Home birth preference, childbirth, and newborn care practices in rural Peruvian Amazon

Abstract

Home birth is very common in the Peruvian Amazon. In rural areas of the Loreto region, home to indigenous populations such as the Kukama-Kukamiria, birth takes place at home constantly. This study aims to understand the preference for home births as well as childbirth and newborn care practices among Kukama-Kukamiria women in rural Loreto. Following a case study approach, sixty semi-structured, face-to-face interviews were conducted with recent mothers who experienced childbirth within one year prior to the interview, female relatives of recent mothers who had a role in childbirth, male relatives of recent mothers, community health workers, and traditional healers. We found that for women from these communities, home birth is a courageous act and an intimate (i.e. members of the community and relatives participate in it) and inexpensive practice in comparison with institutional birth. These preferences are also linked to experiences of mistreatment at health facilities, lack of cultural adaptation of birthing services, and access barriers to them. Preparations for home births included handwashing and cleaning delivery surfaces. After birth, waiting for the godparent to arrive to cut the cord can delay drying of the newborn. Discarding of colostrum, lack of skin-to-skin contact as well as a range of responses regarding immediate breastfeeding and immediate drying of the baby were also found. These findings were used to tailor the educational content of the Mamas del Rio program, where community health workers are trained to identify pregnancy early, perform home visits to pregnant women and newborns, and promote essential newborn care practices in case institutional birth is not desired or feasible. We make recommendations to improve Peru’s cultural adaptation of birthing services.

Factors associated with home birth in Peru: An analysis of the Demographic and Health Survey, 2019

“…On the other hand, the present study showed that women living in rural areas are more likely to have home births, which is consistent with a recent systematic review (24). One possible explanation lies in the fact that pregnant women in rural areas feel fear that their privacy and traditions are not going to be respected in health facilities, and some indicated that they were afraid of being victims of abuse by health professionals (25)(26)(27), which highlights the marked gap between the rural population and health care.…”

“…It should be noted that these regions are characterized by sociodemographic hurdle, which leads to the inaccessibility of health services (20)(21)(22). According to many authors, other reasons why women in the Peruvian Amazon prefer to have a home birth is the cultural pattern and the lack of cohesiveness with health facilities (23), which is why it is suggested to continue promoting the adequacy of intercultural delivery.…”

Innovaciones sociales para mejorar la salud

“…para los controles prenatales, partos y emergencias. Además, notaron que ni la morbilidad ni la mortalidad se reflejaban adecuadamente en los registros oficiales; como si las personas no existieran (8,10).…”

“…En el 2015, investigadores de la Universidad Peruana Cayetano Heredia visitaron el río Marañón en la Amazonía peruana, una de las regiones con los peores indicadores de salud materna y neonatal 10 . Junto con la Dirección Regional de Salud (DIRESA) de Loreto, visitaron 13 comunidades en el distrito de Parinari.…”

“…Se ganaron la confianza de las comunidades y aprendieron de la gran prevalencia de partos domiciliarios atendidos sin personal entrenado, y del pobre acceso a la atención de salud de calidad para los controles prenatales, partos y emergencias. Además, notaron que ni la morbilidad ni la mortalidad se reflejaban adecuadamente en los registros oficiales; como si las personas no existieran 8 , 10 .…”