IMPACT OF FAMILY (SOCIAL) SUPPORT ON DELIVERY OUTCOMES OF ANTENATAL ATTENDEES IN OUR LADY OF APOSTLES (O.L.A.) HOSPITAL, JOS.

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IMPACT OF FAMILY (SOCIAL) SUPPORT ON DELIVERY OUTCOMES OF ANTENATAL ATTENDEES IN OUR LADY OF APOSTLES (O.L.A.) HOSPITAL, JOS.

SUMMARY

Background: Pregnancy and delivery constitute a period of significant life changes in women with associated major physiological and psychological adjustments often associated with anxiety and stress. Providing family support by husbands/family members to the women is expected to reduce this stress and improve delivery outcomes.

Objectives: The general objective was to determine the impact of family support for pregnant women on delivery outcomes in Our Lady of Apostles Hospital Jos, as a step towards reducing infant and maternal mortality in Nigeria. The specific objectives included the following:-

Determining the sociodemographic characteristics of the study participants, proportion of women accompanied by husband/family member to the ANC and/or during labour, level of family support of participants using the perceived social support–family scale, relationship between sociodemographic characteristics and the level of family support, delivery outcomes of study participants and correlation with the level of family support.

Design: An observational study of a cross section of pregnant women attending ANC at OLA hospital, Jos. A total of 350 women were recruited at the ANC and followed up till delivery. All participants completed the study. The level of family support was assessed using a questionnaire and the delivery outcomes measured after delivery. There were three levels of family support (ie strong, weak and none). Maternal delivery outcomes included maternal morbidity/mortality, duration of labour and mode/route of delivery. Fetal outcomes included gestational age at birth, delivery status of fetus, birth weight, Apgar score and fetal morbidity/mortality at birth.

Results: There was a significant difference in both maternal and fetal delivery outcomes in relation to the various levels of family support at p-value of 0.01. Strong family support impacted positively on the delivery outcomes while weak/no family support impacted negatively.

Conclusion: Delivery outcomes can be improved by strengthening the family support for women.

                                      TABLE OF CONTENTS                                                           Pages Title page………………………………………………………………………………………..

