International Journal of Nursing Education and Research

Abstract

Background: In spite of important progress towards attaining the Millennium Development Goals (MDGs), maternal and neonatal mortality continue to figure as major public health problems in developing countries [1, 2]. Improvements in maternal health and reductions in maternal mortality have been slower than anticipated and - despite isolated successes - remain far from the MDG5 target of a 75% reduction in the maternal mortality ratio (MMR) from 1990 to 2015 [3]. Maternal mortality is a global burden, about 287,000 women died in 2010 due to pregnancy and childbirth related complications [4]. In India, Maternal Mortality Ratio is 212 per 100,000 live births [5] Morbidities related to pregnancy are related to medical causes which goes uncounted. Most maternal death occurs during delivery due to unpreparedness for childbirth and managing complications, which results in delivery by the mother itself or untrained attendant. These maternal deaths are unjust and avoidable if preventive measures are taken on time like ensuring antenatal care to all mothers, delivery by skilled birth attendant and timely referral to hospital. As in most rural and tribal areas, delivery takes place at home, far from emergency obstetric services or without access to skilled attendant, there is more risk associated with mother and child life [6]. Many birth preparedness programmes widely promoted by governments and international agencies to reduce maternal and neonatal health risks in developing countries; however, their overall impact is uncertain. Thus investigator felt need to assess whether pregnant women have adequate knowledge on antenatal, Intranatal and postnatal preparedness. The aim of the study was to assess pregnant women's knowledge on elements of birth preparedness i.e. antenatal, Intranatal and postnatal preparedness.

Objectives: To determine knowledge of pregnant women on various elements of birth preparedness.

* To identify association of demographic variables with birth preparedness.

Research Methodologies:

* A Quantitative Cross sectional survey was conducted on Primigravida Pregnant women

* Sample technique: Non probability Purposive Sampling

* Sample size: 425

* Setting: Selected municipal corporation hospital

TOOL:

The tool consisted of Semi structured interview and Structured Questionnaire

This had 2 sections-

* Section I-Socio demographic profile of mother

* Section II-Knowledge regarding birth preparedness had 3 major elements Antenatal, Labor, Postnatal preparedness. Total of 32 questions were included among which 10 were antenatal, 10 Intranatal and 12 were postnatal.

Data Collection:

* Phase I: History collection (Section I)

* Phase II: Structured Questionnaire (Section II)

Procedure: All participants fulfilling the criteria were approached, consent was taken and data was collected( section I and II). The average time taken to fill the questionnaire in the antenatal OPD was almost 15-20 minutes.

RESULT:

* Majority of pregnant women (184) were from age group of 18-22, majority of pregnant women 187 (44%) are educated up to SSC and Below, 154 (36.23%) pregnant women are educated up to HSC, 56 (13.17%) pregnant women are educated up to graduate and above and 28 (6.58 %) pregnant women are Illiterate. In gestation wise distribution of samples majority of pregnant women 210 (49.41%) were in second trimester, 117 (27.52%) were in third trimester and 98 (23.05%) were in first trimester and in occupation wise distribution of samples 304 (71.52%) were housewife, 121 (28.47%) were doing service.

* Age, education, trimester, religion and occupation show a significant association with birth preparedness.

* In Birth preparedness there were 10 elements on antenatal preparedness and pregnant women were not having knowledge on 3 elements ie essential laboratory tests and VCT, antenatal exercises andawareness of warning signs during pregnancy.

* In Birth preparedness there were 10 elements on intranatal preparedness and pregnant women were not having knowledge on 9 elements ie Labor and stages of labor, care during stages of Labor, warning signs during labor, Planning of place to deliver the baby, approximate distance of the planned place of delivery, Transportation facility for delivery, articles kept ready for hospital delivery, accompany of chaperone for hospital delivery, financial arrangements for delivery, Blood donors for emergency.

* In Birth preparedness there were 10 elements on postnatal preparedness and pregnant women were not having knowledge on 9 elements ie Diet during post natal period, episiotomy care, awareness about post natal exercises, articles kept ready for baby, awareness about exclusive breast feeding., schedule of breast feeding the baby, awareness about importance of Colostrums, awareness about new born warning signs, vaccination schedule of baby.

Conclusion: As we are aware that birth preparedness includes antenatal, intranatal and postnatal preparedness, pregnant women needs to be prepared in all the three areas. But according to the survey it shows that pregnant women are Knowledgeable about antenatal preparedness but are fairly Knowledgeable about postnatal preparedness and absolutely not knowledgeable about intranatal preparedness. Thus there is a great need to make them knowledgeable about Intranatal preparedness too, it should not be left assumed that once they enter labour process they will be delivered as it is natural process and health care workers will take care of it.

