Determinants of Mode of Delivery Among Postnatal Mothers Admitted in Wajir County Referral Hospital

Abstract

Background: Globally, vaginal delivery has been widely accepted as unquestioned mode of birth. However, advances in technology and its adoption in reproductive care delivery has resulted in an increase in the number of Caesarean delivery in the recent years including Caesarian sections on maternal requests. This has increased options for preferred mode of delivery for mothers and led to significant reduction in maternal and neonatal mortality and morbidity. However, most African countries, mainly in rural and marginalized areas, use of caesarian section remains low even during emergency obstetric care. Despite this, limited studies to establish determinants of delivery modes have been done especially in remote rural areas such as Wajir County. Study objective: The main objective of this study was to establish determinants of mode of delivery among postnatal mothers admitted in Wajir County referral Hospital Methodology: A hospital based descriptive cross-sectional study design was used. Mixed method of quantitative and qualitative data was employed among 178 postnatal mothers who were systematically sampled from Wajir county Referral hospital. Quantitative data was collected using pre-tested semi-structured questionnaire through interviews and qualitative data was collected using Focus group discussion from the postnatal mothers and Key informants from the staff of the hospital. Descriptive analysis using means, frequency and proportions was computed. Chi-square test (p<0.05) with corresponding 95% confidence interval was used to determine the association between study variables. Qualitative data collected was analyzed thematically. Findings: The most preferred mode of delivery among the respondents was vaginal delivery at 92.1%. Analyses with Chi-Square test of independence revealed that maternal age (p = 0.001), marital status (p = 0.016), level of education (p = 0.007), parity (p=0.03), FGM practice (p=0.001) and belonging to the social health groups (p= 0.001) were the variables significantly associated with mode of delivery. A substantial number of women did not have sufficient knowledge on delivery options, benefits and risks to inform their decisions on delivery modes. This has caused women to embrace negative attitudes towards CS which has led to poor delivery practices like home delivery and CS refusal. Conclusion: Vaginal Delivery is the most preferred mode of delivery even where CS is medically indicated. Caesarian section acceptance remains low due to lack of correct knowledge, poor attitude towards CS and lack of proper women counseling during ANC visits. Therefore, there is need for educational and economic empowerment of women and girls complemented with effective community sensitization and awareness campaigns on delivery-related complications, risks and alternative delivery options for emergency cases.