Declaration……………………………………………………………………………………...i

Dedication……………………………………………………………………………………....ii

Acknowledgement……………………………………………………………………………...iii

Certification……………………………………………………………………………………..iv

Table of Contents…………………………………………………………………………….….v

List of Tables…………………………………………………………………………………....viii

List of Figures…………………………………………………………………………………...ix

List of Abbreviations…………………………………………………………………………......x

Summary………………………………………………………………………………………….1

CHAPTER ONE:  INTRODUCTION

1.1 Introduction…………………………………………………………………………………2

1.2 Statement of the problem……………………………………………………………………6

1.3 Aim ………………………………………………………………………………………….7

1.4 Objectives……………………………………………………………………………………7

1.5 Justification of the study…………………………………………………………………….7

CHAPTER TWO:   LITERATURE REVIEW

2.1      Historical background of antenatal care…………………………………………………...9

2.2      The traditional antenatal care model……………………………………………………...12

2.3      The WHO antenatal care model (Focused antenatal care)………………………………..14

2.3.1   Components of the new WHO antenatal care model……………………………………..15

2.3.2   Activities during the four visits of the basic component of the new WHO ANC model...18.

2.4     Factors affecting delivery outcomes………………………………………………………25

2.4.1 Socioeconomic and cultural factors………………………………………………………..26

2.4.2 Health status of women…………………………………………………………………….26

2.4.3 Reproductive status of women….…………………………………………………………27

2.4.4 Access to health services…………………………………………………………………..27

2.4.5 Health care behaviour/use of health services………………………………………………27

2.5 Factors affecting fetal outcomes ………...…………………………………………………..28

2.6    Relationship between family dynamics and family support………………………………31

2.7    Impact of family (social) support on health……………………………………………….32

2.8    Overview of family support during antenatal care and delivery on birth outcomes………38

CHAPTER THREE:     MATERIALS AND METHOD

3.1   Study area…………………………………………………………………………………..45

3.2   Study population…………………………………………………………………………...45

3.3   Study design………………………………………………………………………………..45

3.4   Sample size determination…………………………………………………………………46

3.5   Sampling method…………………………………………………………………………..47

3.6   Selection criteria……………………………………………………………………………48

3.7   Ethical consideration……………………………………………………………………….48

3.8   Study protocol……………………………………………………………………………...48

3.9   Data analysis………………………………………………………………………………..51

CHAPTER FOUR:   RESULTS

4.1       Introduction………………………………………………………………………………52

4.2       Socio-demographic characteristics of participants…………………………….……...…53

4.3       Level of Family support of study participants……………….………………………….55

4.4     The relationship between sociodemographic characteristics of participants and the level of

family support……………………………………………………………………………………60

4.5      Correlation between delivery outcomes and level of family support…………………….64 CHAPTER FIVE:   DISCUSSION

5.1       Socio-demographic characteristics of participants………………………………………74

5.2        Determinants of Family support………………………………………………………...78

5.3        Family support and delivery outcomes……………………………………………….....81

5.4        Conclusion……………………………………………………………………………....87

5.5        Relevance of the study to Family medicine……………………………………………..87

5.6        Strengths and limitations of the study………………………………………………..….88

5.7        Recommendations…………………………………………………..……………...……88

REFERENCES………………………………………………………………………………......89

APPENDICES:

                                         CHAPTER ONE.  INTRODUCTION.

 

1.1       BACKGROUND OF THE STUDY.

Many definitions of the family have been popularized. One of them states that ‘the family is a small social system made up of individuals related to each other, biologically or by reason of strong affections and loyalty that comprises of a permanent household and persist over decades’.1 The family is the most basic institution in any society. People are born into a family, live much of their lives within a family and consider it to be a high priority in their value systems.1 Social or family support is a support system within the family that provides assistance and encouragement to individuals with physical or emotional problems in order that they may better cope.1,2 The primary function of a family is the provision of nurture and support for psychosocial growth and development of its members.  

A growing body of literature demonstrates that social relationship within the family has a  positive

impact on physical and psychological wellbeing of family members.1,2 Social relationships are thought to be supportive to the extent that they provide individuals with access to resources during times of life stress and transition as well as a general sense of self-worth and psychological wellbeing.1,3 Pregnancy constitutes a time of significant life changes requiring major physiological and psychological adjustments often associated with anxiety and stress.4

During pregnancy and child birth, family support is considered essential to the health and wellbeing of the expectant mother and the fetus.3 The provision of emotional, psychological and material support may mitigate the physical and psychological strains associated with pregnancy and childbirth.3,4 Support may also motivate the expectant mother to engage in positive health behaviours and make life changes that may improve her physical health.5,6 Thus, there are multiple pathways through which social (family) support may be linked to improved maternal and fetal health and consequently better birth outcomes.

Human reproduction is a biological phenomenon. However, sociocultural factors such as marital status influence pregnancy outcomes and reproductive success.7 In a study to determine the impact of maternal marital status on pregnancy outcomes in Austria between 1999-2004, it was found that:  the rate of preterm delivery and the rate of low birth weight term babies were significantly higher among unmarried mothers in comparison to married mothers. In addition, the newborns of unmarried mothers were significantly lighter and shorter than those of married mothers. No significant differences between unmarried and married mothers were found regarding mode of delivery.7 Unmarried status represented an important stress factor for the pregnant women and therefore, lack of family or social support.7

Similar findings were reported by Alio et al in Florida, USA. They reported that most low birth weight babies, preterm births and small for gestational age babies were seen among father-absent births.8 It was recommended that paternal involvement and family support be promoted during the perinatal period in order to decrease the proportion of infants born of very low birth weights or preterm.

A number of other studies have examined the influence of family support during pregnancy on birth weight and gestational age at birth which are considered as primary indicators of newborn health. Results of such studies suggest that the higher amount and quality of prenatal support received by the expectant mother were associated with higher values of the 5–minute Apgar scores and fewer problems during labour.3,5 For example, support from husbands or male partners benefited expectant mothers in terms of better psychological and physical wellbeing and was

related to improved infant outcomes.4-6,9-13 Some researchers in Britain revealed that, lack of close, confiding partner or family member was related to greater risk of having a small for gestational age (SGA) infant.5 Similar research carried out in USA found that, being married, cohabiting with a male partner or having extended family support were both associated with higher infant birth weights.5

Some literature has also shown that women who had one-to-one support in labour were less likely to require obstetric analgesia, instrumental delivery and cesarean section. They were more likely to have shorter labour, achieve spontaneous vaginal delivery and report a more satisfying delivery experience.14

In some Nigerian communities, pregnancy and childbirth connotes family involvement, not just mentally and emotionally, but also physically and economically especially relating to delivery.14 The parturient is usually escorted to the hospital by her husband, in-laws or other relations. The labour companions are usually ‘experienced women’ who have experienced or witnessed the process of labour. They act as coaches to the parturient.11 Nowadays, most educated women desire their spouses to accompany them to the antenatal clinics and labour rooms. They prefer to have their spouses closer to them for encouragement and support and also because they want to communicate their needs to them directly especially during labour. This practice in many hospitals in Nigeria has met with a lot of challenges owing to the fact that cubicles for delivery in most labour rooms are not compartmentalized. It has also been observed in addition that, many health care providers are usually not friendly to the men in the antenatal clinics and the delivery rooms. This type of practice where male partners are allowed in the antenatal clinics and the labour rooms is encouraged. However, a family member or a close neighbour accompanying and providing support to a pregnant woman in the antenatal clinic and labour room is still a welcomed practice. The desired companionship is aimed at providing reassurance, emotional support, comfort and comforting gestures, articulation of her desires and communication with the health care providers.

