one maternal near-miss, all women had stillbirths.

Conclusions:

Prolonged labor is more difficult for family members and health providers to identify than other signs of obstructed labor. Mothers can be saved from obstructed labor if timely care is sought. Raising awareness about the definition of obstructed labor and appropriate treatment and establishing proper referral mechanisms is important in reducing maternal mortality and preventing stillbirths.