Birth and Emergency Planning: A Cross Sectional Survey of Postnatal Women at Korle Bu Teaching Hospital, Accra, Ghana

Birth and emergency planning encourages early decision making, helps overcome barriers to skilled maternity care and reduces preventable maternal and newborn deaths. A facility based postnatal survey of 483 childbearing women in Accra, Ghana determined birth and emergency planning steps, awareness of obstetric danger signs, reported maternal and newborn complications and birth outcome based on length of hospital stay. Supervised antenatal care and delivery were nearly universal. Overall, 62% had a birth plan, 74% had adequate knowledge of danger signs, while 64% and 37% reported maternal and newborn complications respectively. Accompaniment by a birth companion and saving money were considered the most useful planning steps. Knowledge of danger signs was associated with birth and emergency planning, and birth and emergency planning was associated with reported birth outcome. Birth and emergency planning as a critical component of antenatal care can influence birth outcomes and should be extended to all pregnant women.RésuméLa planification des naissances et d'urgence encourage la prise de décision rapide, aide à surmonter les obstacles aux soins de maternité qualifiés et réduit les décès maternels et néonatals évitables. Une enquête post-natale qui a été basée sur l’établissement, et auprès des 483 femmes en âge de procréer à Accra, au Ghana a déterminé les étapes de planification des naissances et d'urgence, la sensibilisation des signes de danger obstétrical, a rapporté des complications maternelles et néonatales et les résultats des naissances selon la durée du séjour à l'hôpital. Les soins prénatals et l'accouchement surveillés étaient presque universels. Dans l'ensemble, 62% avaient un plan de naissance, 74% avaient une connaissance adéquate des signes de danger, tandis que 64% et 37% ont déclaré des complications maternelles et néonatales, respectivement. Le fait d’être accompagné par un compagnon de naissance et d’économiser de l'argent ont été considérés comme les étapes de planification les plus utiles. La connaissance des signes de danger a été associée à la naissance et à la planification d'urgence et la planification des naissances  et d'urgence a été associée à des résultats des naissances déclarées. La planification des naissances et d'urgence comme un élément essentiel des soins prénatals peuvent influer sur les résultats de grossesses et devrait être mis a la portée de toutes les femmes enceintes.Keywords: pregnancy, obstetric complications, birth plan, Accra, Ghan

Predictors and birth outcomes: An investigation of birth and emergency preparedness among postnatal women at a national referral hospital in Accra, Ghana

Objective: Birth and emergency preparedness is a safe motherhood strategy which encourages early decision making and minimizes delays in health care seeking in the event of obstetric complications. The aim of this study was to determine individual level factors influencing birth and emergency preparedness.Methods: A cross sectional, hospital based survey was conducted among 483 postnatal women at a national referral hospital in Accra, Ghana. Eligible women were consenting postnatal attendees aged 15-49 years who had a birth in the two months preceding the survey. Study subjects were recruited serially during routine postnatal clinic visits between March and December, 2011. Interviews were conducted using purpose designed, structured questionnaires and collected data was based on maternal reports of recent pregnancy and childbirth experience. Predictors of awareness and adequate knowledge of danger signs, having a birth plan, and a stable birth outcome were determined using Pearson’s Chi-Square test and binary logistic regression analysis.Results: Educational status was a predictor of awareness of obstetric danger signs. Secondary education and formal employment were predictors of adequate knowledge. Older age (>30 years), formal employment and awareness of any obstetric danger sign were predictors of having a birth plan. Having a birth plan was not predictive of a stable birth outcome after controlling for confounders. Absence of maternal or newborn complications was highly predictive of a stable outcome.Conclusions: Women’s empowerment through better education and formal employment is recommended to enhance birth preparedness and access to skilled maternity care. Birth outcomes may be dependent on factors other than having a birth plan; this requires further exploration.Key words: birth preparedness, factors, pregnancy, Ghan