“I Was Relieved to Know That My Baby Was Safe”: Women’s Attitudes and Perceptions on Using a New Electronic Fetal Heart Rate Monitor during Labor in Tanzania
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Collection
2.2. Recruitment of Participants and Ethics
2.3. Study Setting
2.4. Data Analysis
3. Results
3.1. Demographic Characteristics
3.2. Categories
3.2.1. Understanding Moyo’s Purpose and Functions
I would like if they could turn the device around so I am able to see and know what’s going on, also if they could give us more information about the meaning of colors and what to do if anything ever happens.Hospital 1#3
In my mind I was thinking maybe if the device did not produce any sound my baby was no longer alive. So from time to time I pulled the straps of the device and waited for the sound.Hospital 2#20
3.2.2. Feeling the Device Had a Positive Effect on the Delivery
Previously when pushing the baby after some time the baby returned inside the womb and I had to push again and again. But this time with the device when pushing the baby did not return inside because there were no room for returning, the device had occupied the remaining space.Hospital 2#16
A high number of women lost their babies but now when the labor pains start when you attempt to push, the baby arrives with little hustle not like in the past when you would be in labor for six to eight hours.Hospital 1#7
3.2.3. Feeling Good Knowing the Baby Was Safe
I lost a child 2 years ago—they found out that one of the babies I carried died and I only found out after I gave birth to the other baby.Hospital 2#13
I: Did you feel anything different?R: Yes, I felt the difference, the difference is this time I could see how my baby was progressing while I was going through labor, the device gave me hope that the baby was ok.Hospital 1#9
I was relieved to know that my baby was safe.Hospital 2#7
3.2.4. Receiving Close Care
Respondent: even though the midwife was away she was able to hear.Interviewer: she listening when away?Respondent: Yes.Hospital 2#7
I think there’s more care and attention given when Moyo device was used, they’d attach it from the beginning until you give birth and they’d monitor it in between whereas with Pinard, they’d only monitor once in a while—when you are first admitted and when you are giving birth.Hospital 1#8
I: So how did you feel when you saw that your baby was ok?R: I felt more confident... there was also a lot of cooperation around, compared to the first device (Pinard).I: Why was there no cooperation when the first device was used?R: Because only a doctor/nurse could hear.Hospital 2#11
3.2.5. Suggestions for Improvements
I would suggest that the patient is educated about the device before coming into the labor ward, we are often in so much pain when we enter the (labor) ward, so it’s not easy to listen and take everything in, some may refuse to wear the device because they are worried or in doubt and don’t want to add more pain, so it’s best that patients are told about the device before they enter the ward.Hospital 1#8
4. Discussion
Strengths and Limitations
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
Appendix A
References
- Wang, H.; Liddell, C.A.; Coates, M.M.; Mooney, M.D.; Levitz, C.E.; Schumacher, A.E.; Apfel, H.; Iannarone, M.; Phillips, B.; Lofgren, K.T.; et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: A systematic analysis for the global burden of disease study 2013. Lancet 2014, 384, 957–979. [Google Scholar] [CrossRef]
- Ersdal, H.L.; Mduma, E.; Svensen, E.; Perlman, J. Birth asphyxia: A major cause of early neonatal mortality in a Tanzanian rural hospital. Pediatrics 2012, 129, e1238–e1243. [Google Scholar] [CrossRef] [PubMed]
