Perceptions of isolation during facility births in Haiti - a qualitative study

Abstract

BackgroundHaiti’s maternal mortality, stillbirth, and neonatal mortality rates are the highest in Latin America and the Caribbean. Despite inherent risks, the majority of women still deliver at home without supervision from a skilled birth attendant. The purpose of this study was to elucidate factors driving this decision.MethodsWe conducted six focus group discussions with women living in urban (N = 14) or rural (N = 17) areas and asked them questions pertaining to their reasons for delivering at a facility or at home, perceptions of staff at the health facility, experiences with or knowledge of facility or home deliveries, and prior pregnancy experiences (if relevant). We also included currently pregnant women to learn about their plans for delivery, if any.ResultsAll of the women interviewed acknowledged similar perceived benefits of a facility birth, which were a reduced risk of complications during pregnancy and access to emergency care. However, many women also reported unfavorable birthing experiences at facilities. We identified four key thematic concerns that underpinned women’s negative assessments of a facility birth: being left alone, feeling ignored, being subject to physical immobility, and lack of compassionate touch/care. Taken together, these concerns articulated an overarching sense of what we term “isolation,” which encompasses feelings of being isolated in the hospital during delivery.ConclusionAlthough Haitian women recognized that a facility was a safer place for birthing than the home, an overarching stigma of patient neglect and isolation in facilities was a major determining factor in choosing to deliver at home. The Haitian maternal mortality rate is high and will not be lowered if women continue to feel that they will not receive comfort and compassionate touch/care at a facility compared to their experience of delivering with traditional birth attendants at home. Based on these results, we recommend that all secondary and tertiary facilities offering labor and delivery services develop patient support programs, where women are better supported from admission through the labor and delivery process, including but not limited to improvements in communication, privacy, companionship (if deemed safe), respectful care, attention to pain during vaginal exams, and choice of birth position.

Factors influencing the place of delivery in the rural region of Labrousse, Hati

“…Women who have had more than 5 prenatal visits, whether regular or not, most often give birth in healthcare facility (OR=3.32; p=0.009; 95% CI) (Tab -------------0.00 0.00 0.02 0.00 0.00 ------------- show that, on the contrary, older women are more likely to give birth at home, unlike younger women who give birth in hospital [8]. The marital status of women does not influence the choice of delivery place (p=0.75 at home; p=0.30 at healthcare facility) which corroborates the findings of other studies [7], [8]. The number of pregnancies and / or previous deliveries has no effect on the place of delivery; Primiparous, multiparous and grand multiparas give birth both in hospital and at home.…”

“…Thus we were able to find that in the tertiary sector of activity, the probability for these women to give birth at home was lower compared to other sectors of economic activity; it positively influences childbirth in hospital (OR = 1.32, p= 0.004). studies have shown that women's economic health quintile plays a role in the birthplace [7,8]. n this study, women are more likely to give birth at home if they are far from the health center, and this risk increases even more if there is no transport available.…”

Barriers and facilitators influencing facility-based childbirth in rural Haiti: a mixed method study with a convergent design

“…These same themes have been reported in Haiti and in sub-Saharan Africa. 28 29 Together, these findings point to the possibility that the presence of the matron in the delivery room alongside midwives may facilitate increased comfort and support for women and discourage the mistreatment of women in pain. Midwives could also serve as a resource on biomedical approaches for matrons, thus mitigating the potential for harms related to traditional birth practices.…”

Measuring women's experiences of childbirth using the Birth Satisfaction Scale-Revised (BSS-R)

“…For example, women place value upon being listened to and being placed at the centre of decision-making processes (Heatley et al 2015;Mei et al 2015;Miron-Shatz and Konheim-Kalkstein 2020). Quality and amount of support provided by midwives and allied health care professionals plays a vital role in level of 'birth satisfaction' reported (Luegmair et al 2018;Dev et al 2019;Miron-Shatz and Konheim-Kalkstein 2020), with women testifying that they feel more positive about their birth experience when their needs and comforts are considered (Luegmair et al 2018;Hall et al 2020).…”