BACKGROUND Haiti's maternal mortality, stillbirth, and neonatal mortality rates are the highest in Latin America and the Caribbean. Despite inherent risks, the majority of women still deliver at home without supervision from a skilled birth attendant. The purpose of this study was to elucidate factors driving this decision. METHODS We conducted six focus group discussions with women living in urban (N = 14) or rural (N = 17) areas and asked them questions pertaining to their reasons for delivering at a facility or at home, perceptions of staff at the health facility, experiences with or knowledge of facility or home deliveries, and prior pregnancy experiences (if relevant). We also included currently pregnant women to learn about their plans for delivery, if any. RESULTS All of the women interviewed acknowledged similar perceived benefits of a facility birth, which were a reduced risk of complications during pregnancy and access to emergency care. However, many women also reported unfavorable birthing experiences at facilities. We identified four key thematic concerns that underpinned women's negative assessments of a facility birth: being left alone, feeling ignored, being subject to physical immobility, and lack of compassionate touch/care. Taken together, these concerns articulated an overarching sense of what we term "isolation," which encompasses feelings of being isolated in the hospital during delivery. CONCLUSION Although Haitian women recognized that a facility was a safer place for birthing than the home, an overarching stigma of patient neglect and isolation in facilities was a major determining factor in choosing to deliver at home. The Haitian maternal mortality rate is high and will not be lowered if women continue to feel that they will not receive comfort and compassionate touch/care at a facility compared to their experience of delivering with traditional birth attendants at home. Based on these results, we recommend that all secondary and tertiary facilities offering labor and delivery services develop patient support programs, where women are better supported from admission through the labor and delivery process, including but not limited to improvements in communication, privacy, companionship (if deemed safe), respectful care, attention to pain during vaginal exams, and choice of birth position.

中文翻译：

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海地在设施分娩期间对隔离的看法——一项定性研究。


背景 海地的孕产妇死亡率、死产率和新生儿死亡率是拉丁美洲和加勒比海地区最高的。尽管存在固有的风险，大多数妇女仍然在没有熟练助产士监督的情况下在家分娩。本研究的目的是阐明推动这一决定的因素。方法 我们与生活在城市 (N = 14) 或农村 (N = 17) 地区的妇女进行了六次焦点小组讨论，并向她们询问了有关在设施或在家分娩的原因、医疗机构工作人员的看法、设施或家庭分娩的经验或知识，以及之前的怀孕经历（如果相关）。我们还纳入了目前怀孕的女性，以了解她们的分娩计划（如果有）。结果 所有接受采访的女性都承认在设施分娩有类似的好处，即降低怀孕期间并发症的风险并获得紧急护理。然而，许多妇女也报告了在设施中的不利分娩经历。我们确定了四个关键主题问题，这些问题支撑了妇女对设施分娩的负面评估：被单独留下、感觉被忽视、身体无法活动以及缺乏富有同情心的触摸/护理。总而言之，这些担忧阐明了我们所说的“隔离”的总体意义，其中包括分娩期间在医院被隔离的感觉。结论 尽管海地妇女认识到在设施中分娩比在家里更安全，但患者忽视和在设施中隔离的总体耻辱是选择在家分娩的主要决定因素。 海地孕产妇死亡率很高，如果妇女继续感到与在家中由传统助产士分娩的经历相比，她们在设施中无法获得舒适和富有同情心的触摸/护理，那么海地的孕产妇死亡率就不会降低。根据这些结果，我们建议所有提供分娩服务的二级和三级机构制定患者支持计划，使妇女从入院到分娩过程都得到更好的支持，包括但不限于改善沟通、隐私和陪伴（如果认为安全）、尊重的护理、注意阴道检查时的疼痛以及选择分娩位置。