2023 Volume 37 Issue 1 Pages 72-84
Purpose
This study aimed to evaluate the current state of intrapartum care practices in El Salvador and examine whether the presence or absence of care makes a difference in women's satisfaction with care, based on the recommendations listed in the “WHO recommendations: Intrapartum care for a positive childbirth experience” (hereafter, WHO guidelines).
Methods
Secondary analysis was performed on data from a baseline survey conducted to assess the effectiveness of the interventions of the Japan International Cooperation Agency (JICA) Technical Cooperation Project for “Humanization of Childbirth based on Scientific Evidence in the National Women's Hospital” (hereafter, project). In the project, pregnant women who were admitted to the National Women's Hospital of El Salvador for vaginal delivery were recruited to (1) a direct observation survey on care during labor, and to (2) an interview regarding satisfaction with obstetric care on postpartum women, from May to June 2021. Those who participated in both the survey and the interview were included in the secondary analysis. Of the 56 items of care specified in the WHO guidelines, 22 were examined and the relationships between the care items and the scores of the Care in Obstetrics: Measure for Testing Satisfaction (COMFORTS) scale were analyzed by conducting a Mann-Whitney U test.
Results
Forty-four women were included in the study. The median COMFORTS scale score was 154 out of 200. Women with heavy postpartum hemorrhage were significantly less satisfied with the COMFORTS subscale of “Care during labor” (p=0.046). Further, women who were not administered prophylactic uterotonics for postpartum hemorrhage prevention as part of the active third stage of labor were also significantly less satisfied with obstetric care (p=0.042). Among the recommended care items, those routinized in El Salvador (including the use of prophylactic uterotonics for the prevention of postpartum hemorrhage and early skin-to-skin contact) were followed. However, vaginal examination at intervals of four hours and intermittent fetal heart rate auscultation were not followed. Non-recommended care including fundal pressure (Kristeller maneuver) and nasal or oral suctioning of the newborn was also observed.
Conclusion
Satisfaction was lower when women experienced postpartum hemorrhage or were not administered prophylactic uterotonics during the third stage of labor; these women may have felt that they did not receive adequate care. The results indicate that women who received the adequate care recommended in WHO guidelines and experienced better birth outcomes reported higher levels of satisfaction. The study suggests the need to ensure proper intrapartum care practices and provide adequate obstetric care to women in El Salvador to ensure proper satisfaction.
