Tamar Kabakian-Khasholian

Women's experiences of maternity care : satisfaction or passivity?

This study is a first attempt to describe Lebanese womens responses to the medical management of their pregnancy and delivery. A qualitative approach in data collection and analysis was adopted to gain an in-depth view of womens perceptions. Women of any parity undergoing a normal vaginal delivery during the three months preceding the interview were interviewed in different areas in Lebanon: one urban, one semi-rural and two remote rural. Childbirth for all the women interviewed was managed within the medical system. Findings show that women accord total trust to their physicians, and very rarely question the usefulness of many routinely applied procedures, even those which the literature shows are unnecessary. When probed, women report that many aspects of the technical care are intimidating and that they experience discomfort with these procedures. Women are more vocal about patient-provider communication and value good interaction with their provider. The extent of passivity and feelings of discontent women have varies according to their social class and the amount of psychosocial support they receive throughout the process of childbirth.

A simple way to increase service use: triggers of women's uptake of postpartum services

Objective  To examine the socio‐demographic and service‐related determinants of utilisation of postpartum services.

Perceptions about labor companionship at public teaching hospitals in three Arab countries

To explore the perspectives of women, female relatives, and healthcare providers on labor companionship.

Impact of written information on women's use of postpartum services: a randomised controlled trial.

Background. This study evaluates the impact of providing women with written educational material on their satisfaction with care, and use of health services postpartum. Methods. All women having a live birth at 4 private hospitals in Lebanon were eligible. The sample consisted of 187 women in the intervention and 191 in the control arms. An intervention booklet was developed following a qualitative study of womens information needs; placebo material was 2 leaflets about childproofing the house. Field workers administered a baseline questionnaire to recruit all eligible women, and conducted follow‐up interviews 6–20 weeks postpartum at the womens residences. The written material was handed out to women just before discharge from hospital. At the baseline interview, interviewers and women were blinded to the nature of the written material. Outcome measures were a postpartum visit to a health professional after discharge and before the follow‐up interview, and satisfaction with maternity care received during pregnancy, delivery and postpartum. Results. Satisfaction with care during the postpartum period was 57.2% in the intervention and 38.9% in the control arm (p<0.001). Some 85% of women in the intervention arm had a postpartum visit compared to 55% in the control arm (p<0.001). Conclusion. In the context of high female literacy, the intervention is effective and requires few resources.

Health after childbirth: Patterns of reported postpartum morbidity from Lebanon

PROBLEM AND BACKGROUND The postpartum period is under-researched in low and middle income countries. The scarce literature reveals heavy burden of ill health experienced in that period and under utilisation of health services. Understanding the postpartum morbidity burden and identifying the care-seeking behaviours is essential to improve service delivery. QUESTION This paper examines reported postpartum morbidity, care seeking behaviour and whether postpartum morbidity is associated with method of birth. METHODS A cross sectional study of women delivering in 18 private hospitals from two regions in Lebanon was undertaken. Women in their second or third trimester of pregnancy, visiting private obstetric clinics affiliated with participating hospitals were interviewed for baseline information. Reported postpartum morbidity was assessed in an interview conducted at womens homes from 40 days up to six months postpartum. FINDINGS Of the 269 women recruited, physical postpartum health problems were reported by 93.6% and psychological health problems by 84.4% of women, with more health problems being reported beyond two months postpartum. Women were less likely to seek professional care for psychological health problems. Reporting postpartum health problems was not associated with method of birth. CONCLUSION A heavy burden of postpartum morbidity is experienced by women with gaps in utilisation of relevant health services. Efforts should be directed towards the organisation and delivery of comprehensive maternity care services.

Seeking maternal care at times of conflict: the case of Lebanon.

Providing quality maternity care within the emergency care packages for internally displaced populations in war-affected areas is somewhat challenging, although very essential. In this retrospective study, we describe the experiences and health care seeking behaviors of 1,015 pregnant and postpartum women during the 2006 war in Lebanon. Women reported interruptions in regular maternity care and experienced more complications during this period. Availability of health services and experiences of complications were the most important determinants of health care seeking behaviors. Maternal health services should be a part of any comprehensive emergency responsiveness plan, catering to womens needs in war-affected areas.

