Geisel School of Medicine at Dartmouth College, Hanover, United States.
Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, 330W Borwell, Lebanon, NH, 03756, United States.
Reprod Health. 2019 Dec 27;16(1):185. doi: 10.1186/s12978-019-0843-1.
Haiti's maternal mortality, stillbirth, and neonatal mortality rates are the highest in Latin America and the Caribbean. Despite inherent risks, the majority of women still deliver at home without supervision from a skilled birth attendant. The purpose of this study was to elucidate factors driving this decision.
We conducted six focus group discussions with women living in urban (N = 14) or rural (N = 17) areas and asked them questions pertaining to their reasons for delivering at a facility or at home, perceptions of staff at the health facility, experiences with or knowledge of facility or home deliveries, and prior pregnancy experiences (if relevant). We also included currently pregnant women to learn about their plans for delivery, if any.
All of the women interviewed acknowledged similar perceived benefits of a facility birth, which were a reduced risk of complications during pregnancy and access to emergency care. However, many women also reported unfavorable birthing experiences at facilities. We identified four key thematic concerns that underpinned women's negative assessments of a facility birth: being left alone, feeling ignored, being subject to physical immobility, and lack of compassionate touch/care. Taken together, these concerns articulated an overarching sense of what we term "isolation," which encompasses feelings of being isolated in the hospital during delivery.
Although Haitian women recognized that a facility was a safer place for birthing than the home, an overarching stigma of patient neglect and isolation in facilities was a major determining factor in choosing to deliver at home. The Haitian maternal mortality rate is high and will not be lowered if women continue to feel that they will not receive comfort and compassionate touch/care at a facility compared to their experience of delivering with traditional birth attendants at home. Based on these results, we recommend that all secondary and tertiary facilities offering labor and delivery services develop patient support programs, where women are better supported from admission through the labor and delivery process, including but not limited to improvements in communication, privacy, companionship (if deemed safe), respectful care, attention to pain during vaginal exams, and choice of birth position.
海地的孕产妇死亡率、死产率和新生儿死亡率均为拉丁美洲和加勒比地区最高。尽管存在固有风险，但大多数妇女仍在家中分娩，而没有熟练的接生员监督。本研究旨在阐明推动这一决策的因素。
我们对居住在城市（n=14）或农村地区（n=17）的妇女进行了六次焦点小组讨论，询问她们在医疗机构或家中分娩的原因、对医疗机构工作人员的看法、对医疗机构或家庭分娩的体验或了解程度，以及以前的怀孕经历（如果有的话）。我们还包括了目前怀孕的妇女，以了解她们的分娩计划（如果有的话）。
所有接受采访的妇女都承认在医疗机构分娩有类似的好处，即降低怀孕期间并发症的风险和获得紧急护理的机会。然而，许多妇女也报告了在医疗机构分娩的不良体验。我们确定了四个关键的主题问题，这些问题是妇女对医疗机构分娩负面评估的基础：被单独留下、感到被忽视、身体无法动弹、缺乏同情关怀。这些问题共同表达了一种我们称之为“孤立”的总体感觉，这种感觉包括在分娩期间在医院感到孤立无援。
尽管海地妇女认识到医疗机构是比家庭更安全的分娩场所，但医疗机构中存在患者被忽视和孤立的普遍污名化，这是选择在家分娩的主要决定因素。如果妇女继续认为与传统接生员在家分娩相比，在医疗机构分娩时不会得到安慰和同情关怀，那么海地的孕产妇死亡率仍将居高不下。基于这些结果，我们建议所有提供分娩服务的二级和三级医疗机构制定患者支持计划，在这些计划中，从入院到分娩过程，妇女都能得到更好的支持，包括但不限于改善沟通、隐私、陪伴（如果认为安全）、尊重关怀、关注阴道检查时的疼痛以及选择分娩姿势。