- Lawn, J.; Shibuya, K.; Stein, C. No cry at birth: Global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bull. World Health Organ. 2005, 83, 409–417. [Google Scholar] [PubMed]
- Lawn, J.E.; Kinney, M.; Lee, A.C.; Chopra, M.; Donnay, F.; Paul, V.K.; Bhutta, Z.A.; Bateman, M.; Darmstadt, G.L. Reducing intrapartum-related deaths and disability: Can the health system deliver? Int. J. Gynaecol. Obstet. 2009, 107 (Suppl. 1), S123–S140. [Google Scholar] [CrossRef] [PubMed]
- Cousens, S.; Blencowe, H.; Stanton, C.; Chou, D.; Ahmed, S.; Steinhardt, L.; Creanga, A.A.; Tuncalp, O.; Balsara, Z.P.; Gupta, S.; et al. National, regional, and worldwide estimates of stillbirth rates in 2009 with trends since 1995: A systematic analysis. Lancet 2011, 377, 1319–1330. [Google Scholar] [CrossRef]
- Kumar, S.; Kumar, N.; Vivekadhish, S. Millennium Development Goals (MDGs) to Sustainable Sevelopment Goals (SDGs): Addressing unfinished agenda and strengthening sustainable development and partnership. Indian J. Community Med. 2016, 41, 1–4. [Google Scholar] [CrossRef] [PubMed]
- United Nations Inter-agency Group for Child Mortality. Levels and Trends in Child Mortality Report 2017; United Nations International Children’s Emergency Fund: New York, NY, USA, 2017. [Google Scholar]
- Kidanto, H.L.; Mogren, I.; van Roosmalen, J.; Thomas, A.N.; Massawe, S.N.; Nystrom, L.; Lindmark, G. Introduction of a qualitative perinatal audit at muhimbili national hospital, Dar es Salaam, Tanzania. BMC Pregnancy Childbirth 2009, 9, 45. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lewis, D.; Downe, S.; Panel, F.I.F.M.E.C. Figo consensus guidelines on intrapartum fetal monitoring: Intermittent auscultation. Int. J. Gynaecol. Obstet. 2015, 131, 9–12. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- World Health Organization. World Health Organization Partograph in Management of Labour, World Health Organization Maternal Health and Safe Motherhood Programme; World Health Organization: Geneva, Switzerland, 1994. [Google Scholar]
- Wyatt, J. Appropriate medical technology for perinatal care in low-resource countries. Ann. Trop. Paediatr. 2008, 28, 243–251. [Google Scholar] [CrossRef] [PubMed]
- Wrammert, J.; Clark, R.B.; Ewald, U.; Målqvist, M. Inadequate fetal heart rate monitoring and poor use of partogram associated with intrapartum stillbirth: A case-referent study in Nepal. BMC Pregnancy Childbirth 2016, 16, 233. [Google Scholar]
- Holden, R.J.; Karsh, B.T. The technology acceptance model: Its past and its future in health care. J. Biomed. Inf. 2010, 43, 159–172. [Google Scholar] [CrossRef] [PubMed]
- Moen, K.; Middelthon, A.-L. Qualitative research methods. In Research in Medical and Biological Sciences: From Planning and Preparation to Grant Application and Publication; Laake, P., Breien Benestad, H., Reino Olsen, B., Eds.; Academic Press: London, UK, 2015; pp. 321–378. [Google Scholar]
- Green, J.; Thorogood, N. Qualitative Methods for Health Research, 2nd ed.; SAGE: London, UK, 2009. [Google Scholar]
- Rickham, P.P. Human experimentation. Code of ethics of the world medical association, Declaration of Helsinki. Br. Med. J. 1964, 2, 177. [Google Scholar] [PubMed]
- Freedman, L.P.; Graham, W.J.; Brazier, E.; Smith, J.M.; Ensor, T.; Fauveau, V.; Themmen, E.; Currie, S.; Agarwal, K. Practical lessons from global safe motherhood initiatives: Time for a new focus on implementation. Lancet 2007, 370, 1383–1391. [Google Scholar] [CrossRef]
- Schreier, M. Qualitative Content Analysis in Practice: Margrit Schreier; SAGE: London, UK, 2012. [Google Scholar]