Incidence and correlates of cesarean section in a capital city of a middle-income country.

Abstract Objective: To determine the prevalence and correlates of cesarean deliveries (CS) in Beirut. Methods: A cross-sectional study conducted on 18,837 consecutive infants born at nine hospitals from the National Collaborative Perinatal Neonatal Network (NCPNN). Stepwise Logistic Regression was performed to determine CS correlates. Results: The rate of CS was 26.4% and correlated with socio-demographic, obstetrical and provider-related variables. Regression analysis identified age, paternal occupation, mode of payment, parity, birth weight, gestational age, multiple pregnancies, adequate prenatal care, complications during pregnancy, body mass index at delivery, hospital teaching status, day of the week and year of delivery to be significant correlates of CS. Conclusion: This study shows an increased CS rate in a middle-income country, and identifies the correlates of women delivering by the abdominal route. These correlates may be used for effective reduction policies in the future.

Companion of choice at birth: factors affecting implementation

BackgroundTwo recent recommendations made by the World Health Organization confirm the benefits of companion of choice at birth on labour outcomes; however institutional practices and policies do not always support its implementation in different settings around the world. We conducted a review to determine factors that affect implementation of this intervention considering the perspectives and experiences of different stakeholders and other institutional, systemic barriers and facilitators.MethodsForty one published studies were included in this review. Thirty one publications were identified from a 2013 Cochrane review on the effectiveness of companion of choice at birth. We also reviewed 10 qualitative studies conducted alongside the trials or other interventions on labour and birth companionship identified through electronic searches. The SURE (Supporting the Use of Research Evidence) framework was used to guide the thematic analysis of implementation factors.ResultsWomen and their families expressed appreciation for the continuous presence of a person to provide support during childbirth. Health care providers were concerned about the role of the companion and possible interference with activities in the labour ward. Allocation of resources, organization of care, facility-related constraints and cultural inclinations were identified as implementation barriers.ConclusionPrior to introducing companion of choice at birth, understanding providers’ attitudes and sensitizing them to the evidence is necessary. The commitment of the management of health care facilities is also required to change policies, including allocation of appropriate physical space that respects women’s privacy. Implementation research to develop models for different contexts which could be scaled up would be useful, including documentation of factors that affected implementation and how they were addressed. Future research should also focus on documenting the costs related to implementation, and on measuring the impact of companion of choice at birth on care-seeking behavior for subsequent births.

Mode of delivery and pain during intercourse in the postpartum period: Findings from a developing country

OBJECTIVE This study examines the association of the reporting of pain during intercourse in the postpartum period with mode of delivery, and describes womens reports of pain during intercourse and their health care seeking behavior over a period of 40 days-6 months postpartum. METHODS A cross-sectional study recruited women in their 2nd and 3rd trimester of pregnancy from private obstetric clinics affiliated with 18 hospitals in two regions of Lebanon. Face-to-face interviews using a structured questionnaire were conducted at the womens homes from 40 days to 6 months postpartum. Verbal, informed consent was obtained from all women participating in the study before the interview. RESULTS In a sample of 238 women, 67% reported experiencing pain during intercourse postpartum and 72.3% did not seek care. Women having a cesarean delivery (1.96; CI (1.29-2.63)), who were primiparous (OR=2.44; CI (2.05-2.83)) and residing in the Mount Lebanon region (OR=1.25; CI (1.09-1.40)) were significantly more likely to report pain during intercourse postpartum. CONCLUSIONS Cesarean births may increase the chances of reporting of pain during intercourse postpartum among primiparous women. Given that the increasing cesarean section rates worldwide are perceived to be protective of womens sexual health, prenatal and postpartum care need to address womens sexual health problems.

Validation of an Arabic version of the global Pelvic Floor Bother Questionnaire.

To validate an Arabic version of the global Pelvic Floor Bother Questionnaire (PFBQ), a self‐administered 9‐item symptom assessment tool.