http://doi.org/10.33698/NRF0192 – Anukiranjit Kaur, Manpreet Kaur, Rajwant Kaur
Abstract : Pregnancy is the vital event in the life of a woman. It needs special attention from the time of conception to the postnatal stage. Preparing for the childbirth is one of the most exciting times for a woman. The present study was aimed to determine the extent of birth preparedness and to find out the association of birth preparedness among antenatal mothers with selected demographic variables. An exploratory study was carried out among antenatal mothers residing at selected villages of Amritsar, Punjab. Data was collected from 100 antenatal mothers by convenient sampling technique. Birth preparedness interview schedule was adopted. Out of 100 antenatal mothers 69% had poor extent of birth preparedness followed by 31% had average birth preparedness. Majority (90%) of antenatal mothers had identified the place of delivery, 83% had identified the skilled birth attendant, 69% had arranged the transportation for delivery, 35% had saved money for delivery and only 10% had arranged the blood donor in case of an emergency. Seventy five percent, forty nine percent and forty one percent antenatal mothers knew £ 3 danger signs during pregnancy, childbirth and first two days after birth respectively and sixty six percent antenatal mothers knew £ 3 danger signs during the first seven days after birth that could endanger the life of new-born. Factors which showed significant association on birth preparedness was age, education, socio economic status and trimester at (p<0.05). It concluded that age, education, socio economic status and trimester resulted in better birth preparedness in the present study.
Keywords
Birth preparedness, Antenatal mothers, Danger signs, Amritsar.
Correspondence at
Anukiranjit Kaur
Clinical Instructor
Khalsa College of Nursing Amritsar (Punjab)
Introduction
Pregnancy is the time period between conceptions to birth. Pregnancy is a normal process that results in a series of both physiological and psychological changes in expectant mothers.1 Pregnancy is natural but it does not mean it is problem free.2 Most women get through pregnancy and giving birth without any major health problems. Sometimes, however, a few experience complications that threaten the health of both mother and baby.1
World Health Organization (WHO) estimated that 500,000-600,000 women die annually from maternal causes and out of these 99% deaths are occurring in the of birth preparedness and knowledge about danger signs of pregnancy. Complications can arise suddenly and cause immediate harm if there is no appropriate medical care developing countries.3 According to the and treatment. Therefore understanding
United Nations International Children’s Emergency Fund (UNICEF) that in India, every year about 78,000 mothers die during childbirth and from complications of pregnancy. It is mainly due to large number of deliveries conducted at home by untrained persons, lack of adequate referral facilities to provide emergency obstetric care for complicated cases and it contribute to high maternal morbidity and mortality.4
In developing countries where maternal mortality is high and distance and lack of transportation are the main barriers to seek the health facilities. So activities to improve birth preparedness and recognizing the complications at household and community levels to improve maternal survival.3 Birth Preparedness and Complication Readiness (BPACR) is the process of planning for normal birth and anticipating the actions needed in case of an emergency, Birth preparedness is a strategy to promote the timely use of skilled maternal care, especially during childbirth, based on the theory that preparing for childbirth reduces delays in obtaining this care. A birth plan/emergency preparedness plan includes identification of the following elements: identifying a skilled birth attendant; identifying the location of the closest appropriate care facility; funds for birth-related and emergency expenses; transport to a health facility for the birth and obstetric emergency; and identification of compatible blood donors in case of emergency.5,6
Literature revealed that a large population of the antenatal mothers had poor knowledge regarding various aspects early warning signs and actions to take when complications occur are crucial steps to reduce maternal and newborn morbidity and mortality. Knowledge of danger signs will improve women’s awareness when they need to seek health services. Knowledge and awareness of danger signs can increase women’s confidence and willingness to seek care. It can alert people to take immediate and appropriate actions for preventing and minimizing the development of complications. From the above discussion it is clear that birth preparedness is essential for improving health of mother and child. Hence nurses & health care professionals working in community should continue working in this direction. To start with it is important to assess the level of birth preparedness in the given community so that health education programmes can be planned based on that. Keeping it in mind the present study was conducted.
