The pathway of obstructed labour as perceived by communities in south-western Uganda: a grounded theory study

Abstract

Background : Obstructed labour is still a major cause of maternal and perinatal morbidity and mortality in Uganda, where many women give birth at home alone or assisted by non-skilled birth attendants. Little is known of how the community view obstructed labour, and what actions they take in cases where this complication occurs.

Objective : The objective of the study was to explore community members’ understanding of and actions taken in cases of obstructed labour in south-western Uganda.

Design : Grounded theory (GT) was used to analyse data from 20 focus group discussions (FGDs), 10 with women and 10 with men, which were conducted in eight rural and two urban communities.

Results : A conceptual model based on the community members’ understanding of obstructed labour and actions taken in response is presented as a pathway initiated by women's desire to ‘protecting own integrity’ (core category). The pathway consisted of six other categories closely linked to the core category, namely: (1) ‘taking control of own birth process’; (2) ‘reaching the limit – failing to give birth’ (individual level); (3) ‘exhausting traditional options’; 4 ‘partner taking charge’; (5) ‘facing challenging referral conditions’ (community level); and finally (6) ‘enduring a non-responsive healthcare system’ (healthcare system level).

Conclusions : There is a need to understand and acknowledge women's reluctance to involve others during childbirth. However, the healthcare system should provide acceptable care and a functional referral system closer to the community, thus supporting the community's ability to seek timely care as a response to obstructed labour. Easy access to mobile phones may improve referral systems. Upgrading of infrastructure in the region requires a multi-sectoral approach. Testing of the conceptual model through a quantitative questionnaire is recommended.

• obstructed labour
• community members
• understanding
• actions
• protecting own integrity
• Uganda
• Africa
• maternal mortality
• childbirth
• delivery care
• mobile phones
• transport

Acknowledgements

This study was funded by grants from Global Health Research Initiative (GHRI) and Swedish International Development Cooperation Agency (Sida). We extend our thanks to all women and men who participated in the study and their openness in the discussions. All authors (JK, P-OÖ, ME, PK, KOP) participated in the different phases of the study. JK was the principal investigator. JK and KOP participated in the conception and design of the study. JK and PK did primary data collection. JK and KOP conducted data analysis. JK wrote the first draft whereas the other authors (P-OÖ, ME, PK, KOP) made interpretations, reviews, and contributions towards developing the final manuscript.