Determinants of home delivery in a semi urban setting of Nepal

Abstract

Aim: To study the effect of various determinants of home delivery in Nepal.
Methods: Prospective descriptive study among women who after being delivered at home were admitted in
Nepal Medical College Teaching Hospital (NMCTH), a tertiary care hospital situated at suburban area of
Kathmandu
Results: Of 114 women, majority were between the ages of 20-24 yrs. Most of the women were multipara
(64%). Majority had no formal education accounting for 68.4 %. Lasheta (Lama, Sherpa , Tamang) was the
most common ethnic group. Most (30.1%) of their spouses also were illiterate or had only primary level
education. Majority of the husbands of the respondents were laborers (63.2%). Regarding attendance of
antenatal care (ANC); at least 84 (73.7%) women had attended ANC once and half of the women had
attended 4 more visits. Home delivery was planned by 67 (58.8%) women; whereas only 47 (41.2%) had
chosen hospital delivery and delivered at home due to various reasons. Financial problem was the most
common reason followed by ignorance and transportation problem. Among all the women, only 5.3% were
attended to by a professionally trained provider (doctor, nurse, and midwife). A disturbingly high proportion
of women (87.6%) were attended by an untrained family member, friend or neighbor, and 7% of women
delivered completely unattended. Women were brought to the hospital by family member 59.6% other than
husband and 8.8% were accompanied by neighbors/friends. Most of these women were brought with retained
placenta, primary post partum hemorrhage.
Conclusion: In this study area, usage of the antenatal care was high, but the opportunity to deliver at
hospital was not fully utilized. This study has highlighted some of the factors affecting the choice of place of
delivery among mothers in a semi urban settlement in Nepal namely mothers educational level, husband's
education and occupation, financial constraints, lack of transportation and ignorance. Majority of the
deliveries took place at home and unsupervised by a skilled attendant thus aggravating the risk of the high
perinatal and maternal morbidities and mortalities in the study area.

Key words: Home delivery; determinants; antenatal care; delivery attendance

DOI: 10.3126/njog.v4i1.3329

Nepal Journal of Obstetrics and Gynaecology June-July 2009; 4(1): 30-37