Maternal characteristics and birth outcomes resulting from births before arrival at health facilities in Nkangala District, South Africa: a case control study

Abstract

BackgroundRisks of severe, avoidable maternal and neonatal complications at birth are increased if the birth occurs before arrival at the health facility and in the absence of skilled birth attendants. Birth Before Arrival (BBA) is a preventable phenomenon still common in modern-day practice despite extensive improvements made in obstetric care and in accessibility to healthcare in South Africa. This study aimed to determine the risk factors and outcomes in mothers and babies associated with being born before arrival at hospitals.MethodsA prospective case control study design was conducted. All BBAs presenting to the hospitals in Nkangala District between November 2015 and February 2016 were included and compared to a consecutive hospital delivery occurring immediately after the arrival of each BBA. T-tests and chi square tests were used to analyse the differences between the groups and a binary logistic regression analysis used to determine predictors of BBAs. All statistical analysis were done using STATA version 14 using a 5% decision level and a 95% confidence interval.ResultsDuring the study period, 4397 in-facility births and 201 BBAs were recorded, 78 BBAs and 75 controls were investigated in this study. The district BBA prevalence was 4.6%. Risk factors identified in mothers of BBAs were: single mothers (83.3% vs 69.3%; p = 0.04); residing in an informal settlement (23.1% vs 5.3%; p = 0.002); and higher gravidity with plurigravida significantly more (60.3% vs 32.5%; p < 0.0001). A prevalent maternal complication in cases was haemorrhage due to retained placenta. Most neonates were born alive with a higher proportion of cases experiencing perinatal complications such as respiratory distress, hypothermia and asphyxia. No significant differences in maternal age, employment status and immediate birth outcomes were found. Residing in informal settlements, higher gravidity, unplanned pregnancy, low birth weight and unbooked were found to predict the occurrence of BBAs.ConclusionAlthough no significant numbers of mortalities were recorded in this study, service delivery interventions targeting the reduction of BBAs are needed so as to minimise the morbidity experienced by the group.

Risk of infection in neonates born in accidental out-of-hospital deliveries

“…Over the study period, the incidence of OHD in this study was 0.22%, which is similar to that reported in other studies ( Table 4 ), and our findings were in line with previous studies of accidental OHDs [ 1 – 8 , 11 ]. OHDs have been reported to be associated with the risk of prematurity [ 1 – 3 , 25 ].…”

“…Multiparous mothers and lack of prenatal care were also related to OHDs in previous reports [ 1 – 5 , 9 ]. Furthermore, OHDs may cause high neonatal mortality and morbidity, especially in developing countries and areas short of medical assistance [ 11 ]. Prompt intervention and care may be required for all OHD neonates to improve outcomes.…”

Factors Associated with Born Before Arrival and Birth Outcome among Postnatal Women Attending Irchagadera Hospital, Garissa County, Kenya

“…46.0% of BBA mothers had abnormal mode of previous delivery compared with 19.4% of hospital delivered mothers. The findings are consistent with studies which found previous history of precipitate delivery, BBA and preterm birth puts a woman at risk of BBA [3,8]. The study established significant statistical tal birth outcome.…”

“…Slightly more than half (54.1%) of BBA mothers were unemployed compared with 45.9% of hospital delivered mothers. The findings are consistent with study conducted in South Africa which found occupation not a risk factor for BBA [3]. The findings are inconsistent with study conducted in Coast general hospital which found occupation (being house wife) to be a risk factor for BBA [13].…”

“…The rate of BBAs serves as an index of accessibility to perinatal care; a rate greater than 1.5% signals challenges in health care provision. If such a rate exists, further investigations and appropriate interventions are merited [3]. pital, Garissa County.…”