EFFECTIVENESS OF EDUCATIONAL PROGRAM ON UTILIZATION OF ALTERNATIVE BIRTHING POSITIONS DURING SECOND STAGE OF LABOUR AMONG PARTURIENT WOMEN IN FORMER WESTERN KENYA

Abstract

Alternative birth positions are one of the interventions in reducing maternal and neonatal mortality and morbidity (WHO, 2020).The use of supine positions during second stage has been associated with maternal neonatal complications. supine or lithotomy positions is the most used position in both develop and developing countries, despite of evidenced based literature which discourages its utilization, this has been associated to lack of knowledge among parturient women. The study, therefore aimed at investigating effectiveness of educational program on utilization of alternative birth positions during second stage of labor among parturient mothers in western Kenya. The study was a non-equivalent pre and post test quasi experimental research design. Antenatal register was used as sampling frame and systematic sampling was used to identify and allocate participants to both groups of study.Sample size was computed using fleis formular with a total 500 as the sample size. The intervention group received two sessions of 2 hours each of the training between the 32th to 37th weeks of gestation. Data was collected using standard questionnaire, checklist,and focus group discussions. Data was analyzed using Statistical SPSS version 28. Chi-Square, paired t-test, logistic regression were the main statistical tests with p<0.05.Lithotomy position was the most used birth position during the last delivery, with 94.6% control,93.3% intervention. Both groups had limited Knowledge about alternative birth positions at baseline, with only 1.68%(intervention) and 1.23% (control group).The intervention group had increase in knowledge of alternative birth positions, from 0% at baseline to 68.5% at end line ( χ2= 41.6, p < 0.001),control group remained static, with no knowledge reported at baseline and only 9.4% at end line(after education).The intervention group uptake alternative positions from 6.7% to 68.5% at end line, control group (5.3% to 10.7% in end line), χ2= 16.8, p= < 0.001.Being married ( p = 0.028) or being unemployed (housewives or farmers) ( p = 0.044) decreased uptake of alternative birth position. Necessary resources, facilitated utilization of alternative birth position (AOR = 28.64; p < 0.0001). Previous birthing experiences negatively influenced decision regarding birth positions (AOR = 0.40; p = 0.037). Spontaneous labor was also more in the intervention group (51.0%),control group (49.0%), χ2=4.6, p=0.032).Intact perineums (62.1%) and a lower rate of episiotomies (4.7%) compared to the control group, with (χ2=96.4, χ2=306.7, respectively, p= 0.0001. Intervention group had higher rate of blood loss less than 500ml (53.6%), control group (46.4%), χ2 =27.1, p=< 0.0001 and a lower rate of augmentation during the second stage of labor (28.6%) ,control group (71.4%), χ2 =6.6 , p= 0.010 was also observed. Likewise intervention group had shorter mean duration of the second stage of labor (18.9 minutes) compared to the control group (62.1 minutes), with a t-test = -18.8, p=< 0.0001 and had a higher rate of 1st Minute APGAR scores ≥7 (57.4%),control group (42.6%), with a p= < 0.0001.In conclusion the study showed that educating Parturient women during prenatal visits increases the knowledge on alternative birth positions and improves uptake of alternative birth positions during second stage of labour. Marital status, occupation, previous birthing experiences, access to equipment are critical factors influencing the uptake of alternative birth positions educating parturient women on alternative birth positions during second stage will enable them to make inform choice and enhance the overall positive birth outcomes. the study recommend incorporating educational program into routine prenatal care to ensure that all parturient women have access to information on alternative birthing positions.