Childbirth practices in rural Rajasthan, India: implications for neonatal health and survival
Childbirth practices in rural Rajasthan, India: implications for neonatal health and survival
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DOI：
10.1038/jp.2008.174
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发表时间：
2008-12-01
影响因子：
2.9
通讯作者：
Deora, K. K.
中科院分区：
文献类型：
--
作者：
Iyengar, S. D.;Iyengar, K.;Deora, K. K.
在印度北部拉贾斯坦邦的一个农村社区，我们探索了家庭、社区和提供者在分娩和分娩期间的做法，这些做法可能会影响新生儿的健康结果。乌代布尔地区的两个农村集群应用了一系列定性数据收集方法。本文报告了对家庭和初级卫生机构分娩和分娩的 8 次直接观察、10 次焦点小组讨论、对刚分娩的妇女的 18 例病例访谈以及在社区内进行的 39 次关键知情人访谈的主要发现。尽管大多数家庭更喜欢在家分娩，但对于第一胎，尤其是青少年，首选医疗机构分娩。由传统助产士或年长女性亲属领导的助产士团队在家庭分娩过程中做出决定并履行关键职能。现代医疗服务提供者通常被邀请进行肌肉注射催产素以加速家庭分娩，而卫生人员往往在设施分娩期间也这样做。出于对妇女无法自然分娩的过度担忧，在这两种情况下施加强力宫底压力的做法几乎很普遍。在设施和家庭中，对分娩的监测主要限于重复的不卫生的阴道检查，很少或根本没有对胎儿或母亲的健康状况进行监测。在家中出生的婴儿一直躺在潮湿的地板上，直到胎盘娩出。绳子通常使用可用的麻线或仪式线绑住，并使用新刀片切割。在医疗设施中，婴儿出生后的干燥和包裹被推迟，复苏准备工作也很少。家庭相信将母乳喂养推迟到出生后三天，因为那时他们可以获得母乳。即使医院工作人员让母亲和新生儿出院，也没有开始母乳喂养。传统和现代实践的结合，植根于诱导热量以促进分娩的概念，发生在家庭和设施分娩环境中。在这种农村环境中提高新生儿生存率的计划需要投资于通过培训和监测加强临产和分娩期间提供的初级卫生服务，并投资于社区促进改善新生儿护理实践。
In a rural community of Rajasthan in north India, we explored family, community and provider practices during labor and childbirth, which are likely to influence newborn health outcomes. A range of qualitative data-gathering methods was applied in two rural clusters of Udaipur district. This paper reports on the key findings from eight direct observations of labor and childbirth at home and in primary health facilities, as well as 10 focus group discussions, 18 case interviews with recently delivered women and 39 key informant interviews carried out within the community. Although most families preferred home delivery, health-facility deliveries were preferred for first births, especially among adolescents. A team of birth attendants led by a traditional birth attendant or an elder female relative took decisions and performed key functions during home childbirth. Modern providers were commonly invited to administer intramuscular oxytocin injections to hasten home delivery, whereas health staff tended to do the same during facility deliveries. The practice of applying forceful fundal pressure, stemming from overriding concern about the woman's inability to deliver spontaneously, was near universal in both situations. In both facilities and homes, monitoring of labor was largely restricted to repeated unhygienic vaginal examinations with little or no monitoring of fetal or maternal well-being. Babies born at home remained lying on the wet floor till the placenta was delivered. The cord was usually tied using available twine or ceremonial thread and cut using a new blade. In facility settings, drying and wrapping of the baby after birth was delayed and preparedness for resuscitation was minimal. Families believed in delaying breast-feeding till 3 days after birth, when they believed breast milk became available. Even hospital staff discharged the mother and newborn without efforts to initiate breast-feeding. A combination of traditional and modern practices, rooted in the concept of inducing heat to facilitate labor, occurred in both home and facility delivery settings. Programs to improve neonatal survival in such rural settings will need to invest both in strengthening primary health services provided during labor and delivery through training and monitoring, and in community promotion of improved newborn care practices.