A Qualitative Study to Explore the Barriers for Nonadherence to Referral to Hospital Births by Women with High-Risk Pregnancies in Nepal
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Study Settings
2.3. Sample and Recruitment Procedures
2.4. Data Generation
2.5. Data Analysis
2.6. Trustworthiness
3. Results
3.1. Characteristics of Participants
3.2. Barriers for Nonadherence
3.2.1. Preference for Homebirth
The Women’s Intention was to Give Birth at Home
My wish was to give birth at home, it’s better at home, if you go to the hospital, you have to endure some pain and if one givesing birth at home. I was happy if it [childbirth] was at home.(P0014)
Where to give birth? If you can give birth at home, then give birth at home, if you cannot, and then go to the hospital.(P003)
Trust in Healthcare Providers’ Word, Ultrasound and Medical Test Reports
In the ultrasound report, it stated that everything is fine, the baby is fine, and I was told that it would be fine …(P003)
Family Members were Decision-Makers; Pregnant Women Had a Passive Role in Decision Making
If she cannot give birth, she will be taken outside [birthing center], but there was only slight pain, so she stayed at home … Kept her [participant] at home during the night, the next day, when it was 10 am, the pain got intense. Then we called the ambulance took her to the birthing center.(P004 participant mother)
3.2.2. Lack of Women’s Autonomy and Financial Dependence
Fear of Hospital Environment, Past Negative Experiences, Privacy Issues, and Rumors
At the hospital, [laughs] I heard that they would tie the legs and hands [laughter]… And when one has normal birth, then also, they will cut a bit. Since then, I am afraid [laughter].(P0014)
Unfamiliar Place and Lack of Knowledge of the New Environment
Lack of Transportation, Poverty and Distance
Here, to give birth at the birthing center, there are no transportations. So, people here give birth at home because of the scarcity of transportation services.(P005)
There is an ambulance service, but if we sometimes summon an ambulance. They charge Rs. 1500 (≈14.3 USD).(P005)
3.2.3. Conditional Factors
Labor Pain Started at Night, Sudden Onset, and Short Labor
Just like while working [household chores], for a while, … there was slight pain at 1 am, I felt that I wouldn’t give birth tonight … as the night progressed then the pain intensified, … then at 9:10 am, the baby was born.(P0014)
I don’t know [laughs]. There won’t be anyone at home. I am usually alone, that’s why… Yes, family members are there, but I usually don’t talk with anyone.(P0013)
Labor Pain Ahead of the Expected Date of Birth
It was not yet the time of birth that time. The doctor gave few additional more days, and I forgot the exact menstrual period missing date.(P002)
3.2.4. Sociocultural Practices
Births Attended by the Traditional Birth Attendants and Consulting Spiritual Healers
At night, now nothing, mother-in-law heated some hot water and gave it to me to drink. The grandmother [traditional birth attendant] was there who used to come if there is labor pain at home for support in childbirth … but I could not give birth, that’s why I was taken there [birthing center].(P0012)
Role of Women Relatives
I was scared, and afterward, my mother-in-law told me that it is labor pain. The aunties here also asked what is happening, and I told them I am having this [explain her pain]; then they [aunties] told me it means you are having labor pain.(P0012)
4. Discussion
5. Strengths and Limitations
6. Conclusions
7. Recommendations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | n | (%) |
---|---|---|
Ethnicity Muslim Santhal Terai Madhesi Janajati Dalit | 5 4 2 2 1 | (35.8) (28.5) (14.3) (14.3) (7.1) |
Age (years) ≤18 19–24 25–29 30–34 | 8 4 1 1 | (57.1) (28.6) (7.1) (7.1) |
Marital status Married Unmarried | 11 3 | (78.6) (21.4) |
Type of family Joint Nuclear Extended | 10 3 1 | (71.4) (21.4) (7.1) |
Education None Primary Secondary Higher secondary | 3 7 3 1 | (21.4) (50.0) (21.4) (7.1) |
Occupation Housewife | 14 | (100) |
Husband occupation Labour work Sales Agriculture | 9 3 2 | (64.3) (21.4) (14.3) |
ANC * visits <4 ≥4 | 8 6 | (57.1) (42.9) |
Parity Primipara Multipara | 8 6 | (57.1) (42.9) |
Place of birth Homebirth Birthing centre | 9 5 | (64.3) (35.7) |
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Rajbanshi, S.; Norhayati, M.N.; Nik Hazlina, N.H. A Qualitative Study to Explore the Barriers for Nonadherence to Referral to Hospital Births by Women with High-Risk Pregnancies in Nepal. Int. J. Environ. Res. Public Health 2021, 18, 5801. https://doi.org/10.3390/ijerph18115801
Rajbanshi S, Norhayati MN, Nik Hazlina NH. A Qualitative Study to Explore the Barriers for Nonadherence to Referral to Hospital Births by Women with High-Risk Pregnancies in Nepal. International Journal of Environmental Research and Public Health. 2021; 18(11):5801. https://doi.org/10.3390/ijerph18115801
Chicago/Turabian StyleRajbanshi, Sushma, Mohd Noor Norhayati, and Nik Hussain Nik Hazlina. 2021. "A Qualitative Study to Explore the Barriers for Nonadherence to Referral to Hospital Births by Women with High-Risk Pregnancies in Nepal" International Journal of Environmental Research and Public Health 18, no. 11: 5801. https://doi.org/10.3390/ijerph18115801