"Home births in a squatter settlement of Karachi: why women choose homebirth; factors, issues and experiences

Home birth is common in developing world due to lack of resources, unawareness and cultural restrictions. Home birth rates in developed countries are considerably low. In Pakistan, 80% of the births take place at home... [ view full abstract ]

Home birth is common in developing world due to lack of resources, unawareness and cultural restrictions. Home birth rates in developed countries are considerably low. In Pakistan, 80% of the births take place at home attended by 'untrained" personnel.

The basic purpose of our study was to provide an understanding of the reasons and factors behind homebirths in a squatter settlement. We aim to provide the implications for practice for Traditional Birth Attendants(TBAs), physicians, obstetric nurses and women of childbearing age.

The women who had given birth at home were asked to participate in the study. The data were collected by conducting in-depth interviews. Out of 100 women interviewed, 84% gave birth to their first child at home and 56 % had all home births. Deliveries conducted by Dai's at home were most common (46%), others were conducted by either female members at home or neighbours (10%). 54% responded that the decision of home delivery was self-made, 27.4% reported the family members specifically the mother in law made the decision. the reasons presented to giving birth at home were 1)poor economic status (2) afraid of doctors/hospitals (3) belief that home is comfortable (4) more trust in TBAs conducting delivery (5) following tradition (6) under peer pressure.
In the last two pregnancies, at least one antenatal care visit to an obstetrician/gynaecologist was made by 64% but less than half consulted a doctor for postnatal care(25.5%). 53% stated that home births are not safer and 70% said that they had a better experience of delivering at home.
Neonatal deaths were common in cases conducted by TBAs. Major barrier to hospital births turns out to be economic constrains and fear of doctors and hospital among women.

Key words: pregnant women, home delivery, TBAs, doctor, postnatal care, antenatal care, squatter settlement.