Timely referral saves the lives of mothers and newborns: Midwifery led continuum of care in marginalized teagarden communities - A qualitative case study in Bangladesh

Abstract

Background: Prompt and efficient identification, referral of pregnancy related complications and emergencies are key factors to the reduction of maternal and newborn morbidity and mortality. As a response to this critical need, a midwifery led continuum of reproductive health care was introduced in five teagardens in the Sylhet division, Bangladesh during 2016. Within this intervention, professional midwives provided reproductive healthcare to pregnant teagarden women in the community. This study evaluates the effect of the referral of pregnancy related complications. Methods: A qualitative case study design by reviewing records retrospectively was used to explore the effect of deploying midwives on referrals of pregnancy related complications from the selected teagardens to the referral health facilities in Moulvibazar district of the Sylhet division during 2016. In depth analyses was also performed on 15 randomly selected cases to understand the facts behind the referral. Results: Out of a total population of 450 pregnant women identified by the midwives, 72 complicated mothers were referred from the five teagardens to the facilities. 76.4% of mothers were referred to conduct delivery at facilities, and 31.1% of them were referred with the complication of prolonged labour. Other major complications were pre-eclampsia (17.8%), retention of the placenta with post-partum hemorrhage (11.1%) and premature rupture of the membrane (8.9%). About 60% of complicated mothers were referred to the primary health care centre, and among them 14% of mothers were delivered by caesarean section. 94% deliveries resulted in livebirths and only 6% were stillbirths. Conclusions: This study reveals that early detection of pregnancy complications by skilled professionals and timely referral to a facility is beneficial in saving the majority of baby's as well as mother's lives in resource-poor teagardens with a considerable access barrier to health facilities.

Keywords: Bangladesh; Midwives led continuum of care; marginalised teagarden communities; mothers and newborns; referral.

Figure 1.. Referral process from the selected five teagardens to the higher referral centre.

Figure 2.. Place of referral of complicated women.

Figure 3.. Distribution of referred mothers by cause of referral.

Figure 4.. Analysis of the three delays reported for referral of complicated mothers.

( A) First (decision) delay- delay indecision to seek care. ( B) Second (transportation) delay- delay in reaching to the facility, Third (treatment) delay- delay in receiving treatment.