Characteristics
of Deliveries At A Maternity Hospital
.........................................................................................................................
Gusun Bayraktar, MD, Asistant Doctor;
Department of Family Medicine, Uludag University
School of Medicine, Bursa, Turkey
Ganime Sadikoglu, MD, Assistant Professor;
Department of Family Medicine, Uludag University
School of Medicine, Bursa, Turkey
Alis Ozcakir, MD, Assistant Professor;
Department of Family Medicine, Uludag University
School of Medicine, Bursa, Turkey
Sengül Cangür; Researcher;
Department of Biostatistics, Uludag University
School of Medicine, Bursa, Turkey
Serhat Tatlikazan, MD, Specialist;
Zubeyde Hanim Maternity Hospital,Bursa,Turkey
Nazan Bilgel, MD, Professor;
Department of Family Medicine, Uludag University
School of Medicine, Bursa, Turkey
Correspondence
to:
Ganime Sadikoglu, MD Assistant Professor;
Department of Family Medicine, Uludag University
School of Medicine, Gorukle Campus, 16059, Gorukle,
Bursa, Turkey.
Tel: 0 224 2950000
Fax: 0224 2341172
E-mail: ganimes@uludag.edu.tr
.........................................................................................................................
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ABSTRACT
Introduction:
The planning of the birthplace is considered
as important as the pregnancy period.
To be aware of the factors that have a
strong effect on the preference of maternity
hospitals plays an important role in this
planning. The aim of this study is to
define the socio-demographic traits, birth
forms and the prenatal-antenatal care
rates of women who preferred Zubeyde Hanim
Maternity Hospital.
Methods:
This study focuses on 500 pregnant women
who applied to Zubeyde Hanim Maternity
Hospital between July 2005-September 2005.
The data has been obtained by the investigators
who filled out survey forms, which were
prepared by a research group, by way of
face to face interview. For the statistical
measurements SPSS 9.01 program was used.
Results:
The average age of the study group was
defined as 25.5 ± 5.2. 80.4% of
women were from the town centre of Bursa,
18.4% were from small towns of Bursa and
the other 1.2% were from other neighboring
cities. When the women in the study group
were examined according to their education,
it became clear that 65.1% were primary
school graduates, 22.2% high school graduates,
7% uneducated and 5.6% higher educated.
Whilst 87.8% of women were housewives,
just 12.2% were working (p<0.001).
The birth form was in 58.4% normal spontaneous
birth and in 41.6% caesarean operation.
Although 56.3% of women who had a caesarean
operation were primary school graduates,
60.7% of higher educated women preferred
caesarean operation. It was observed that
the caesarean operation rates, age of
first birth and prenatal-antenatal care
rates increased and the number of children
decreased concerning the augmentation
of the education level.
Discussion:
Pregnancy and birth are periods during
which women require a health centre most.
Women's age, education level and socio-economic
factors play an important role in preference
of these health centres. The primary care
physician is the most important person
who can examine the socio-demographic
traits and preferences of the woman and
can assist with the planning of the consultations
during the pregnancy period and birth.
Key words:
Maternity hospital, socio demographic,
pregnancy.
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To contribute to personal,
familial and public health, to protect and improve
maternal health at all stages of life, to resolve
problems related to women's health, maternal
and children's health and also reproductive
health are of important duties of family physicians
in primary health care(1).
The problems experienced
by the mother before or during pregnancy and
existent risk factors affect the unborn baby.
It is quite important for the unborn baby to
become a healthy individual to detect the risk
factors of the mother and the problems that
arise before or during pregnancy which cause
symptoms or not(2). By consulting their physicians,
mothers must find out whether they carry risk
factors and if so they must learn how their
pregnancy, labor and babies will be affected
and what to pay attention to. This can be only
possible if mothers comprehend the importance
of prenatal and antenatal care. Several factors
such as maternal age during pregnancy, occupation,
inhabitation, socio-economic and educational
status can play a role in this comprehension.
Also these factors may be effective for determining
the appropriate delivery method(3).
