BACKGROUND In urban Kenya, couples face a wide variety of choices for delivery options; however, many women end up delivering in different facilities from those they had intended while pregnant. One potential consequence of this is delivering in facilities that do not meet minimum quality standards and lack the capacity to provide treatment for obstetric and neonatal complications. METHODS This study investigated why women in peri-urban Nairobi, Kenya deliver in facilities they had not intended to use. We used 60 in-depth audio-recorded interviews in which mothers shared their experiences 2-6 months after delivery. Descriptive statistics were used to summarize socio-demographic characteristics of participants. Qualitative data were analyzed in three steps i) exploration and generation of initial codes; ii) searching for themes by gathering coded data that addressed specific themes; and iii) defining and naming identified themes. Verbatim excerpts from participants were provided to illustrate study findings. The Health Belief Model was used to shed light on individual-level drivers of delivery location choice. RESULTS Findings show a confluence of factors that predispose mothers to delivering in unintended facilities. At the individual level, precipitate labor, financial limitations, onset of pain, complications, changes in birth plans, undisclosed birth plans, travel during pregnancy, fear of health facility providers, misconception of onset of labor, wrong estimate of delivery date, and onset of labor at night, contributed to delivery at unplanned locations. On the supply side, the sudden referral to other facilities, poor services, wrong projection of delivery date, and long distance to chosen delivery facility, were factors in changes in delivery location. Lack of transport discouraged delivery at a chosen health facility. Social influences included others' perspectives on delivery location and lack of aides/escorts. CONCLUSIONS Results from this study suggest that manifold factors contribute to the occurrence of women delivering in facilities that they had not intended during pregnancy. Future studies should consider whether these changes in delivery location late in pregnancy contribute to late facility arrival and the use of lower quality facilities. Deliberate counseling during antenatal care regarding birth plans is likely to encourage timely arrival at facilities consistent with women's preferences.

中文翻译：

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女人为什么要把她们原计划去的地方送去？来自肯尼亚内罗毕郊区的定性研究。

背景技术在肯尼亚市区，夫妻在分娩方式上面临多种选择。但是，许多妇女最终分娩的方式与怀孕时的原意不同。这样做的潜在后果之一是提供的设备达不到最低质量标准，并且缺乏提供产科和新生儿并发症治疗的能力。方法这项研究调查了为何肯尼亚内罗毕郊区的妇女提供其本来不打算使用的设施。我们进行了60次深度录音采访，母亲在分娩后2-6个月分享了他们的经验。描述性统计用于总结参与者的社会人口统计学特征。定性数据通过以下三个步骤进行分析：i）探索和生成初始代码；ii）通过收集针对特定主题的编码数据来搜索主题；iii）定义和命名已识别的主题。提供了参与者的逐字摘要以说明研究结果。健康信念模型用于阐明分娩地点选择的个人驱动因素。结果研究结果表明，多种因素使母亲倾向于在意想不到的设施中分娩。在个人层面上，会加剧分娩，财务限制，疼痛发作，并发症，分娩计划变更，未公开的分娩计划，怀孕期间的旅行，对医疗机构提供者的恐惧，对分娩的误解，分娩日期的估计错误以及分娩夜间的劳动力，有助于在计划外地点交货。在供应方面，突然转介到其他设施，服务水平差，交货日期的错误预测以及与选定交货地点的距离过长，都是导致交货地点发生变化的因素。缺乏运输不鼓励在选定的医疗机构进行分娩。社会影响包括其他人对交付地点的看法以及缺乏助手/护送。结论这项研究的结果表明，多种因素导致妇女在怀孕期间未打算使用的设施中分娩。未来的研究应考虑妊娠后期分娩地点的这些变化是否会导致迟到的设施和使用质量较低的设施。在产前保健期间对生育计划进行慎重的咨询可能会鼓励及时到达符合妇女喜好的设施。以及与所选运送设施的长距离是运送地点变化的因素。缺乏运输不鼓励在选定的医疗机构进行分娩。社会影响包括其他人对交付地点的看法以及缺乏助手/护送。结论这项研究的结果表明，多种因素导致妇女在怀孕期间未打算使用的设施中分娩。未来的研究应考虑妊娠后期分娩地点的这些变化是否会导致迟到的设施和使用质量较低的设施。在产前保健期间对生育计划进行慎重的咨询可能会鼓励及时到达符合妇女喜好的设施。以及与所选运送设施的长距离是运送地点变化的因素。缺乏运输不鼓励在选定的医疗机构进行分娩。社会影响包括其他人对交付地点的看法以及缺乏助手/护送。结论这项研究的结果表明，多种因素导致妇女在怀孕期间未打算使用的设施中分娩。未来的研究应考虑妊娠后期分娩地点的这些变化是否会导致迟到的设施和使用质量较低的设施。产前保健中有关生育计划的慎重咨询可能会鼓励及时到达符合女性喜好的设施。缺乏运输不鼓励在选定的医疗机构进行分娩。社会影响包括其他人对交付地点的看法以及缺乏助手/护送。结论这项研究的结果表明，多种因素导致妇女在怀孕期间未打算使用的设施中分娩。未来的研究应考虑妊娠后期分娩地点的这些变化是否会导致迟到的设施和使用质量较低的设施。在产前保健期间对生育计划进行慎重的咨询可能会鼓励及时到达符合妇女喜好的设施。缺乏运输不鼓励在选定的医疗机构进行分娩。社会影响包括其他人对交付地点的看法以及缺乏助手/护送。结论这项研究的结果表明，多种因素导致妇女在怀孕期间未打算使用的设施中分娩。未来的研究应考虑妊娠后期分娩地点的这些变化是否会导致迟到的设施和使用质量较低的设施。在产前保健期间对生育计划进行慎重的咨询可能会鼓励及时到达符合妇女喜好的设施。结论这项研究的结果表明，多种因素导致妇女在怀孕期间未打算使用的设施中分娩。未来的研究应考虑妊娠后期分娩地点的这些变化是否会导致迟到的设施和使用质量较低的设施。在产前保健期间对生育计划进行慎重的咨询可能会鼓励及时到达符合妇女喜好的设施。结论这项研究的结果表明，多种因素导致妇女在怀孕期间未打算使用的设施中分娩。未来的研究应考虑妊娠后期分娩地点的这些变化是否会导致迟到的设施和使用质量较低的设施。在产前保健期间对生育计划进行慎重的咨询可能会鼓励及时到达符合妇女喜好的设施。