Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun 9;18(1):115.
doi: 10.1186/s12978-021-01166-z.

Knowledge on intrapartum care practices among skilled birth attendants in Cambodia-a cross-sectional study

Mitsuaki Matsui  1 , Yuko Saito  2 , Rithy Po  3 , Bunsreng Taing  4   5 , Chamnan Nhek  4   6 , Rathavy Tung  4   7 , Yoko Masaki  4 , Azusa Iwamoto  4   8
Affiliations

Knowledge on intrapartum care practices among skilled birth attendants in Cambodia-a cross-sectional study

Mitsuaki Matsui et al. Reprod Health. .

Abstract

Background: Delivery is a critical moment for pregnant women and babies, and careful monitoring is essential throughout the delivery process. The partograph is a useful tool for monitoring and assessing labour progress as well as maternal and foetal conditions; however, it is often used inaccurately or inappropriately. A gap between practices and evidence-based guidelines has been reported in Cambodia, perhaps due to a lack of evidence-based knowledge in maternity care. This study aims to address to what extent skilled birth attendants in the first-line health services in Cambodia have knowledge on the management of normal delivery, and what factors are associated with their level of knowledge.

Methods: Midwives and nurses were recruited working in maternity in first-line public health facilities in Phnom Penh municipality, Kampong Cham and Svay Rieng provinces. Two self-administered questionnaires were applied. The first consisted of three sections with questions on monitoring aspects of the partograph: progress of labour, foetal, and maternal conditions. The second consisted of questions on diagnostic criteria, normal ranges, and standard intervals of monitoring during labour. A multiple linear regression analysis was performed to identify relationships between characteristics of the participants and the questionnaire scores.

Results: Of 542 eligible midwives and nurses, 523 (96%) participated. The overall mean score was 58%. Only 3% got scores of more than 90%. Multivariate analysis revealed that 'Kampong Cham province', 'younger age', and 'higher qualification' were significantly associated with higher scores. Previous training experience was not associated with the score. Substantial proportions of misclassification of monitoring items during labour were found; for example, 61% answered uterine contraction as a foetal condition, and 44% answered foetal head descent and 26% answered foetal heart rate as a maternal condition.

Conclusion: This study found that knowledge was low on delivery management among skilled birth attendants. Previous training experience did not influence the knowledge level. A lack of understanding of physiology and anatomy was implied. Further experimental approaches should be attempted to improve the knowledge and quality of maternity services in Cambodia.

Keywords: Cambodia (MeSH terms); Intrapartum care; Midwifery (MeSH terms); Partograph; Skilled birth attendant.

Plain language summary

Pregnancy and childbirth are natural phenomena, but sometimes have risk for mothers and babies. Therefore, childbirth should be carefully and continuously monitored by the health care professional. The ‘partograph’ is a useful tool that defines three monitoring aspects of the delivery progress, and conditions of the mother and intrauterine baby. However, it is often used inaccurately or inappropriately in low- and middle-income countries. We hypothesised that health professionals who assist childbirth cannot effectively monitor delivery conditions because their knowledge is insufficient. Therefore, we evaluated the knowledge on monitoring the process of childbirth and explored factors which affect the level of knowledge among health care providers in Cambodia.Midwives and nurses were targeted in this study who deal with normal deliveries in the capital city and two provinces. The questionnaire was designed to evaluate if their knowledge on three monitoring aspects is accurate.Of 542 eligible personnel, 523 (96%) participated. The mean score was 58%. Only 3% got scores of more than 90%. According to the statistical analysis, ‘working in Kampong Cham province’, ‘younger age’, and ‘higher qualification’ were significantly associated with higher scores. Previous training experience was not associated with the score.This study found that basic knowledge was low on delivery management among health care providers. We suspect that a deficiency of basic medical knowledge, such as physiology and anatomy, causes the lack of knowledge on the childbirth process. Further intervention should be attempted to improve the knowledge and quality of maternity services in Cambodia.

PubMed Disclaimer

Conflict of interest statement

All the authors declare that they have no competing interests.

References

    1. Ayres-de-Campos D, Arulkumaran S, FIGO Intrapartum Fetal Monitoring Expert Consensus Panel FIGO consensus guidelines on intrapartum fetal monitoring: Physiology of fetal oxygenation and the main goals of intrapartum fetal monitoring. Int J Gynaecol Obstet. 2015;131(1):5–8. doi: 10.1016/j.ijgo.2015.06.018. - DOI - PubMed
    1. Alliance for Maternal and Newborn Health Improvement (AMANHI) mortality study group Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study. Lancet Glob Health. 2018;6(12):e1297–e1308. doi: 10.1016/S2214-109X(18)30385-1. - DOI - PMC - PubMed
    1. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9947):980–1004. doi: 10.1016/S0140-6736(14)60696-6. - DOI - PMC - PubMed
    1. World Health Organization Maternal Health and Safe Motherhood Programme World Health Organization partograph in management of labour. Lancet. 1994;343(8910):1399–1404. - PubMed
    1. World Health Organization . WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018. - PubMed