Objectives
- To determine the extent of birth preparedness among antenatal
- To find out the association of birth preparedness among antenatal mothers with selected demographic
Methodology
Resear ch Design was non experimental exploratory survey design and was conducted at the selected villages under the jurisdiction of Rural Health Centre, Mallunangal, field practice area of Shri Guru Ram Dass Institute of Medical Sciences & Research (SGRDIMSR), Vallah, Amritsar.
Before conducting the study, ethical clearance was obtained from Head of the Community Medicine Department of SGRDIMSR, Vallah, Amritsar.
The study was conducted among antenatal mothers residing under the jurisdiction of Rural Health Centre, Mallunangal, field practice area of SGRDIMSR, Vallah, Amritsar and who were accessible and willing to participate were selected for the present study. 100 antenatal mothers were selected as sample by non probability convenient sampling technique. The period of data collection was planned from January 2014 to February 2014.
Birth preparedness interview schedule was adopted to collect information regarding birth preparedness, which was developed based on extensive review expert guidance and validated by experts in the field of Community Health Nursing, Obstetric and Gynaecological Nursing, Community Medicine and Obstetrics and Gynaecology. The tool was consisted of three parts. The first part consisted of socio demographic profile like the age, education, religion, occupation, type of family and socio economic status. The second part is the obstetric history like last menstrual period, antenatal visits, parity and trimester. The third part Birth Preparedness interview schedule was consisted 15 items and 44 statements like place of delivery, skilled birth attendant/person, transport, money, blood donor and knowledge of danger signs during pregnancy, childbirth, after childbirth and in a new-born.
The criterion measure used in the study was extent of score on birth preparedness. Maximum obtainable score was 44 and divided into three levels like indicating preparation not made zero mark was awarded. The investigator herself conducted the interview at their households itself. Women were made comfortable and interview was conducted in separate room of house. Average time was taken 30 minutes. The data was analyzed by using descriptive and inferential statistics through frequencies, percentages, ANOVA test and t test.
Results
Socio Demographic Profile of Antenatal Mothers
More than half (55%) of antenatal mothers were in age group 21 -25 years. Mean age of the antenatal mothers were 23.46±3.27 years. As per education, nearly one fourth (23%) of the antenatal mothers were in the category of primary school and high school each whereas 18% of antenatal mothers were illiterate. Majority of (97%) antenatal mothers were Sikhs, 86% were housewives and 88% were from joint families. As per socio economic status, 53% antenatal mothers were in the lower/upper lower class.
Table 1 shows the extent of birth preparedness among antenatal mothers. Nearly 70% antenatal mothers had poor birth preparedness and only 31% mothers had average birth preparedness and none was found to be having good birth preparedness.
Figure 1 shows that the components of
Table 1: Extent of birth preparedness among antenatal mothers
N=100
Poor: 0-14, Average: 15-28, Good: ≥ 29.
Scores were based on preparation made for each statement listed in interview schedule, one mark was given for response indicating preparation made and for response
Mean±SD 11.99±5.91, Obtainable range 0-44, Range of obtained score 1-27 birth preparedness among antenatal mothers. Regarding place of delivery, majority (90%) of antenatal mothers had planned for the place of delivery. As per skilled birth attendant, 83% antenatal mothers had made arrangement for availability of skilled birth attendant during delivery. Regarding transportation more than half (69%) antenatal mothers had planned transportation to reach the health facility for delivery. Thirty five percent antenatal mothers had saved money for their delivery whereas only 10% antenatal mothers had arranged blood donor for any emergency during delivery.
