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.
PIP: A descriptive survey conducted at 11 maternity facilities in Lusaka, Zambia, and Zambia's rural Southern Province from July 1994 to January 1995 sought to characterize the routine care of women during uncomplicated labor and delivery and the immediate care of newborns by type of health facility. A total of 84 women from 8 rural hospitals, 2 urban health centers, and 1 teaching hospital were enrolled. All facilities had a qualified midwife assigned to women in labor. Women were confined to their beds throughout labor and delivery and were not permitted to have a partner or companion present. Fetal monitor and partograph use was inconsistent. Primiparous women were put in stirrups during the second and third stages of labor, and all women were delivered in the lithotomy position. None of the newborns was fully dried to prevent hypothermia. Notable was a lack of staff support for early mother-infant contact or initiation of breast feeding. Midwives were unaware of the guidelines of the Baby Friendly Hospital Initiative. These findings indicate a need for a reassessment of present maternity ward routines, both psychological and physiological, and a review of the midwifery educational curriculum. First, however, a larger, more representative study should be conducted of maternity facilities throughout Zambia.