Developing a culturally congruent continuous labour support framework for women in South-West Nigeria

Abstract

Childbirth is a multifaceted experience that is usually influenced by several factors that could result in an unsatisfactory or satisfactory childbirth experience. These factors include quality of support during labour of which Continuous Labour Support (CLS) is a part; it has been identified as a positive contributor to maternal health. Although CLS has been recommended by the World Health Organization (WHO), lack of a framework has also been an impediment to its implementation in Nigerian hospitals. The purpose of this study is to develop a culturally congruent Continuous Labour Support framework for women in Nigeria. The study adopted a concurrent mixed method design to gain information from various dimensions for the study. The study populations included pregnant women, nurse-midwives and health policy-makers in Ondo state, Nigeria, who were selected through simple random sampling using computer-generated tables for the quantitative strand of the study. For the qualitative strand, participants were selected using a purposeful sampling method. The study was conducted in two phases. Phase 1 focused on the assessment of the perceptions, attitudes and preferences of all groups of participants. Collected quantitative data was analysed using descriptive and inferential statistics through the use of the Statistical Package for Social Science (SPSS) Version 21. Qualitative data was analysed using Tesch's Method of Content Analysis. Findings the study shows that the pregnant women had positive perceptions and attitudes towards CLS from a familiar, close and trusted person, in public health facilities. Findings from the midwives revealed that pregnant women's family members are not usually involved in women's care during labour in public health facilities. However, nurse-midwives expressed satisfaction with the few occasional/discretional occasions on which the practice had been implemented, and the majority showed positive perceptions and attitudes to the introduction of CLS from a person of the woman's choice, in public health facilities. Findings from interviews with the policy-makers affirmed family support system during labour as a cultural expectation and a traditional practice at home but alien to the hospital. The policy-makers also expressed a positive standpoint on the introduction of CLS by persons of the woman’s choice from her social network, in the public hospital. Phase 2 of the study involved the development of the culturally congruent Continuous Labour Support framework for women in south-west Nigeria. The framework was developed using the Model Development Approach by Walker and Avant (2005, 2011). Findings from processes with all stakeholders in Phase 1 of the study were synthesised with literature review, using concept identification and classification. The concepts in this study were identified, described and developed through synthesis of data from questionnaire, the focus group and individual interviews of all stakeholders. Concept classification, description and validation was achieved through the six vantage points of surveying activity listed by Dickoff et al, (1968) in consultation the selected expert reviewers in maternal and child care. The developed framework was followed by a detailed description, and validation of the framework was done through consensus agreement with four experts.