- Graneheim, U.H.; Lindgren, B.M.; Lundman, B. Methodological challenges in qualitative content analysis: A discussion paper. Nurse Educ. Today 2017, 56, 29–34. [Google Scholar] [CrossRef] [PubMed]
- Graneheim, U.H.; Lundman, B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Educ. Today 2004, 24, 105–112. [Google Scholar] [CrossRef] [PubMed]
- Tesfaye, R.; Worku, A.; Godana, W.; Lindtjorn, B. Client satisfaction with delivery care service and associated factors in the public health facilities of Gamo Gofa zone, Southwest Ethiopia: In a resource limited setting. Obstet. Gynecol. Int. 2016, 2016, 5798068. [Google Scholar] [CrossRef] [PubMed]
- Mbaruku, G.; Msambichaka, B.; Galea, S.; Rockers, P.C.; Kruk, M.E. Dissatisfaction with traditional birth attendants in rural Tanzania. Int. J. Gynaecol. Obstet. 2009, 107, 8–11. [Google Scholar] [CrossRef] [PubMed]
- Stal, K.B.; Pallangyo, P.; van Elteren, M.; van den Akker, T.; van Roosmalen, J.; Nyamtema, A. Women’s perceptions of the quality of emergency obstetric care in a referral hospital in rural Tanzania. Trop. Med. Int. Health 2015, 20, 934–940. [Google Scholar] [CrossRef] [PubMed]
- Kumbani, L.C.; Chirwa, E.; Malata, A.; Odland, J.O.; Bjune, G. Do Malawian women critically assess the quality of care? A qualitative study on women’s perceptions of perinatal care at a district hospital in Malawi. Reprod. Health 2012, 9, 30. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Solnes Miltenburg, A.; Lambermon, F.; Hamelink, C.; Meguid, T. Maternity care and human rights: What do women think? BMC Int. Health Hum. Rights 2016, 16, 17. [Google Scholar] [CrossRef] [PubMed]
- Thaddeus, S.; Maine, D. Too far to walk: Maternal mortality in context. Soc. Sci. Med. 1994, 38, 1091–1110. [Google Scholar] [CrossRef]
- Gabrysch, S.; Campbell, O.M. Still too far to walk: Literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 2009, 9, 34. [Google Scholar] [CrossRef] [PubMed]
- Tautz, S.; Jahn, A.; Molokomme, I.; Gorgen, R. Between fear and relief: How rural pregnant women experience foetal ultrasound in a Botswana district hospital. Soc. Sci. Med. 2000, 50, 689–701. [Google Scholar] [CrossRef]
- Raynor, D.K. Health literacy. BMJ 2012, 344, e2188. [Google Scholar] [CrossRef] [PubMed]
- Osman, H.M.; Egal, J.A.; Kiruja, J.; Osman, F.; Byrskog, U.; Erlandsson, K. Women’s experiences of stillbirth in somaliland: A phenomenological description. Sex Reprod. Health 2017, 11, 107–111. [Google Scholar] [CrossRef] [PubMed]
- Lailulo, Y.A.; Susuman, A.S.; Blignaut, R. Correlates of gender characteristics, health and empowerment of women in ethiopia. BMC Womens Health 2015, 15, 116. [Google Scholar] [CrossRef] [PubMed]
- Jennings, L.; Na, M.; Cherewick, M.; Hindin, M.; Mullany, B.; Ahmed, S. Women’s empowerment and male involvement in antenatal care: Analyses of demographic and health surveys (DHS) in selected African countries. BMC Pregnancy Childbirth 2014, 14, 297. [Google Scholar] [CrossRef] [PubMed]
- Adhikari, R.; Sawangdee, Y. Influence of women’s autonomy on infant mortality in Nepal. Reprod. Health 2011, 8, 7. [Google Scholar] [CrossRef] [PubMed]
- Georges, E. Fetal ultrasound imaging and the production of authoritative knowledge in Greece. Med. Anthropol. Q. 1996, 10, 157–175. [Google Scholar] [CrossRef] [PubMed]
- Newnham, E.C.; McKellar, L.V.; Pincombe, J.I. Documenting risk: A comparison of policy and information pamphlets for using epidural or water in labour. Women Birth 2015, 28, 221–227. [Google Scholar] [CrossRef] [PubMed]
- Leff, B.; Finucane, T.E. Gizmo idolatry. JAMA 2008, 299, 1830–1832. [Google Scholar] [CrossRef] [PubMed]