Therefore family physicians
are responsible for determining every risk profile
that can be experienced during pregnancy follow-up
within their responsibility scope. Towards the
determination of the risk factors during pregnancy,
planning the place of labor is important. In
light of this knowledge it can be observed that
in our country some studies were performed about
delivery methods, reasons for caesarean delivery
and prenatal-antenatal care; also socio-demographic
characteristics of pregnant women living in
rural areas need to be investigated. Saka et
al evaluated the socio-demographic characteristics
and smoking status of pregnant women who gave
birth at Diyarbakir Maternity Hospital, while
Ozkaya wanted to exhibit the annual birth rates
and caesarean delivery indications in Demirel
University Obstetrics and Gynecology Clinic(4,5). Bozkurt et al investigated the situation
of receiving prenatal, natal and postnatal health
care of married women aged 15-49 years who were
admitted to primary health care centers for
any reason in Gaziantep, and also the factors
affecting this situation6. However neither study
could be found in literature that evaluates
socio-demographic characteristics of pregnant
women, delivery methods and prenatal-antenatal
care status all together.
In this study defining the
prenatal-antenatal care ratio and delivery methods
of women who preferred Zubeyde Hanim Maternity
Hospital, as well as socio-demographic features
which affect these situations is our aim.
500 pregnant women were included
in this study who admitted to Zubeyde Hanim
Maternity Hospital in Bursa for delivery between
June 2005 and September 2005. The study is based
on questionnaire method. A questionnaire form
including 23 questions related to socio-demographic
features, as well as characteristics of previous
labors, prenatal-antenatal follow-up and delivery
methods was prepared by investigators. In the
course of the study, the method in which the
research assistant who works in the study group,
interviewed the pregnant woman one by one was
preferred; in this manner it was ensured that
collecting data was more reliable. Analysis
using descriptive statistics of data was performed
using SPSS 9.01 computer software. Depending
on characteristics of variables Pearson chi-square
test and Fisher exact chi-square test were performed
for categorical variables, while Kruskal-Wallis
and Mann-Whitney U test of non-parametric tests
were used to compare the groups for quantitative
variables. Correlation analysis was performed
to define the statistical significance of the
relation between quantitative variables.
The mean age of pregnant women admitted to
Bursa Zubeyde Hanim Maternity Hospital was 25.5±5.23.
Of the cases 80.4% resided in Bursa, 18.4 in
boroughs and villages of Bursa and 1.2% resided
in other cities. 87.8% of the women were housewives
while 12.2% were working at various jobs. Mean
age of first delivery was detected as 22.5±3.81,
mean pregnancy duration was 38.9±1.94
weeks and monthly income was 715.17±584.71
YTL. If the distribution of the women in the
study group according to their educational status
is examined it could be seen that 65.1% of the
women were primary school graduated, 22.2% were
high school graduated, 5.6% were college graduated
and 7.1% were illiterate (Table 1).
|
Table 1: General demographic features
of the cases |
| Mean
age |
25.5±5.23 |
| Mean
first pregnancy age (years) |
22.5±3.81 |
| Mean
duration of pregnancy (weeks) |
38.9±1.94 |
| Mean
monthly income (YTL) |
715.17±584.71 |
| Inhabitation |
|
|
. Bursa |
80.4% |
|
. Boroughs and villages of
Bursa |
18.4% |
|
. Other cities |
1.2% |
| Occupational
groups |
|
|
. Housewives |
87.8% |
|
. Working women |
12.2% |
| Educational
status |
|
|
. Illiterate |
7.1% |
|
. Primary school graduated |
65.1% |
|
. High school graduated |
22.2% |
|
. College graduated |
5.6% |
56.2% of the cases gave birth to their first
children; also 57.4% had no live children. During
previous pregnancies 18.7% of participants had
a history of abortion and/or curettage, 3.2%
had a history of stillbirth and 1.4% had a history
of giving birth to a baby with a congenital
anomaly. Considering the type of labor 41.6%
had a history of caesarean delivery while 58.4%
had normal spontaneous vaginal delivery. 74.4%
received prenatal-antenatal follow-up, whereas
25.6% hadn't received this care.
