EFFECTS OF AN EDUCATIONAL INTERVENTION PROGRAM IN THE OUTCOME OF NORMAL CHILDBIRTH: A CASE STUDY OF KAKAMEGA COUNTY, KENYA

Abstract

Women experience severe childbirth pain, which is one of the most agonizing pains experienced by women in their lifetime. As such, there are attempts to effectively manage childbirth pain. However, limited studies have been done on childbirth pain interventions and hence their effectiveness in the context of Kenyan health system. The study sought to find out the impact of an educational intervention program on normal childbirth among women attending maternal health services in Kakamega County since its maternal and neonatal mortality rates compare with national statistics hence need for reduction of these outcomes. Specifically, the study sought to determine the effect of the educational intervention program on the intensity of childbirth pain, self-efficacy during labour, specific maternal and neonatal outcomes as well as women’s experiences with childbirth pain at the health facilities in Kakamega County. A mixed method approach was adopted where both quantitative and qualitative data was collected. A quasi-experimental design was used for the quantitative data while phenomenological design was utilised for the qualitative data on women’s experiences with child birth pain. The target population were pregnant women attending antenatal services at the health facilities within Kakamega County. Fisher et al formula was utilised with a total of 400 as the sample size. Inclusion criteria entailed mothers who had low risks and went through spontaneous vaginal delivery. Simple random sampling was used to choose the facilities as well as mothers in the intervention N=184 and the control N=191 groups. Theintervention group received two sessions of 3 hours each of the training between the 31st 33rdweeks of gestation. Ethical standards were adhered to and informed consent was obtained from all the participants. Data collection tools included structured questionnaires, Mac Gill pain questionnaire, visual analogue scale, childbirth self efficacy inventory questionnaire and an audio tape recorder for describing women’s experiences with pain. Data analysis was done by means, Mann-Whitney –tests, chi square, multivariate logistic regression; independent t tests.19 mothers had in-depth interviews and thematic analysis was utilised to analyse their qualitative data. The intervention group significantly demonstrated lower perceived pain both on the visual analogue scale (P<0.001) and the McGill pain questionnaire (P<0.001). Mothers in the intervention group had higher post-test scores for Outcome Expectancy (OE) and Efficacy Expectancy (EE), P<0.001, reported less fear and anxiety than in control group P<0.001 and felt capable and more in control during childbirth.On the contrary mothers in the control group had more maternal and neonatal complications(P<0.001) and a negative birth experience compared to those in the intervention group. In the qualitative analysis mothers in the intervention had positive birth experiences and more coping strategies compared to their counterparts. The study concludes that an educational intervention program based on self-efficacy theory was effective in lowering pain perception, enhancing self-efficacy, improving maternal and neonatal outcomes as well as recording positive experiences among mothers. The study therefore recommends that this program should be incorporated into antenatal care specifically in the third trimester to prepare mothers adequately for the adverse process of labour by increasing their knowledge, coping mechanisms to childbirth pain and improving their psychological status before labour to achieve better maternal neonatal outcomes.