Studies on the participation of husbands in maternity care reported in southern Nigeria by Odimegwu and colleagues revealed favourable outcomes for both mother and fetus.15 Other studies conducted by Morhason–Bello in Osun state reported favourable delivery outcomes of pregnant women accompanied by their husbands and providing support in the antenatal clinic.16 Zubairu et al working in Aminu Kano Teaching Hospital, Kano revealed that 32.1% of men accompanied their wives to the hospital and provided support resulted in positive pregnancy outcomes for both mother and child.17 The importance of family support in maternity care therefore, cannot be over emphasized if maternal and child health indices are to be improved in Nigeria.

In some countries, professional support caregivers in labour known as ‘doulas’ are available and employed during labour to offer these support services described above.18,19 In male dominated societies such as Nigeria and other African nations, reproductive health decisions including seeking institutional delivery lie mostly with the men who are key support partners in the family.14 The male partner (husband) may therefore be a source of companionship and provide emotional support during the antenatal care and delivery of his wife. The men do not only influence or take major decisions such as consent for operative delivery, but control the family’s finances and appropriate resources at their discretion.14

Lack of family support on the other hand, constitutes an important risk factor for maternal

wellbeing during pregnancy and has adverse effects on pregnancy outcomes.4,20-25 Preterm delivery, small for gestational age and low Apgar scores of infants have been shown to be contributory factors to infant mortality5,6 and maternal exposure to severe life events may increase

the risk of preterm and small for gestational age (SGA) infants.5,6,20-26 It is therefore important to minimize the increasing infant and maternal mortality rates in Nigeria by promoting family support for intending mothers in order to meet the millennium development goals 4 and 5.

Because the birth of a child occurs in the context of the family and community, sociodemographic factors such as distance to health facility, educational status and religion may influence the access to family support during pregnancy.3,8,9

 

1.2           STATEMENT OF THE PROBLEM:  

Low birth weight due to both impaired fetal growth and preterm birth is still a high priority public health problem in most low and middle income countries including Nigeria. High levels of psychological stress and mothers’ low socioeconomic condition are also prevalent among large sectors of resource–poor settings with consequent poor birth outcomes.

The problem is whether or not family (social) support of women during pregnancy impacts on delivery outcomes. It is therefore important to study the impact of family support for pregnant women to know the patterns of birth outcomes in order to have guidance in providing health care to this group of people. The study is also necessary because it will provide useful information on the relationship between family dynamics and family support on maternal/child health issues.

1.3    AIM:  To determine the impact of family support for pregnant women on delivery outcomes  in Our Lady of Apostles (OLA) hospital, Jos as a step towards reducing infant and maternal mortality in Nigeria.

1.4       OBJECTIVES:

  1. To determine the sociodemographic characteristics of study participants at OLA hospital

Jos.

  1. To determine the proportion of women accompanied by a family member to the ANC and/or during labour.
  2. To determine the level of family support of subjects using the perceived social support- family scale.
  3. To determine the relationship between sociodemographic characteristics and the level of family support.
  4. To determine delivery outcomes of study participants and correlate them with the level of family support.

 

1.5        JUSTIFICATION OF THE STUDY.

Family medicine encourages family members to practice healthy relationships within the family. Healthy relationships among members of a family translate into high functionality of that family and consequent good health outcome. Such healthy relationships promote support for one another in the family. This is particularly relevant in reproductive health matters concerning wives, husbands and other members of the family.

Family physicians are frontline doctors in every community and are involved in health prevention and promotion of individuals, their families and communities. Antenatal care is a typical example of a preventive health service that involves families and not only the pregnant woman.

It has been observed that most African families including Nigerian families enjoy good family relationships and consequently high social support for members in times of need such as during ill health, marriage, education and bereavement. Family support activities for pregnant women are encouraged in order to improve the poor maternal and infant health indices in Nigeria. However, much work has not been done to directly examine how family support impacts on birth outcomes of pregnant women in Nigeria. This reason justifies the study.

IMPACT OF FAMILY (SOCIAL) SUPPORT ON DELIVERY OUTCOMES OF ANTENATAL ATTENDEES IN OUR LADY OF APOSTLES (O.L.A.) HOSPITAL, JOS.

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