ANTE-NATAL CARE SERVICES, PLACE OF DELIVERY AND BIRTH OUTCOMES AMONG WOMEN OF CHILD BEARING AGE IN NIGERIA
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1.1 Background of the study
ANC services can provide opportunities for health workers to promote a specific place of delivery or give women information on the status of their pregnancy, which in turn informs their decisions on where to deliver. Risk assessment during ANC may explicitly recommend a place for delivery, for instance to deliver in a hospital for twin pregnancy. On the other hand women who are told their pregnancy is fine may feel encouraged to deliver without a skilled attendant (Nwokoro, 2014).
Childbirth in a health facility while attended by trained health professional has been shown to be associated with lower rates of maternal and neonatal mortality compared to home birth. In poor settings, non-health facility deliveries are associated with increased maternal morbidity and mortality and increased newborn morbidity and mortality. In developed countries, some studies conducted in the United States of America have shown an increased maternal and neonatal risk associated with planned home birth (Umurung 2010). According to Titaley, Hunter, Dibley and Heywood (2010), in low and middle-income countries, many deliveries still occur at home without the assistance of a trained attendant. This has generated serious concerns since women who develop life threatening complications during pregnancy and delivery require appropriate and accessible care. 20 – 30% of infant mortality could be reduced by implementing skilled birth care services.
According to Amankwa (2010) Parity is another significant factor that can influence a woman’s decision to deliver with a skilled attendant He cited Bangladesh where women with lower parity are less likely to deliver at home. Ekene&Tunau cited in Amankwa (2010) stated that in Sokoto in Nigeria, women of high parity were found to be more likely to decide to prefer home delivery with unskilled attendants. Amankwa further stated that the first birth is known to be more difficult and the women have noprevious experience of delivery. Often a high value is placed on the first pregnancy and in some settings; the woman’s natal family helps her get the best care possible. Furthermore, health workers may recommend a facility delivery for primipara. By contrast women of higher parity can draw on their maternity experiences and may not feel the need to receive professional care if previous deliveries were uncomplicated. Also women with several small children may have greater difficulty in attending facilities due to the need to arrange child care (Amankwa, 2010).
According to Nwokoro, (2014) if a client use health services, she will be able to evaluate self from past experiences or from knowledge gained through health education given at the health facilities. This will make client to use health services promptly to avoid complications e.g a mother who attends ANC will be educated on danger signs of pregnancy and this will make her seek help early enough to avoid further complications and death whenever she sees the sign of complication; because she will perceive the complication as a danger to her health and that of her baby. When one uses health services she will be able to benefit from evaluation of her health status by health care providers and be advised properly on what to do and the best place for her delivery. If any complication is detected, she will be informed earlier to enable her choose the appropriate healthcare provider during delivery (Nwokoro, 2014).