Figure 1: Components of birth preparedness among antenatal mothers
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Table: 2 Number of danger signs reported by antenatal mothers
Table 2 depicts the knowledge regarding number of danger signs among antenatal mothers during pregnancy, childbirth, first two days after birth and during the first seven days after birth in newborn. Out of 71 antenatal mothers 75% knew less than three or three danger signs and 25% know more than three danger signs during pregnancy. All antenatal mothers knew less than three or three danger signs during childbirth. All antenatal mothers (100%) knew less than three or three danger signs during the first two days after birth and out of 71 antenatal mothers, 92.96% knew less than three or three danger signs and 7.04% antenatal mothers had knowledge more than three danger signs during the first seven days among newborn
Table 3 depicts the birth preparedness of subjects in different aspects. Most of them (90%) had heard about birth preparedness but only 69% had made arrangement for delivery. It was rather disturbing that 88% of them registered the pregnancy of 12% mother did not even registered their pregnancy. Though 90% of antenatal mothers identified the place of delivery and 83% identified the skilled birth attendant. Only 69% arranged for transportation though 73% planned to have someone to look after her health during & after childbirth. Very few have arranged money for delivery (35%) and blood donor (10%) for obstetric emergencies.
It is important to know warning signs of mother & baby during after birth. The awareness about warning signs during pregnancy & during first seven days of child birth were reported by 71% mothers only. They did not know all warning signs. Awareness of warning signs during child birth & first two days after child birth was reported by less than half of antenatal mothers.
Table 3 shows that as per age the antenatal mothers with age group £ 20 years birth preparedness mean score was 8.70 followed by 12.31 in age group 21-25 years whereas in age group 26-30 years, birth preparedness mean score increased upto 14.43, but the mean score declined to 8 for S 30 years age group. F value was 4.07 and it was found statistically significant (p<0.05) indicating that women in age group of 21-30 years were better prepared for birth as compared to younger & older age women.
Findings depicts that with increase in qualification birth preparedness mean score also increases. Birth preparedness mean score was 19.56 in graduate/above and 17.50 in antenatal mothers had post high school education followed by 8.61 who were illiterate. Hence, it was concluded that the antenatal mothers who were highly educated were better prepared than less educated. (F=9.04, p <0.05)
As per socio economic status, findings revealed that antenatal mothers who belonged to upper middle class, mean birth preparedness score was 14.75, but birth preparedness mean score increased in middle/lower middle class 16.62 and further birth preparedness mean score decreased in lower/upper lower and lower class 10.42 and 10.86 respectively. This indicate that women in middle/lower middle class were significantly better prepared as compared to other social class women (F=7.23, p<0.05)
As per trimester, findings revealed that antenatal mothers having high birth preparedness mean score 14.09 who were in third trimester. The mean score was comparatively low in second trimester (11.56) and it was further low (9.70) in first trimester indicates that level of birth preparedness significantly increases with the advancement of pregnancy (F=4.23, p<0.05)
Discussion
In many societies in the world, cultural beliefs and lack of awareness inhibit preparation in advance for delivery and expected baby. The majority of pregnant women do not know how to recognize the danger signs of complication. When complications occur, the unprepared antenatal mother and their family wastes a great deal of time in recognizing problem, getting organized, getting money, finding transport and reaching the appropriate health facility.
Birth Preparedness is considered by the world community as an important strategy to avert maternal and perinatal deaths. The concept of birth preparedness is
