INTRODUCTION:

The birth of a baby is a major reason for celebration in a family. World Health Organization (WHO) estimated that 5,29,000 women die annually from maternal cause and about 99% of deaths occur in developing countries. Every pregnant woman faces the risk of sudden, unpredictable complications that could end in death or injury to herself or to her infant. Lack of advance planning for use of a skilled birth attendant for normal delivery and particularly inadequate preparation for rapid action in the event of obstetric complications are well documented factors contributing to delay in receiving skilled obstetric care.

Birth preparedness is a strategy to promote timely utilization of skilled maternal and neonatal care and appropriately preparing for childbirth.¹Birth Preparedness also helps pregnant women to acquire skills and confidence needed to make birth a positive experience as it dissolves fears and makes pregnancy a time to remember.²The birth-preparedness package promotes active preparation and decision-making for delivery by pregnant women and their families.³As far as preference towards delivery is concerned most of the women prefer normal vaginal delivery as compared to caesarean section but it may vary according to socio demographic variables.⁴In India, maternal mortality ratio in 2011 was 254 per 1,00,000 live births. According to demographic and health surveys in 2009, only 51% of women in developing countries were assisted by skilled provider at last birth.⁵In India, most mothers have poor knowledge of antenatal and intranasal care available to them. Lack of education, poverty and lack of knowledge and transport facility make them vulnerable to serious consequences. Furthermore, during the posting in Community, the investigator found that antenatal women had various queries regarding delivery and they were not having any knowledge about the concept of birth preparedness including care for herself as well as for baby. The differences in preparedness and preferences among antenatal women ultimately affect the outcome of delivery. Hence, keeping in view, this study has been taken up.

OBJECTIVE OF THE STUDY:

To assess and compare the preparedness and preference towards delivery among antenatal women residing in selected rural and urban areas of district Ludhiana, Punjab.

MATERIALS AND METHODS:

A comparative study was conducted in the month of January 2013 at Pohir and OPD of DMC and Hospital with a purpose to assess preparedness and preference towards delivery among antenatal women residing in selected rural and urban areas. A total number of 100 antenatal women (50 rural and 50 urban) were selected using convenience sampling technique. Structured questionnaire and checklist were used to collect the data regarding preparedness and preference toward delivery. Reliability of research tool was established with the help of test-retest method and tool was found to be highly reliable (r = 0.9). Analysis of the data was done by using both descriptive and inferential statistics.

RESULTS:

Table 1 depicts the socio demo graphic variable of antenatal women in rural and urban area as per age, education, occupation, socioeconomic status, gravida, parity and period of gestation. It was found that more than half i.e 27(54%) of women in rural area and 22 (44%) in urban area were between age of 26-30 years. About 5 (10%) of antenatal women in rural area and 40 (80%) in urban area were graduate or above and 48 (96%) in rural area and 40 (80%) urban area were housewives. About 2/3 i.e 34 (68%) in rural and 5 (10%) in urban belonged to upper lower class. Less than half 22 (44%) antenatal women in rural area and2/3^rdi.e 33 (66%) in urban area had first gravida and less than half 22 (44%) antenatal women in rural area and 2/3^rdi.e 33 (66%) in urban area were nulliparous. About half of women 25 (50%) in rural area and 14 (28%) in urban area belonged to more than 35 weeks of gestation.

Table 1: Sociodemographic variables of antenatal women in rural and urban area N=100

Socio Demographic characteristics

Group of subjects

χ²

Rural n= 50 f(%)

Urban n= 50 f(%)

Total (f%)

Age (in yrs.)

20- 25

26- 30

31- 35

36- 40

20 (40.0)

27 (54.0)

02 (04.0)

01 (02.0)

19 (38.0)

22 (44.0)

07 (14.0)

02 (04.0)

χ²= 3.64

df= 3

p= 0.30^NS

Education of antenatal woman

Elementary

Higher secondary

Graduate or above

28 (56.0)

17 (34.0)

05 (10.0)

04 (08.0)

06 (12.0)

40 (80.0)

χ²= 50.48

df= 1

p= 0.001^**

Occupation of antenatal woman

Job

Business

Housewife

02 (04.0)

48 (96.0)

09 (18.0)

01 (02.0)

40 (80.0)

χ²= 2.98

df= 2

p= 0.22^NS

Socio-economic status of family

Upper class

Upper middle class

Lower middle class

Upper lower class

05 (10.0)

11 (22.0)

34 (68.0)

12 (24.0)

25 (50.0)

08 (16.0)

05 (10.0)

χ²= 47.37

df= 3

p= 0.001^**

Gravida

22 (44.0)

20 (40.0)

05 (10.0)

03 (06.0)

33 (66.0)

15 (30.0)

02 (04.0)

χ²= 4.18

df= 3

p= 0.242^NS

Parity

Nulliparity

22 (44.0)

20 (40.0)

05 (1.0)

03 (6.0)

33 (66.0)

15 (30.0)

02 (04.0)

χ²= 4.18

df= 3

p= 0.24^NS

Period of gestation(in wks)

<35

>35

46 (92.0)

04 (08.0)

29 (58.0)

21 (42.0)

χ²= 15.41

df= 1

p= 0.001^**

*Significant (p<0.05), ** Highly significant (p<0.01), NS= Non significant

Figure 1 depicts preparedness towards delivery in rural antenatal women in which approximately 3/4^th of antenatal women 37 (74%) had good preparedness and few of antenatal women 12 (24%) had average preparedness towards delivery.

