Beliefs and practices regarding delivery and postpartum maternal morbidity in rural Bangladesh

Abstract

Most maternal deaths occur in the puerperium and most maternal morbidities probably also arise at that time. Maternal morbidities occur much more frequently than maternal deaths, but very little is known about their magnitude or causes. This study uses focus-group discussions to explore the experiences of childbirth and postpartum illness among rural Bangladeshi women. The women's beliefs about disease causation, and their use of traditional health care, are explored. The significance of the findings for the training of traditional birth attendants and for programs of postpartum care is discussed.

PIP: In August 1991 in rural central Bangladesh, researchers conducted focus group discussions with mothers of all ages and trained and untrained traditional birth attendants (TBAs) to examine the experiences of childbirth, postpartum morbidity, local beliefs, and practices. They intended to use the information to design a prospective study of postpartum morbidity and its relation to delivery practices. Postpartum morbidity was common. Most frequently described postpartum conditions were breast problems, perineal problems, infections, and prolapse. Participants mentioned a wide range of local treatments, but few mentioned antibiotics as a treatment for infections. They believed in supernatural causes of disease. Training did not substantially change the belief systems or practices of TBAs. Harmful traditional practices included internal manipulations and massage, introduction of oils into the vagina, use of fundal pressure or tight abdominal bands during labor, pulling on the umbilical cord, choking or inducing vomiting in the mother to facilitate placental delivery, and not using uterine massage to prevent and treat postpartum hemorrhage. Beneficial practices were adopting an upright position and walking during labor, squatting for delivery, noninterferring with the membranes, having psychological support from attendants, and being in familiar surroundings. The custom of seclusion was a key obstacle to health-care seeking after delivery. Thus, home visits during the first two weeks after delivery are needed. Relatives rather than TBAs performed many deliveries. Food taboos were not as significant as earlier believed. These discussions revealed that the preventive aspect of modern prenatal care has not been incorporated into the women's belief system. They also suggest that the need for health care is not being addressed.