There was a statistically significant difference
between cities where cases resided and the history
of a previous stillbirth (p<0.05) and prenatal-antenatal
follow-up (p<0.05). The ratio of previous
stillbirth was 2.8% and for prenatal-antenatal
follow-up it was 74.9% in cases who resided
in Bursa or its boroughs and villages, whereas
stillbirth ratio was 33.3% and prenatal-antenatal
follow-up ratio was 20% in cases residing in
other cities (Graph 1).
|
Graph 1
Distribution of prenatal-antenatal follow-up
and history of stillbirth in previous
pregnancies according to habitation.
|
History of previous stillbirth and congenital
anomaly with respect to the distribution of
mean ages can be seen in Table 2. Statistically
significant relations were found between ages
of the cases and the history of stillbirth and
the history of congenital anomaly (p<0.05).
|
Table 2: Distribution of the history
of stillbirth and baby with a congenital
anomaly in previous pregnancies with respect
to mean ages |
| |
History
of stillbirth in previous pregnancies |
History
of giving birth to a baby with congenital
anomaly |
| Mean
age of the cases |
YES |
NO |
YES |
NO |
|
29.43±6.14 |
25.44±5.15 |
30.0±5.19 |
25.51±5.21 |
Correlation analysis revealed positive correlation
between maternal age and total number of deliveries,
also between maternal age and the number of
abortions and/or curettages (r=0.597, p=0.00
and r=0.275, p=0.008 respectively); whereas
there was a negative correlation between first
pregnancy age and total number of deliveries
(r=-0.210, p=0.00).
There was statistical significance among educational
status and number of deliveries (p<0.001),
first pregnancy age (p<0.001), number of
live children (p<0.005), history of previous
stillbirths (p<0.001), delivery methods and
prenatal-antenatal follow-up (p<0.001). The
relation between educational status and mean
number of deliveries, first pregnancy age and
number of live children can be seen in Table
3.
|
Table 3: Distribution of total number
of deliveries, first pregnancy age and number
of live children with respect to educational
status |
|
Educational
status |
Total
number of deliveries |
First
pregnancy age |
Number
of live children |
|
Illiterate |
2.25±1.42 |
19.83±3.94 |
1.08±1.31 |
|
Primary
school graduated |
1.63±0.81 |
21.98±3.34 |
0.57±0.74 |
|
High
school graduated |
1.43±0.70 |
23.73±3.68 |
0.40±0.62 |
|
College
graduated |
1.35±0.48 |
27.0±4.58 |
0.35±0.48 |
There was history of stillbirth in 20% of participants
who were illiterate, 1.8% of those who were
primary school graduated, 1.8% of those who
were high school graduated and 3.5% of participants
who were college graduated. 64.7% of cases who
were illiterate, 28% of primary school graduates
and 12.8% of high school graduates received
no prenatal-antenatal follow-up care, whereas
all college graduates received follow-up care.
History of caesarean delivery existed in 48.6%
of illiterates, 36% of primary school graduates,
51.4% of high school graduates and 60.7% of
college graduates.
There was statistical significance between
occupation and prenatal-antenatal follow-up
(p<0.05); while prenatal-antenatal follow-up
ratio was 72.5% among housewives, it was 100%
among working women.
Defining the features
that mother candidates possess is required to
prevent medical or obstetrical complications
that can occur during pregnancy. It is also
very important to make a risk analysis, appropriate
follow-up and delivery planning for mother and
baby, together with the family.
In our study it was observed that cases who
admitted to the maternity hospital from outside
of Bursa had a higher stillbirth but lower prenatal-antenatal
follow-up ratio during their previous pregnancies
(33.3% and 20% respectively). But it is also
possible that stillbirth ratio of these cases
is higher because most participants in this
study are from Bursa and its boroughs and villages,
whereas the number of participants admitted
from other cities was small and complication
probability was higher in these cases because
they didn't receive proper follow-up care.
Seven percent of the
cases in our study were illiterate; whereas
the ratio of illiterate pregnant women who gave
birth at Diyarbakir Maternity Hospital between
April 1997-May 1997 was 54.6% in the study of
Saka et al in which socio-demographic features
and smoking status of pregnant women was investigated
(4). Comparing to our study this ratio seems
too high; this difference in educational status
could have resulted from regional properties.
In the study of Ozkaya
et al which investigated 1502 deliveries that
took place at Suleyman Demirel University Obstetrics
and Gynecology Clinic between years 1998-2002,
the ratio of caesarean delivery was found to
be 53.7% and normal vaginal delivery ratio was
found to be 46.3%(5). The results of this study
seem to be similar to the results of our study.
