Birth Outcomes in Mothers Presenting in First Stage Compared to Second Stage of Labour at Kakamega County General Hospital

Abstract

Maternal mortality is unacceptably high. About 830 women die from pregnancy or childbirth-related complications around the world every day. It was estimated that in 2015, roughly 303 000 women died during and following pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. Admission of women in second stage of labour is often associated with poor maternal and fetal outcomes. These outcomes include: postpartum haemorrhage, obstructed labour and ruptured uterus. This study aimed to compare the birth outcomes among mothers presenting in Second Stage of labour with those who presented in First Stage of labour at Kakamega County Referral hospital. Specifically, it examined maternal outcomes and reasons why mothers presented in Second Stage of labour. A cross-sectional study using mixed methods approach was conducted in the study area. Systematic sampling technique was used to recruit the participants. Data was collected using a pre-tested structured questionnaire administered to 320 women who presented in second stage and another 320 who were admitted in first stage of labour. Two focus group discussions were also conducted in groups of six mothers. Quantitative data were coded and analysed using Statistical Package for Social Sciences (SPSS) version 20. Chi-square test and multiple logistic regression were employed in the analysis. A p < 0.05 was considered significant at 95% confidence interval. Null hypothesis was tested at 5% significance level. A significantly higher proportion of mothers in second stage 90.9% (291/320) were housewives with the majority having attained primary education (98.4%) (p < 0.0001). Prolonged/obstructed labour (11.9%) and primary PPH (9.7%) were the leading complications recorded in mothers who reported in second stage compared to 3.1% and 0.3% respectively, among those who reported in first stage. The study revealed that mothers presenting in first stage of labour had higher chances of normal labour compared to those presenting in second stage of labour (df=1, χ2 =46, p<0.0001). Mothers who reported in Second Stage (28.1%) had delayed at home because progress of labour was too fast while 26.3% presented in Second Stage because the husband was not at home.In conclusion, the study found out that most of mothers presenting in second stage of labour had either no formal education or were primary school leavers with the majority being housewives with no formal employment. It was also noted that mothers who attended ANC and completed the 4-visits presented early in labour. In regard to maternal complications, prolonged/obstructed labour and postpartum haemorrhage were most prevalent among mothers who reported in second stage of labour. For the wellbeing of the neonates and mothers, labour needs to be monitored and delivery conducted by skilled personnel. Therefore, male involvement and sensitising mothers during antenatal visits on birth preparedness would encourage them to present early in the hospital during labour.

Keywords: First Stage of labour, second stage, and factors for presentation in first and second stage, Term pregnancy.