4.3.5.1 Places and methods of delivery
Perhaps, Ethiopia has the worst facility based delivery records in the world. Based on the most recent Ethiopian Demographic and Health Survey (CSA 2014:45), fifteen percent of births in Ethiopia are delivered at a health facility - 14 percent in a public
facility and 1 percent in a private facility. Even though the percentage of facility births continues to be low in Ethiopia, there has been remarkable progress in the last fifteen years that progress from 6% (CSA 2001:113) to 15% (CSA 2014:45). An important constituent of efforts to reduce health risks to mothers and children, however, is increasing the proportion of babies that are delivered in health facilities. Proper medical attention and hygienic conditions during delivery can reduce the risk of complications and infections that can cause the death or serious illness of the mother and/or the newborn baby. The study sought to gather information on places of delivery for maternal cases and mother of the deceased Newborn babies. In this health facility centred/based study, 44 percent of maternal cases and 38 percent of mothers of deceased newborn babies deliveries had taken place at the health facility (Hospital, Health centre and Health Post including private clinics). This high institutional delivery figure (in comparison to the national data) is due to the nature of the study which is based in health facilities as the starting point of case identification. Of the remaining, 42 percent of maternal cases and 51 percent of the mothers of the deceased newborn babies deliveries had taken place at home and the rest 14 and 11 percent respectively took place elsewhere on the way to the health facilities. Similarly, 60 percent of maternal cases and 64 percent of the mothers of the deceased newborn babies deliveries were normal spontaneous vaginal delivery; 14 and 15 percent respectively were instrumental delivery (forceps or vacuum); and, 19 and16 percent of deliveries were emergency/elective caesarean section, respectively.
Table 4.12: Places and methods of delivery
Maternal cases Mothers of deceased newborn babies case Place of delivery Frequency Percent Frequency Percent
Home 56 42.10 145 50.70
4.3.5.2 Delivery outcomes
Out of the 58 cases that had delivered in health facilities, 17 were multiple pregnancies.
Noticeably, it was only for 3 of the deceased women that the diagnosed made during the prenatal period by ultra-sound scan while the others was detected during delivery.
Actually, nine of the remaining cases were referred for scanning at the hospital but did not go. The reason for not going was lack of funds as revealed during the autopsy.
They stayed on average more than 60 kilometres away from the hospital. The average number of prenatal care visits for the fourteen women with multiple pregnancies that was not diagnosed was 2. Of the 41 single births, 18 were live births and 23 ended as stillbirths. Among the multiple pregnancies, in 8 out of the 17 twins cases were still births; in another 4 women the outcome of delivery was a live birth and stillbirth twin. In only two case twins' were live births. More strikingly, of the 37 maternal and 63 newborn case deliveries that took place in the hospitals, it was only 10 of the maternal case and 14 of the deceased newborn mothers that were recommended for hospital delivery at the prenatal care clinic.
4.3.5.3 Assistance during delivery
The type of assistance a woman receives during childbirth has important health consequences for both the mother and the child. In addition, the proportion of births attended by skilled providers is a measure of the health system’s effectiveness, accessibility, and quality of care. Delivery assisted by skilled providers is the most important proven intervention in reducing maternal mortality and newborn death, and one of the MDG indicators to track national effort towards safe motherhood. Hence, obstetric care during delivery by a skilled health worker is considered critical for the reduction of maternal mortality and newborn death. Table 17 shows delivery assistance at both institutional and home delivery by types of providers. Specific to this study, nearly one in two births took place with assistance from traditional birth attendant (TBA) or relatives and the other half was managed by skilled birth attendants (SBA).
Table 4.13: Assistance during delivery
Maternal Cases Mothers of deceased newborn
Assistance during delivery Frequency Percent Frequency Percent
Doctor 11 8.27 18 6.29
Nurse/midwife 47 35.34 91 31.82
Health Extension Worker 0 0 1 0.35
Traditional Birth Attendant 39 29.32 117 40.91
Relatives (not health worker) 22 16.54 33 11.54
Non-relative 14 10.53 26 9.09
Total 133 100.00 286 100.00
Based on the most recent national data, fifteen percent of births in Ethiopia were assisted by a skilled provider: about 4 percent by a doctor and about 10 percent by a nurse or midwife. About 2 percent of births were assisted by a HEW, and 51 percent of births were assisted by a relative, or some other person. Twenty-seven percent of births were assisted by a traditional birth attendant, while 5 percent of births were unattended.
Skilled assistance at delivery increased from 6 percent to 15 percent in the last fifteen years (CSA 2014:46).
4.3.5.4 Very common issues identified at health facilities
Table 4.14: Common issues at the health facilities
Obstetric referral hospital Primary care facilities Delay in deciding to institute active management
by the doctor providing care
Condition of patient not detected early Intermittent blackout or erratic electricity supply; Low standard of prenatal care services Shortage of drugs such as dyzapam/magnesium
sulphate, octicitonine,
Delay in evacuating patients Non-functional amenities such as sterilisers,
refrigerators, water systems, etc
Unavailability of ambulance to evacuate a patient
Shortages of blood bags Lack of reliable electricity supply
Lack of readily available blood for necessary
Patograph not systematically used and even if used only the post-partum section is attended
Delivery conducted by untrained nurse