However in a study that examines 5128 deliveries
carried out in Dicle University Medical Faculty
Obstetrics and Gynecology Clinic between years
1995-1999 retrospectively the ratio of caesarean
deliveries was 29.7%(7); also in another retrospective
study that investigated 32699 deliveries carried
out in Kayseri Maternity Hospital between years
1998-2001, the ratio of caesarean deliveries
was reported as 10.15%(8). In the study which
investigated the methods of deliveries performed
during the last six years in SSK Ege Maternity
Hospital, ratio of caesarean deliveries was
reported as 19.24%, whereas vaginal delivery
ratio was reported as 80.76%(9). When we compare
these results with our study it is seen that
caesarean ratios are lower in these three studies.
This could be due to the higher number of cases
or because number of deliveries and delivery
methods could be defined.
Mean ages of the cases
who have a history of stillbirth or giving birth
to a baby with a congenital anomaly seem to
be higher than cases who didn't have such a
history. This may be related to the fact that
women who have such a history get pregnant at
an earlier age and they have a higher number
of pregnancies.
In the study performed
by Bozkurt et al which evaluated receiving prenatal,
natal and postnatal care regarding the status
of 500 married women aged 15-49 years who admitted
to primary health care centers in Gaziantep
for any reason between March 1999-April 1999
and also the factors affecting this situation,
it was found that 24.1% of the cases didn't
receive any prenatal care during their last
pregnancies and 10.2% of the cases gave birth
to their children without help of any medical
staff in their last pregnancies. This situation
is thought to be due to living in rural areas,
low educational status of woman and her spouse
or lack of social security(6). In the study
performed at a maternity and children's hospital
in Adelaide of South Australia in 2000 women
participated in the study were of the same opinion
that caesarean is an easy and appropriate method
for delivery; but this situation was determined
as independent from variables like age and educational
status(10). In our study three-quarters of
the cases seem to have received prenatal-antenatal
follow-up. As educational level rises mean number
of deliveries and number of live children decreases
but mean first pregnancy age increases; however
as educational level decreases the ratio of
prenatal-antenatal follow-up also decreases
but history of stillbirth in previous pregnancies
increases. 64.7% of illiterates received no
prenatal-antenatal follow-up during their pregnancies
and 20% of them was had a history of stillbirth.
As educational level raised the ratio of caesarean
deliveries also increased.
However caesarean delivery
ratio of illiterate women was also high. Inadequate
prenatal-antenatal follow-up and pregnancy complications
which probably occurred due to this situation
could be effective for the high caesarean ratio
of illiterate women. Higher caesarean ratio
in participants with higher educational level
could be due to the increase in first pregnancy
age or social indication for caesarean decided
between patient and physician. When housewives
and working women were compared according to
prenatal-antenatal follow-up status, it was
found that all of the working women had received
prenatal-antenatal follow-up, whereas 72.5%of
working women received such care. Low educational
level of housewives could play a role in detecting
this lower ratio of prenatal-antenatal follow-up.
In the study which investigated
the demographical factors and factors that affect
the fertility of 15-49 years aged married women
in Malatya Yesilyurt, 20.5% of the cases were
illiterate, 6% were literate, 58% were primary
school graduated, 15.5% of cases were graduated
from middle school or higher and mean first
pregnancy age was 19.1±3.1. High delivery
rate was evaluated in this study and it was
observed that the number of live children negatively
but first pregnancy age younger than 20 years
and educational status of primary school graduate
or lower positively affected this situation(11). In our study, although mean first pregnancy
age was higher than 20, number of deliveries
was high in cases who had a low educational
level. This result can be due to the fact that
education makes women conscious of contraceptive
methods and so they accept them.
Mean ages of cases with
caesarean delivery history being low can be
attributed to the high proportion of cases being
housewives, low educational level and inadequate
prenatal-antenatal follow-up.
As a result, pregnancy
and labor are periods in which women need health
care centers most. Age, educational status and
socio-economic factors are determinative for
preferring these health care centers. In our
study it was observed that inhabitation, occupational
status and educational level are effective for
receiving prenatal-antenatal care, additionally
age of the mother, inhabitation and educational
level affects the history of stillbirth during
previous pregnancies and finally educational
level influences the selection of delivery method.
The family physician
is the most important person that can help women
by organizing the required consultations in
the pregnancy period and by planning the labor,
after evaluating her socio-demographic features
and choices fully.
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