- Oluoch, D.A.; Mwangome, N.; Kemp, B.; Seale, A.C.; Koech, A.; Papageorghiou, A.T.; Berkley, J.A.; Kennedy, S.H.; Jones, C.O. “You cannot know if it’s a baby or not a baby”: Uptake, provision and perceptions of antenatal care and routine antenatal ultrasound scanning in rural Kenya. BMC Pregnancy Childbirth 2015, 15, 127. [Google Scholar] [CrossRef] [PubMed]
- Tancred, T.; Schellenberg, J.; Marchant, T. Using mixed methods to evaluate perceived quality of care in Southern Tanzania. Int. J. Qual. Health Care 2016, 28, 233–239. [Google Scholar] [CrossRef] [PubMed]
- Shekelle, P.G.; Wachter, R.M.; Pronovost, P.J.; Schoelles, K.; McDonald, K.M.; Dy, S.M.; Shojania, K.; Reston, J.; Berger, Z.; Johnsen, B.; et al. Making health care safer II: An updated critical analysis of the evidence for patient safety practices. Evid. Rep. Technol. Assess. (Full Rep.) 2013, 211, 1–945. [Google Scholar]
- Maxwell, J.A. Qualitative Research Design: An Interactive Approach; SAGE: London, UK, 2013; Volume 41. [Google Scholar]
- Dahlgren, L.; Emmelin, M.; Winkvist, A. Qualitative Methodology for International Public Health; Umeå International School of Public Health: Umeå, Sweden, 2007. [Google Scholar]
- Henriksen, L.; Grimsrud, E.; Schei, B.; Lukasse, M.; Bidens Study, G. Factors related to a negative birth experience–A mixed methods study. Midwifery 2017, 51, 33–39. [Google Scholar] [CrossRef] [PubMed]
- Bitew, K.; Ayichiluhm, M.; Yimam, K. Maternal satisfaction on delivery service and its associated factors among mothers who gave birth in public health facilities of Debre Markos town, northwest Ethiopia. BioMed Res. Int. 2015, 2015, 460767. [Google Scholar] [CrossRef] [PubMed]
Translated Transcribed Interview | Code | Category |
---|---|---|
I: Okay, great, so can you tell us if this device changed your birth experience compared to your previous deliveries where devices like Pinard were used? R: Yes, I saw the difference because this device allowed the nurse to be closer as opposed to previously where they’d walk around and monitor from afar, they would come to me more often too. | Feels that she received closer and more frequent attention from the nurse compared to previous deliveries due to the device. | Receiving close care 1 |
Variable | Sub-Groups | n (20) | % |
---|---|---|---|
Age | 20–29 | 6 | 30 |
30–40 | 13 | 65 | |
above 40 | 1 | 5 | |
Occupation | Run a small business | 7 | 35 |
Maid | 1 | 5 | |
Teacher | 2 | 10 | |
Stay at home | 5 | 25 | |
Farmer | 2 | 10 | |
Nurse | 1 | 5 | |
Entrepreneur | 1 | 5 | |
Business woman | 1 | 5 | |
Number of children | 1 | ||
2 | 6 | 30 | |
3 | 4 | 20 | |
4 | 8 | 40 | |
above 4 | 1 | 5 |
© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Rivenes Lafontan, S.; Sundby, J.; Ersdal, H.L.; Abeid, M.; Kidanto, H.L.; Mbekenga, C.K. “I Was Relieved to Know That My Baby Was Safe”: Women’s Attitudes and Perceptions on Using a New Electronic Fetal Heart Rate Monitor during Labor in Tanzania. Int. J. Environ. Res. Public Health 2018, 15, 302. https://doi.org/10.3390/ijerph15020302
Rivenes Lafontan S, Sundby J, Ersdal HL, Abeid M, Kidanto HL, Mbekenga CK. “I Was Relieved to Know That My Baby Was Safe”: Women’s Attitudes and Perceptions on Using a New Electronic Fetal Heart Rate Monitor during Labor in Tanzania. International Journal of Environmental Research and Public Health. 2018; 15(2):302. https://doi.org/10.3390/ijerph15020302
Chicago/Turabian StyleRivenes Lafontan, Sara, Johanne Sundby, Hege L. Ersdal, Muzdalifat Abeid, Hussein L. Kidanto, and Columba K. Mbekenga. 2018. "“I Was Relieved to Know That My Baby Was Safe”: Women’s Attitudes and Perceptions on Using a New Electronic Fetal Heart Rate Monitor during Labor in Tanzania" International Journal of Environmental Research and Public Health 15, no. 2: 302. https://doi.org/10.3390/ijerph15020302