A qualitative exploration of women’s experiences of antenatal and intrapartum care: The need for a woman-centred approach in the Peruvian Amazon

Abstract

ObjectiveTo explore women’s experiences and perceptions of antenatal and intrapartum care in the Peruvian Amazon, including their perceived motivators, enablers and barriers to accessing care.DesignInterpretive descriptive qualitative study using semi-structured face-to-face interviews.SettingPrimary healthcare centre, Iquitos, Peru.ParticipantsWomen (n = 20) attending the healthcare centre who had given birth in the past 6 months.MeasuresInterviews were conducted using a female interpreter, transcribed clean verbatim and thematically analysed.FindingsFour core themes relating to antenatal care were interpreted. (1) Perceived knowledge of antenatal care and its importance: women generally understood the importance of care, mainly for their baby’s health rather than their own. (2) Appointments and information received: women wanted more appointments to facilitate greater depth of information relating to their pregnancy. (3) Interaction with healthcare practitioners: women felt they received inadequate attention, care lacked continuity and they were often uncomfortable with male practitioners. (4) Perceived motivators, barriers and enablers to accessing antenatal care: Knowledge of the importance of care acted as the main motivator. Few direct barriers were identified, other than employment. Free care and ease of access enabled attendance. Two core themes were interpreted relating to intrapartum care. (1) Expectations and preferences for labour and delivery: the need for a safe environment for childbirth was acknowledged. (2) Actual experiences of labour and delivery: for most women labour and delivery experiences were not as they had expected. Women objected less to male professionals during labour than antenatal care.Conclusions and implications for practiceWomen reported negative experiences of both antenatal and intrapartum care. There is clearly a need for a more woman-centred approach to care and service provision. Ideally, this would involve employing more staff, acknowledging the implications on resources, improving attitudes towards women, facilitating continuity of care, and allowing patient choice to give women greater involvement.

The timing and quality of antenatal care received by women attending a primary care centre in Iquitos, Peru: A facility exit survey

“…In-keeping with findings from qualitative research in Iquitos, antenatal care providers must ensure that all women feel involved in decision making about their birth [23]. Women in this study also expressed a desire for more written information to take home, reflecting the perceptions of other women from Iquitos [23]. More written pregnancy-related information could be added to women's…”

“…The lower frequency of second-time services received out of routine appointments could be due to women not being able return to healthcare centres to independently seek these services. This could be due to childcare, employment or inconvenient opening hours, as previously demonstrated in qualitative studies investigating barriers to accessing ANC amongst Peruvian women [23,62]. Such services might be received more frequently if they were provided within routine appointments.…”

“…This was not explored as part of this study. The high proportion of women attending their recommended number of appointments for their gestational age may be due to free access [2,23,28]. As well as women missing appointments, the lower proportion of women attending according to the MoHP schedule could be due to delayed initiation of ANC, resulting in an absence of appointments in earlier gestational windows.…”

“…There is limited literature concerning women's perceptions about their ANC in Loreto. One qualitative study amongst twenty post-partum women in Iquitos found that some women were content with their care, whilst others reported that they wanted more information and appointments during their ANC [23].…”

Exploring women’s decisions of where to give birth in the Peruvian Amazon; why do women continue to give birth at home? A qualitative study

“…Marsland et al, conducted a study about women's perceptions of antenatal and IPC in Loreto; women reported free appointments facilitated antenatal care attendance and IPC was often poor, including discontinuity of care [35]. Westgard et al, also reported that women in rural Peru understood the importance of seeking obstetric care, particularly with complicated pregnancies [36].…”