Wallace Heather Julie, McDonald Susan, Belton Suzanne, Miranda Agueda Isolina, da Costa Eurico, Matos Livio da Conceicao, Henderson Helen, Taft Angela
Judith Lumley Centre, La Trobe University, Bundoora, Victoria 3086, Australia.
La Trobe University/ Mercy Health, Bundoora, Victoria 3086, Australia.
Midwifery. 2018 Oct;65:35-42. doi: 10.1016/j.midw.2018.05.013. Epub 2018 Jun 7.
While global maternal deaths have decreased significantly, hundreds of thousands of women still die from pregnancy and birth complications. Interventions such as skilled birth attendants, emergency transportation to health facilities and birth preparedness have been successful at reducing such deaths, however barriers to seeking, reaching, and receiving respectful care persist.
This study aimed to identify what influences people's decisions to seek antenatal care and care during labour and birth in Timor-Leste, a low-middle income newly independent nation in South East Asia with a high maternal death rate. The study aimed to provide emic/local insights to help midwives and maternal health providers tailor care and resources appropriately, thus improving maternal health.
This qualitative study with a decolonising methodology, was designed to explore the perceptions of reproductive aged Timorese women and men, situating Timorese worldviews in the centre of the research process. Data collection occurred in four municipalities of Timor-Leste in October 2015 and included 9 focus group discussions with 80 men, and 17 individual reproductive history interviews with women.
An expanded 'Three Delays' model was used to frame the findings. The study found multiple factors impacting on decisions to seek antenatal care and care during labour and birth. Husbands, history, minimal birth preparedness, ethno-physiological beliefs (personal perceptions of how the body works), infrastructure limitations, geographical location, hospital policies and staff attitudes influenced and potentially delayed the decision to seek or reach care.
Policies and programs that increase accessibility of midwives and encourage birth preparedness are vital. Given the current locus of power in families in Timor-Leste, it is imperative that men are educated regarding the importance of care from skilled providers, and supported to access such care with their partners. Culturally respectful, inclusive and quality care needs to be emphasised so that trust is established between health providers and communities.
尽管全球孕产妇死亡人数已显著下降，但仍有数十万妇女死于妊娠和分娩并发症。诸如熟练的助产人员、送往医疗机构的紧急交通以及分娩准备等干预措施在减少此类死亡方面取得了成功，然而，寻求、到达和获得尊重性护理仍存在障碍。
本研究旨在确定哪些因素影响东帝汶（东南亚一个中低收入的新独立国家，孕产妇死亡率较高）人们寻求产前护理以及分娩期间护理的决定。该研究旨在提供本土见解，以帮助助产士和孕产妇健康服务提供者适当地调整护理和资源，从而改善孕产妇健康状况。
这项采用去殖民化方法的定性研究旨在探索东帝汶育龄妇女和男子的观念，将东帝汶的世界观置于研究过程的中心。2015年10月在东帝汶的四个市进行了数据收集，包括与80名男性进行的9次焦点小组讨论，以及与女性进行的17次个人生育史访谈。
采用扩展的“三个延误”模型来阐述研究结果。该研究发现有多个因素影响寻求产前护理以及分娩期间护理的决定。丈夫、既往史、分娩准备不足、民族生理观念（个人对身体运作方式的看法）、基础设施限制、地理位置、医院政策和工作人员态度都影响并可能延误寻求或获得护理的决定。
增加助产士可及性并鼓励分娩准备的政策和项目至关重要。鉴于东帝汶目前家庭中的权力所在，必须让男性了解熟练提供者护理的重要性，并支持他们与伴侣一起获得此类护理。需要强调文化上尊重、包容和高质量的护理，以便在医疗服务提供者和社区之间建立信任。