Figure 1: Percentage distribution of rural antenatal woman as per preparedness towards delivery

Figure 2 depicts preparedness towards delivery in urban area in which maximum number of antenatal women had 45(90%) good preparedness and about 5(10%) had average preparedness towards delivery.

Figure 2: Percentage distribution of antenatal woman as per preparedness towards delivery in urban area.

Table 2 depicted that in both rural and urban areas, maximum number of antenatal women preferred normal vaginal delivery to be conducted in hospitals by doctors and 2/3^rdantenatal women 33 (66%) in rural area preferred mothers but more than 2/3^rdi.e. 34 (68%) preferred mother-in-law in urban to be accompanied at the time of delivery.

Table 2 Frequency and percentage distribution of rural and urban antenatal women as per preference towards delivery N= 100

Preference towards delivery

Rural

n= 50

f (%)

Urban

n= 50

f (%)

Mode of delivery

Normal vaginal delivery

Caesarean – section

46 (92.0)

04 (08.0)

45 (90.0)

05 (10.0)

Place for delivery

Home

Institution/ Hospital

Private Nursing home

02 (04.0)

46 (92.0)

02 (04.0)

10 (20.0)

40 (80.0)

Person conducting delivery

Doctor

Registered nurse

Trained Dai

48 (96.0)

01 (02.0)

49 (98.0)

01 (02.0)

Family member accompanying at the time of delivery

Mother-in-law

Mother

Husband

16 (32.0)

33 (66.0)

01 (02.0)

34 (68.0)

04 (8.0)

12 (24.0)

Table 3 depicts the comparison of mean scores of preparedness towards delivery among antenatal women in rural and urban areas. The mean scores of preparedness towards delivery in rural area antenatal women was (28.94±5.12) and significantly higher (32.10 ±4.37) in urban area antenatal women. Hence, it shows that urban antenatal women had better preparedness towards delivery as compared to rural area antenatal women (p<0.05).

Table 3 Comparison of mean score of preparedness towards delivery among antenatal woman in rural and urban area. N=100

Habitat	Preparedness towards delivery	t- value	p-value
	Mean ±SD
Rural	28.94±5.12	3.319	0.001*

Urban	32.10 ±4.37

*Highly significant (p<0.01) n=50 in each group Max score=55, Min score=0 df= 98

DISCUSSION:

Findings of the present study revealed that maximum number of antenatal women (90%) in urban area and (92%) in rural area preferred normal vaginal delivery to be conducted in hospital and preferably by the doctor were supported by Shoji A et al. (2011) who conducted a study on 247 antenatal women at Nagpur, Maharashtra which revealed that 91.5% women preferred normal vaginal delivery and 65.1% preferred caesarean delivery and 63.6% preferred their delivery to be conducted in the hospital by the doctors.⁷

Findings of the present study also showed that preparedness towards delivery in which approximately 3/4^th of antenatal women 37 (74%) in rural area and 45 (90%) in urban area had good preparedness and few of antenatal women 12 (24%) in rural area and 5 (10%) in urban area had average preparedness towards delivery were supported by Onayede AA et al. (2010) who conducted a study on 197 antenatal women at Nigeria which revealed that nearly 87.5% had decided their place of delivery, 9.1% of these planned to deliver at home, 87.8% had started to purchase items needed for delivery or newborn care. Hence, it is concluded that 61% of the pregnant women studied made adequate or good preparedness for delivery.⁸

Another findings of the present study showed that in urban area, antenatal women had better preparedness with mean score was (32.10 ±4.37) towards delivery as compared to rural area antenatal women whose mean score was (28.94±5.12) In contrast to this study, Hailu M et al. (2011) conducted a study on 298 antenatal women at Southern Ethiopia which revealed that majority (87.9%) of the respondents reported that they want to deliver at home and only 60 (8%) planned to deliver at health facilities. Overall only 17% of pregnant women were well prepared means they had knowledge regarding birth preparedness. Hence, it concluded that antenatal women had low preparedness.

CONCLUSION:

The Study that mean scores of preparedness towards delivery was significantly higher value was (32.10 ±4.37) in antenatal women from urban area as compared to antenatal women from rural area (28.94±5.12) (p<0.05). Hence, it shows that in urban antenatal women had better preparedness towards delivery as compared to rural area antenatal women. Furthermore, it is recommended to replicate the study on large sample to validate and generalized the findings.

REFERENCES:

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4. RK Adageba, KA Danso, A Donkor, F A Kokroe. Knowledge, perceptions and attitudes towards caesarean delivery among women attending antenatal clinic Kumasi, Ghana. Ganna Medical Journal 2008; 42(4): 137–140.

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Received on 02.07.2015 Modified on 27.07.2015

Int. J. Adv. Nur. Management 3(4): Oct. - Dec. 2015; Page 299-302

DOI: 10.5958/2454-2652.2015.00021.9