A Timeframe Study on Delay in Seeking Care During Delivery on a Group Representative of Mortality Cases

There is often a paucity of data on maternal mortality partly due to failure to handle a sensitive issue and partly due to under reporting of maternal mortality Most maternal deaths occur just before, during, or just after delivery, It can be assumed that those obstretics morbidities which require active emergency intervention (operative/instrumental) are representative of causes of maternal mortality, where lack of timely intervention in the peri delivery period can cause mortality. Further the list of most common indications for intervention coincides with the leading causes of maternal mortality. These mothers who receive active and emergency management at a hospital can be justified to be proxy representative of the unfortunate maternal mortality cases where similar circumstances but dissimilar management caused the catastrophe Thus conducting a study on this proxy representative population can throw light on various factors causing maternal mortality.

Based on the classical 3 delays that model this study was designed to find out the time frame and significant events causing delay in seeking medical attention during delivery on a representative proxy population.

Study was done for 45 days (1July-15 August, 2011) days on cases which were decided upon intervention (i.e proxy representative population of maternal mortality) within one hour of admission with a pretested questionnaire administered by investigator

89% were unbooked,. 33% were obstructed labour disorder. 17 cases were referred twice with a total delay of 20.5 hours(transit expense Rs 675), 53 delayed for 13 hours with one referral(transit expense Rs 450) while the last group of 29 delayed 8 hours entirely at home(transit expense Rs 230) 76% received government based health insurance with Rs 100 as transit money.

Conclusive findings were large percent of unbooked cases, untrained personels attending the mothers causing delay at initial stage, inadequacy at first level health facility & lack of reimbursement for travelling. Avid campaigning at household level for institutional delivery, proper reimbursement can cut short the delay in seeking health care. Furthermore these study population can be further explored to find out more about the problems of maternal health which require attention.