Routine care of women experiencing normal deliveries in Zambian maternity wards: a pilot study.

OBJECTIVE

To describe the routine care of women during normal labour and delivery, and the immediate care of newborn babies in Zambia at different levels of health care.

DESIGN

A descriptive survey carried out between July 1994 and January 1995.

SETTING

Eleven maternity facilities, one University teaching hospital, two urban health centres and eight rural hospitals in one province in Zambia.

PARTICIPANTS

Eighty-four women in normal childbirth and their babies studied from admission to the labour ward until time of discharge from the labour ward.

MEASUREMENTS AND FINDINGS: Observations related to the care of the women during normal labour and delivery, and the immediate care of the baby. The findings show that women were confined to bed during the whole labour and delivery period, food and drinks were withheld, and no gowns were provided. None of the women were allowed to have a companion present during labour. Fetal monitoring was inconsistent and the partograph was either not used or partly lacking. All women were delivered in a lithotomy position and primiparae were fixed in stirrups during the second and third stages of labour. There was general lack of support for early mother/baby contact, prevention of hypothermia in the babies and early initiation of breast feeding.

IMPLICATIONS FOR PRACTICE: Based on our findings we suggest that many present maternity ward routines, both physiological and psychological, should be carefully studied. It is also suggested that the midwives reorient their caring practices to more culturally and evidenced-based maternity care. Refresher courses for midwives who have been working for many years are recommended.