International Journal of Nursing Education and Research

Abstract

Birth preparedness and complication preparedness (BPACR) is a key component of globally accepted safe motherhood programs, which helps ensure women to reach professional delivery care when labor begins and to reduce delays that occur when mothers in labor experience obstetric complications.In Indian community like Odisha, pregnancy and childbirth continue to be regarded as exclusively women's affairs, But male are considered as primary decision maker and financier for women's health. Hence it is observed that due to lack of involvement of husband in maternity care, proper decision cannot take for women to access care for obstetric emergency which lead to disastrous consequences. This situation makes men critical partners for the improvement of maternal health and reduction of maternal mortality by raising their awareness about emergency obstetric conditions, and engaging them in birth preparedness and complication readiness.

A descriptive cross-sectional study was undertaken among 200 ever married men in Mendhasal village, Khorda District which is a rural community in odisha state, India. Multi-stage sampling was used to select the samples and questionnaires was administered to assess men's birth preparedness, complication readiness and attitude of women towards male participation in maternity care and in-depth interviews was done to find out reasons for poor involvement of their husband in maternity care. The study found that majority of pregnancies was unplanned (96%). Only 28.5% of men ever accompanied their spouses for maternity care. There was very little preparation for skilled assistance during delivery (6.2%), savings for emergencies (19.5%) or transportation during labour (24.2%). Young paternal age, formal education and Hindu male were independent predictors of male participation in maternity care.

In Indian community set up, the role of men in maternity care is very poor, despite their economic dominance and decision making power. There is a need to increase involvement of men in their partner's maternity care through peerled, culturally-sensitive community education and appropriate health system reforms.

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Abstract

Hysterectomy is one of the most common surgeries performed in gynecology. Abdominal and vaginal hysterectomies are the two predominant operative modalities for various uterine conditions. A large scale survey of hysterectomy has shown that 70.0% to 80.0% of hysterectomies are performed by the abdominal route and only 10.0% of hysterectomy done by vaginal rout. But many studies show the rate of morbidity and complications are comparatively less in vaginal hysterectomies than Abdominal. This study was undertaken to evaluate the patient comfort and satisfaction in two routes of hysterectomy (abdominal or vaginal) in a hospital population for women with benign disease by comparing intra-operative and post-operative complications.

Methodology: The study is a quasi-experimental design, which was undertaken at the SUM hospital, a tertiary teaching hospital, Bhubaneswar, Odisha, India from April 2012 to January 2013. 100 subjects were selected by convenience (non-probability) sampling and equally divided into vaginal and abdominal hysterectomy groups. The intra-operative and post-operative outcomes were compared between two groups which were measured by operative time, blood loss, post-operative pain, wound infection, febrile morbidity, self- care abilities, ambulation, hospital stay and secondary hemorrhage, estimated cost, post-operative complications, re-admission, and re-opening.

Results: There were no differences in the patients' mean age, parity, body mass index, and preoperative hemoglobin levels between two groups. Main indication for women having abdominal operation was leiomyoma, whereas vaginal hysterectomy had done for women having dysfunctional uterine bleeding and utero-vaginal prolapsed. The level of patient comport and satisfaction was more in VH compared to AH patients as because VH patients could exhibit early ambulation, independent self- care activities, good wound healing and was associated with comparatively less postoperative pain, febrile morbidity, wound infection, operative time, economic cost, bleeding requiring less transfusion and low rate of re-admission than abdominal hysterectomy.

Conclusion: Patients are more comfortable and satisfied in terms of postoperative pain, early return to work, less hospital stay and cost in vaginal rout of hysterectomy than abdominal. Hence patients requiring a hysterectomy can be offered vaginal route for surgery in case of desirable conditions.

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