Present Beliefs in Relation to Antepartum, Intrapartum and Postpartum Periods in Kenya

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Present Beliefs in Relation to Antepartum, Intrapartum and Postpartum Periods in Kenya

Brief Overview of Childbirth Culture in Kenya

Culture has always been at the center of the childbearing journey as cultural practices and beliefs tend to influence the childbearing decisions among women. According to World Health Organization 2018) each day, 830 women die every day, with Sub-Saharan Africa accounting for 546 in 100 000 live births and 66% globally. The Kenya Demographic Health Survey (KDHS, 2014), Kenya experiences 362 maternal deaths in every 100,000 live births, a number that is five times the target set for the Sustainable Development Goals for 2030, which is 70 maternal deaths in every 100 000 live births. Additionally, the World Health Organization points out that common causes of death include unsafe abortion, haemorrhage, obstructed labour, sepsis and eclampsia with 60-80% of the obstetric complications being preventable of women who seek help early in their pregnancy, birth, labour and motherhood. Kenya has 44 tribes and 13 ethnic groups, including European and Indian immigrant tribes. The rich history and unique culture of every tribe shape its diverse background. Despite efforts to improve healthcare access by the government, in Kenya 95% of expectant women receive antenatal care but only 40% access skilled birth care. Cultural impact is one of the notable factors causing the underutilization of intrapartum services.

Prenatal Care

Prenatal care in Kenya is offered by private and public hospitals with the latter being confusing and crowded. Private hospitals provide a prenatal package that includes tests and scans, prenatal consultations, delivery and hospital stay. This option is more cost-effective than paying for each visit individually but on the downside one is less likely to be assigned a dedicated obstetrician. Such packages cost up to 130, 000 including the cost of delivery. However, that is not all the costs. Common additional costs in the package might include care for the newborn, meals, additional interventions and even extended stays in hospitals. Individual prenatal visits will cost a few thousand Kenyan shillings and additional costs for scans and tests. An ultrasound costs up to 4000 Kenyan shillings. Worth noting, some hospitals in Mombasa and Nairobi provide maternity tours for expectant mothers early in the pregnancy that proves helpful in deciding the right hospital to deliver.

Labor

Labor occurs in two stages, with stage one being dilation and stage two being expulsion. Some women opt not to give birth via natural labor and prefer to be induced. In the first stage of dilation, the cervix tends to become thin as the head descends to the pelvis. The process is painful and long particularly for first-time mothers. The cervix dilates to 8 centimeters and the midwife keeps on checking progress. If the water has not broken at eight centimetres, nurses do it using a long thin tool. To ease pain, expectant mothers are guided to breathe slowly, stay in comfortable positions during contraction and breathe a bit slower than regular breathing. In the expulsion stage, the head moves towards the dilated cervix and contractions come every two to three minutes. Expectant mothers are advised to take every contraction at a time. They feel pressure in the bowel and most feel sick to their stomachs and their body shakes too. With the assistance of a medical team, the mother is guided to the delivery room. For first-time mothers, delivery can last up to 40 minutes, while that have given birth before takes about twenty minutes.

Caesarian Section

Recent reports by the Ministry of Health in Kenya indicate that the rate of cesarean section deliveries is nearly double the average for Africa and have been rising significantly to 16.4% in 2021 from 14.5% in 2017. The World Health Organization (WHO) recommends a 9.2% average c-section rate in Africa. Kenya’s numbers exceed the said number. WHO also noted that caesarian sections important in saving lives in incidences where vaginal deliveries pose a danger or risks. The Ministry of Health noted that the government initiative dubbed “Linda Mama” has informed the rising number of c-sections noting that the trend is not homogenous when compared to the 47 counties (Gitobu, Gichangi, & Mwanda, 2018). The health department also cautions facilities from taking advantage of vulnerable expectant women noting that among the reasons that they recommend caesarian section is that they earn more money as the procedure is more expensive.

Genetic Defects

`Major external birth defects are typical and have been linked with childhood mortality, morbidity, and lifelong disabilities that are resource-intensive. While birth defects continue to take place in Kenya, they are yet to be considered a public health issue. Birth defects or congenital anomalies are deemed critical causes of childhood and infant deaths, disability, and chronic illness. According to the World Health Organization, birth defects are functional or structural anomalies taking place in intrauterine life. While the conditions develop prenatally, they can be identified after or before birth and, in some instances, much later in life. Examples of birth defect include Down’s syndrome, sickle cell, cleft lip, congenital heart defects, spina bifida and club foot. According to the World Health Organization the coding and gene mutations cause gene defects and the risk of childhood death, intellectual disability, neonatal death and other birth defects doubles if the parents are blood relatives.

New Born and Sick Baby

According to recent 2019 statistics about the main causes of neonatal death in Kenya the following factors are responsible for newborn deaths; diarrhoea (1%), tetanus (0%), pneumonia (9%), preterm complications (39%), intrapartum vents (26%), sepsis (6%), congenital abnormalities (7%) and other conditions (12%). Additionally, mortality rates for newborns are t 21 per every 1 000 live births, with the proportion of deaths below the age of five standing at 50%. The annual reduction of mortality between 2000 and 2020 was 1.6%, skilled birth attendance rate of 70% and a stillbirth rate of 20 deaths in every 1000 births. The maternal mortality ratio stands at 342 deaths in every 100,000 live births. With new born deaths contributing to a rising childhood mortality, increased access to inpatient care is a key contributor for boosting child health.

Breastfeeding

Exclusive breastfeeding (EBF) is recommended for the first half a year in a child’s life. It is also recommended for up to two years couples with timely incorporation of complementary feeding from six months. These are critical for optimal child development and growth. Exclusive breast feeding has various social, economic, and financial benefits. The Global Breastfeeding Scorecard of 2019 only 41% of children below six months are breastfed exclusively (Oluoch- Smith-Oka, Milan, & Dowd, 2018). Across Kenya, the exclusive breastfeeding rates stand at 61%. While this is a notable improvement from 2008, there is still a need to further push for exclusive breastfeeding.

Post Partum

The World Health Organization recommends having a minimum of four postnatal clinics scheduled for within 24 hours of delivery, at 10-14 days, at 4-6 weeks, and at 4-6 months of delivery. In Kenya post, natal care visits are scheduled as follows after 48 hours of delivery, after 1-2 weeks, at 4-6 weeks, and at 4-6 months (Warren, Njue, Ndwiga, & Abuya, 2017). In the event of home delivery, newborns and mothers should be directed to the closest health facility as fast as possible before 48 hours collapse. Postnatal care is important as it supports the mother and the baby and facilitates the early diagnosis, prevention and treatment of complications, referral for specialized care, counseling on baby care, counseling on contraception, immunization, support of exclusive breastfeeding and maternal counseling and support.

References

Gitobu, C. M., Gichangi, P. B., & Mwanda, W. O. (2018). The effect of Kenya’s free maternal health care policy on the utilization of health facility delivery services and maternal and neonatal mortality in public health facilities. BMC pregnancy and childbirth, 18(1), 1-11.

Oluoch-Aridi, J., Smith-Oka, V., Milan, E., & Dowd, R. (2018). Exploring mistreatment of women during childbirth in a peri-urban setting in Kenya: experiences and perceptions of women and healthcare providers. Reproductive health, 15(1), 1-14.

Warren, C. E., Njue, R., Ndwiga, C., & Abuya, T. (2017). Manifestations and drivers of mistreatment of women during childbirth in Kenya: implications for measurement and developing interventions. BMC Pregnancy and Childbirth, 17(1), 1-14.