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Abstract

BACKGROUND: Pregnancy, labor and birth of a child are important milestones in a couple's life. Regular medical care, knowledge of your choices, and understanding the unknown event during pregnancy can make childbirth an extremely enriching and joyful event. Antenatal care is the clinical assessment of mother and fetus during pregnancy, for the purpose of obtaining the best possible outcome for the mother and the child. The purpose of ANC is to prevent or identify and treat conditions that may threaten the health of the fetus and the mother, and to help a woman approach pregnancy and birth as positive experience. All pregnancies and deliveries are at risk. However, there are certain categories of pregnancies where the mother, the fetus or the neonate in state of increased jeopardy. About 20 to 30 percent pregnancies belong to this category. If we desire to improve obstetric results, this group must be identified and given extra care. Even with adequate antenatal care, this small group is responsible for 70 to 80 percent of perinatal mortality and morbidity. Pregnancy complications and child birth related are the major cause of death among women in their reproductive ages. Around 5, 29,000 women died each year from maternal causes: and for every woman who dies approximately 20 more suffer from injuries, infections and disabilities during pregnancy or child birth. Delayed access to antenatal care is linked to maternal deaths and morbidity. Social deprivation also accounts for much maternal and child ill health, which national health data showing the access and utilization of the care by groups of women who differ by ethnicity, age and socio economic status. The knowledge of pregnant women regarding antenatal care and their compliance to it is of paramount importance in preventing maternal and infant mortality rate and morbidity.

The Indian society is made of large number of socio-culturally diverse groups. Their views of antenatal care and the health care system in general, may be different. The disparity of their knowledge and practice has to be assessed for improving the delivery of such services to these groups. Research can also help us to compare the levels of knowledge and practice of Primigravida and multiparas. This helps us to assess the stress given to preventive obstetric care within the health care system as well as the dissemination of knowledge in the community. Such a study could also potentially help us find the source of knowledge of those who have it and to intensify the use propaganda through such media. So the researcher felt a need to identify the duration when mother comes for registration which helps in assessing the risk factors to the antenatal women. This would help in identifying associated risk factors which will help to bring down the perinatal and maternal mortality rate as well as to have healthy mother with healthy baby.

OBJECTIVES:

*  To assess outcome of pregnancy with early registration.

*  To assess outcome of pregnancy with delayed registration.

*  To assess outcome of pregnancy with selected demographic variables

*  To associate early and delayed antenatal registration with maternal and fetal outcome

RESEARCH APPROACH: Quantative Evaluative approach.

RESEARCH DESIGN: Retrospective cross sectional design was adopted.

SETTING: Selected corporation hospital in Pune city

PARTICIPANTS: Postnatal mothers in the selected corporation hospitals.

METHODOLOGY: Tool consisted of Semi structured Interview and questionnaire. Data was collected from the mothers when they were in the hospital during their immediate postpartum period. Demographic data was collected during interview; records like ANC registration card, delivery notes etc were assessed to find out outcome of delivery. Tool consisted of two sections: Section I Demographic data, Section II Outcome of pregnancy (Mode of delivery, Complications during labor process, Mother condition on delivery, Baby condition on delivery) All participants fulfilling the criteria was approached, consent was taken and data was collected over 24 hours according to the patient's transfer to postnatal ward after delivery. The average time taken to fill the questionnaire after delivery was almost 15-20 minutes.

RESULTS: Majority of mothers had done ANC registration in 2^nd trimester (42%), whereas (41%) had done ANC registration in 3^rd trimester and less percentage in 1st trimester (17%). Majority of mothers done delayed ANC registration and they were having complications such as Anemia (40%), PPH (33.3%), PIH (11.6%), DM (8.33%), Pre Eclampsia (3.33%), Pre-term labor (1.6%) and convulsions (1.66%). Majority of mothers were alive without complications (60%), whereas less percentage alive with complications (40%). Majority of baby's were alive with complications (60%), whereas (26%) alive without complications and less percentage death (1.4%).

In association of early registration with outcome of pregnancy the Chi Square is 5.5319, P value is 0018673 which is significant at p < 0.05. Thus explains that early registration reflects healthy (good) outcome of pregnancy.

In association of delayed registration with outcome of pregnancy the Chi Square is 23.5558, P value is 1E-06 ("E" represents "times ten raised to the power") which is significant at p < 0.05. Thus explains that delayed registration reflects unhealthy (bad) outcome of pregnancy.

In association of early and delayed antenatal registration with maternal outcome the Chi Square is 18.541, P value is 1.7E-05 ("E" represents "times ten raised to the power"). The result is significant at p < 0.05. Suggest that there is an significant association of early and delayed antenatal registration with maternal outcome.

In association of early and delayed antenatal registration with fetal outcome the Chi Square is 40.1053, P value is 0. Result is significant at p < 0.05. Thus it means that there is an significant association of early and delayed antenatal registration with fetal outcome.

CONCLUSION: To conclude with the help of above findings this study provides us with evidence that early ANC registration have less complication in the outcome of pregnancy than the delayed registration. Thus importance should be given be given to delayed registration of cases, with identification of risk factors or complications and prompt treatment is necessary. Preconceptional counseling is an important aspect which must be emphasized as she is the future mother who needs to prepare herself for pregnancy to ensure a safe motherhood.

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