Table 3: Birth preparedness of subject on different aspects
N=100
| Sr. Items No. | Correct responses (f) |
| 1. Heard the term birth preparedness | 90 |
| 2. Arrangements for the birth | 69 |
| 3. Registered your pregnancy | 88 |
| 4. Speak with anyone outside of a health facility about where you should give birth to your baby | 83 |
| 5. Identified the place of delivery | 90 |
| 6. Identified the transportation for going to the health facility for delivery | 69 |
| 7. Knew the time it will take to reach the health facility for delivery | 57 |
| 8. Identified the skilled birth attendant | 83 |
| 9. Saved money for your delivery | 35 |
| 10. Arranged blood donor for any obstetrical emergency | 10 |
| 11. After child birth, planned to have someone to look after your health | 73 |
| 12. Knew about warning signs during pregnancy | 71 |
| 12(1) Severe abdominal pain | 55 |
| 12(2) Vaginal bleeding | 35 |
| 12(3) Water breaks without labour | 32 |
| 12(4) Reduced fetal movement | 22 |
| 12(5) Swollen hands/face | 15 |
| 12(6) Difficulty in breathing | 10 |
| 12(7) Convulsions | 7 |
| 12(8) Loss of consciousness | 1 |
| 12(9) Others* | 45 |
| 13. Knew about warning signs during childbirth | 49 |
| 13(1) Labor lasting > 12 hours | 41 |
| 13(2) Severe bleeding | 21 |
| 13(3) Severe headache | 12 |
| 13(4) Placenta not delivered 30 minutes after birth of baby | 3 |
| 13(5) Convulsions | 1 |
| 13(6) Other** | 4 |
| 14. Knew about warning signs during first two days after birth | 41 |
| 14(1) High fever | 31 |
| 14(2) Severe bleeding | 14 |
| 14(3) Foul smelly vaginal discharge | 5 |
| 14(4) Convulsions | 1 |
| 14(5) Loss of consciousness | 1 |
| 14(6) Others*** | 16 |
| 15. Knew about warning signs during the first seven days after child birth | 71 |
| and could endanger the life of a newborn baby | |
| 15(1) Severe jaundice | 62 |
| 15(2) Poor sucking or feeding | 38 |
| 15(3) Difficulty or fast breathing | 14 |
| 15(4) Red or swollen eyes with pus | 13 |
| 15(5) Lethargy / unconsciousness | 10 |
| 15(6) Skin lesions or blisters | 9 |
| 15(7) Pus, bleeding or discharge around umbilical cord | 3 |
| 15(8) Others**** | 59 |
* Anaemia, hypertension, hypotension, constipation, severe back pain, high grade fever
** Absence Labour Pains and Vomiting
***Severe abdominal pain, severe headache, hypotension, leucorrhoea and oedema
****Diarrhoea, fever, pneumonia, abdominal pain, constipation, vomiting
Table: 4 Association of birth preparedness among antenatal mothers
with demographic characteristics N=100
| Characteristics | Mean ±SD | df | F/t# Value | P Value | |
| Between Group | Within Group | ||||
| Age (in years) | |||||
| £20 | 8.70±5.19 | 3 | 96 | 4.07* | 0.009 |
| 21-25 | 12.31±5.22 | ||||
| 26-30 | 14.43±7.03 | ||||
| S30 | 8.00±1.41 | ||||
| Education | |||||
| Illiterate | 8.61±4.27 | 5 | 94 | 9.04* | <0.01 |
| Primary school | 9.74±4.02 | ||||
| Middle school | 10.84±5.44 | ||||
| High school | 12.96±6.06 | ||||
| Post high school | 17.50±5.80 | ||||
| Graduate or more | 19.56±3.4 | ||||
| Religion | |||||
| Sikh | 11.94±5.87 | 1 | 98 | 0.24NS | 0.62 |
| Christian | 13.67±8.62 | ||||
| Occupation | |||||
| Housewife | 11.42±5.673 | 3 | 96 | 1.98NS | 0.12 |
| Unskilled | 14.50±9.19 | ||||
| Skilled | 15.64±6.63 | ||||
| Professional | 16.00±0.00 | ||||
| Type of family | |||||
| Joint family | 11.86±6.12 | 98 | 3.22NS | 0.07 | |
| Nuclear family | 12.92±4.23 | ||||
| Socioeconomic status* | |||||
| Upper middle | 14.75±7.45 | 3 | 96 | 7.23* | 0.00 |
| Middle/lower Middle | 16.62±6.05 | ||||
| Lower/ upper lower | 10.42±4.99 | ||||
| LowerLower | 10.86±5.48 | ||||
| Trimester | |||||
| First | 9.70±5.45 | 2 | 97 | 4.23* | 0.01 |
| Second | 11.56±5.80 | ||||
| Third ˂ | 14.09±5.82 |
˃ |
*Significant p 0.05 NS: Not Significant p 0.05*Kuppuswamy’s scale # t test used for only two categories yet to spread its root in Indian socio- cultural settings. Birth preparedness and complication readiness is the process of planning for normal birth and anticipating the actions needed in case of an emergency. Components of birth preparedness include place of delivery, skilled birth attendant, transportation, saving money and blood donor.
