Background: One factor that contributes to high maternal mortality in developing countries is the delayed use of\r\nEmergency Obstetric-Care (EmOC) facilities. The objective of this study was to determine the factors that hinder\r\nmidwives and parturient women from using hospitals when complications occur during home birth in Sistan and\r\nBaluchestan province, Iran, where 23% of all deliveries take place in non- hospital settings.\r\nMethods: In the study and data management, a mixed-methods approach was used. In the quantitative phase, we\r\ncompared the existing health-sector data with World Health Organization (WHO) standards for the availability and\r\nuse of EmOC services. The qualitative phase included collection and analysis of interviews with midwives and\r\ntraditional birth attendants and twenty-one in-depth interviews with mothers. The data collected in this phase\r\nwere managed according to the principles of qualitative data analysis.\r\nResults: The findings demonstrate that three distinct factors lead to indecisiveness and delay in the use of EmOC\r\nby the midwives and mothers studied. Socio-cultural and familial reasons compel some women to choose to give\r\nbirth at home and to hesitate seeking professional emergency care for delivery complications. Apprehension about\r\nbeing insulted by physicians, the necessity of protecting their professional integrity in front of patients and an\r\ninability to persuade their patients lead to an over-insistence by midwives on completing deliveries at the mothers�\r\nhomes and a reluctance to refer their patients to hospitals. The low quality and expense of EmOC and the\r\nmothers� lack of health insurance also contribute to delays in referral.\r\nConclusions: Women who choose to give birth at home accept the risk that complications may arise. Training\r\nmidwives and persuading mothers and significant others who make decisions about the value of referring women\r\nto hospitals at the onset of life-threatening complications are central factors to increasing the use of available\r\nhospitals. The hospitals must be safe, comfortable and attractive environments for parturition and should give\r\nappropriate consideration to the ethical and cultural concerns of the women. Appropriate management of financial\r\nand insurance-related issues can help midwives and mothers make a rational decision when complications arise.
Loading....