Both quantitative and qualitative surveys revealed that birth planning was a neglected issue. The present study was aimed to assess the extent of birth preparedness and knowledge of danger signs during antenatal, intranatal, postnatal and in newborn among antenatal mothers. The present study showed that antenatal mothers had poor birth preparedness. Similar another study conducted by Nawal D, Goli S in 20118 at Nepal, reported that 70% women did not have any preparation for delivery.
Majority of the antenatal mothers had identified the place of delivery ahead of childbirth. Place of delivery identification is very important especially in rural area settings.These results are similar to those transportation. This plan is important as one of the factors leading to maternal death has been identified as delay in reaching the health facility. A similar finding was obtained in a study Kushwal SS etal10 (2008) at Rewa district Madhya Pradesh. Whereas contradictory result was reported by Hailu Metal5 (2011) at Southern Ethiopia i.e only 7.7% antenatal mothers had identified the transportation for delivery.
In rural setting where blood bank services are nonexistent or inadequate, the prior identification of a donor cannot be over emphasized. More so in rural area where pregnant women suffer from anaemia, the risk of bleeding, especially postpartum is higher than the developed world. In the present study arranged blood donor for any obstetrical emergency was very low. The study was supported by Hailu M etal5 (2011) at Southern Ethopia reported that there were only 2.3% of antenatal mothers had arranged the blood donor prior to the onset of labour and compared to a study in Kenya (2006) by Mutiso S M11 which was 28.7%. The practice of saving money for any obstetric emergency / delivery was in this reportedby Pembe AB etal8 in 2012 at study, as was same reported by another
Tanzania 97.2% of antenatal mothers had identified the place of delivery.
Results indicate that majority of the antenatal mothers had planned for skilled birth attendants Similar findings were reported by Kumar P9 at Uttar Pradesh 76% antenatal mothers had identified the skilled birth attendant for delivery. Delay in seeking care from skilled birth attendants to manage obstetric complications when they occur thereby leading to maternal and neonatal morbidity and mortality.
More than half of the antenatal mothers had planned for arranging author Hiluf M etal12 (2006) at North Ethiopia reported 35.6% of antenatal mothers had saved money for her delivery and any obstetrical emergency.
Knowledge of danger signs is essential to motivating to seek skilled attendance at birth and prompt referral when complications may arise. Overall, result show that knowledge about danger signs was less than half, especially regarding danger signs during childbirth and first two days after childbirth. Knowledge of the danger signs of obstetric complications is an essential step in recognition of complications and could enable women take appropriate action to access emergency care.13
The results that antenatal mothers could identify at least three danger signs but some identified during pregnancy and in newborn more than three danger signs agree with those reported in Ethiopia14 A study by Pembe AB etal8 depict that there was significant association of age and education with birth preparedness. Another study by Goli S, Nawal Detal7 (2013) result shows that there was a significant association of wealth status with birth preparedness. The present study also revealed that there was significant association of birth preparedness with the age, education, socio economic status and duration of pregnancy.
It is concluded that the extent of birth preparedness was poor in the study area, with gaps identified as the need for antenatal mothers to make plans for place of delivery, skilled birth attendants, transportation, blood donors and save money for delivery or for any complications.
The present study will be implemented in various fields like nursing health personnel should have adequate knowledge and skill to educate women regarding birth preparation. A nurse educator plays a major role so they should plan and organize health teaching for them.Health personnel mainly working in antenatal clinic and in community set up, can play a very important role in promotion of health of pregnant women. ANM/Nurse should have adequate knowledge about antenatal, intranatal and postnatal preparation.Nursing administrators should plan in-service education programmes related to birth preparedness in rural areas.
Similar study can be conducted on a large sample size, in urban slums area, evaluate the effectiveness of planned teaching programme on birth preparedness among primigravida women. Other studies can be done to assess the practices and cultural belief regarding birth preparedness. Comparative study may be carried out between primigravida and multigravida for birth preparedness and it is also recommended to assess the knowledge of health providers regarding birth preparedness and complication readiness.
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