Study Area
The study was conducted in three hospitals within the Tamale metropolis. These include Tamale Teaching Hospital, Tamale West Hospital and Tamale Central Hospital. These hospitals record high patient attendance especially for maternal healthcare services like ANC, labour and delivery as well as post-delivery services. The Metropolis features a total estimated land size of 646.90180sqkm (Hassanzadeh et al., 2020). It shares boundaries with the Sagnarigu District to the west and north, Mion District to the east, East Gonja to the south, and Central Gonja to the south-west with a population of 233,252 representing 9.4 per cent of the region’s population.
Males constitute 49.7per cent and females represent 50.3 per cent.
Study Design
The study was qualitative in nature employing an explorative descriptive design. Burns and Grove (2003) describe a qualitative approach as “a systematic subjective approach used to explore and describe experiences, situations and give them meaning. Holloway and Wheeler
(Hassanzadeh et al., 2020) refers to qualitative research as “a form of social inquiry that focuses on the way people interpret and make sense of their experiences and the world in which they live in”. By these definitions, qualitative research seeks to explore the behaviors, perspectives, feelings, and experience of people and have an understanding of these elements. This design was chosen because it allowed participants to give an in-depth information on the subject under study in their own words through open-ended questions. It also allowed the researchers the flexibility to probe responses from the participants for clarification. By this, responses that would be meaningful and culturally relevant to the participants would be called to mind. Through this study design, issues that would have never been anticipated by the researcher was discussed as the participants would give their responses (Shourab et al., 2016)
Study Population
The study population comprised all first-time mothers in the Tamale metropolis.
Sample Size Determination
This was based on data saturation, where no new themes were emerging. Approximately 15 first time mothers were recruited from the selected hospitals within the Tamale metropolis.
Sampling Technique
A purposive sampling technique was used to select participants from among the three health facilities within the Tamale metropolis. Kassiani N. (2022) describes purposive sampling as “sampling technique in which researcher relies on his or her own judgement when choosing members of population to participate in a study”. This approach was therefore used to select first time mothers to share insightful information about the research questions to achieve the research objectives.
Data Collection Method
Interviews were conducted for data collection. The interview was a face-to-face, one-on-one interaction and it involved an interviewer and a participant which was audio-recorded. This was done to elicit a “vivid picture of the participant’s perspective” on the research topic (Arranz-
Martín et al., 2021). Mack et al., (2005) describe this form of the interview as a “student-expert” chat where the researcher is considered a student and the interviewee is the expert. This was because the researcher wishes to know more about the research topic by asking the interviewee questions and then aimed to understand and not miss any vital information by listening attentively and asking follow-up questions and probing for clarification. Interviews helped the researcher to elicit rich and complex information from the participants. In-depth interviews were chosen as the primary data collection method to enabled participants to ‘tell their story most deeply and richly possible during the interview process. Field notes were taken on observable and non-verbal information as a backup to the audio recordings in the sense that the observed nonverbal clues could add some meaning to the verbal recordings during the write-up of the report. The notes were taken during the interviews and immediately after the interviews, they were transcribed. Some of the field notes taken, were captured as nonverbal clues such as movement of body, laughter or prolong silence before answering a question that was asked, the facial expression of surprise, sadness, etc.
Data Collection Instrument
The validity of any research is dependent on the extent to which it can be imitated by another researcher. For this reason, apart from having a clear data collection approach, it is equally important to have good data collection instruments. The study therefore, would employ the use of a semi-structured interview guide for the discussions. A semi-structured guide was used because it only serves as a guide, as the name suggested, while it allowed participants to speak on other issues through probing by the interviewer during the process. The guide included information on participants’ socio-demographic data such as the age of mother and child, marital/partner status, occupation, educational level, religion and the main questions were asked to elicit responses to meet the objectives of the study.
Pre-Testing of Data collection Instrument
Before the actual data collection in the study area, a pilot study was conducted to test the interview guide to improve its quality and efficiency of the interview guide. The pilot study is a small-scale version of the full study to be performed later (Huang et al., 2021) allowed us to experience some of the challenges that we were likely to face in the field during the actual data collection. The pilot study would help design a further confirmatory study and help in testing the study procedures, the validity of tools, estimations of the recruitment rate. The pilot study was conducted with two mothers to find out if the questions were clear and understandable. This allowed us to add more items as follow-up questions and possible probes.
Data Collection Procedure
Introductory letter from the Department of Midwifery and Women’s Health and approval letter from the research Supervisor as well as Ethical clearance from the Ethics committee of KNUST was collected towards data collection. Authority letter from recruitment sites was also taken. One-on-one and face to face interviews with a semi-structured interview guide developed based on literature and guided by the study objectives was conducted. Informed consent was sought from recruited participants preceding data collection.
The interviews conducted with mothers was done in a quiet and convenient environment. To guarantee efficient time management, the interview process started as soon as the first mother was recruited. Before the interview, an introduction of the investigators was done and then the purpose of study, the structure of the interview, possible length of the interview, the benefits and risks of participating, volunteer agreement, and also confidentiality of any information was given. Based on this explanation, participants were allowed to sign/thumb print a consent form to indicate their voluntary participation. Permission to use a tape recorder was sought from participants before the interview. The tape recorder was positioned close enough to the researcher and participants to record the conversation to preserve the participants’ words during the interview. This enabled the researchers to maintain eye contact with the participant. Notetaking of nonverbal behavior was done to give additional meaning to audio-recorded interviews.
The questions took the form of a narrative and then problem-focused. The narrative part was requesting the participant to tell her story of her pregnancy including whether it was planned or not, reaction to news of pregnancy by self or others. Then was followed by the problem-focused questions on her actual experiences, physical changes, antenatal services, delivery/labour and a few weeks after delivery, support received, and sources of support. During the interview session, follow-up questions were asked based on the responses of the participants to help them understand issues better and to obtain more information for this study.
Data Processing and Analysis
- Interviews were transcribed verbatim using a computer.
- The researcher finally counts all the interviews and compare if it tallies with the number transcribed into the laptop.
- The transcripts were read through severally to gain understanding and become engrossed with the content.
- Data was coded and similar codes grouped into sub-themes, then main themes with the assistance of Microsoft office word.
- To understand the meanings and the experiences of first-time mothers, content analysis was used.
Ethical Considerations
Ethics for this study was sort from the Committee on Human Research Publication and Ethics of the Kwame Nkrumah University of Science and Technology, Kumasi.
The following ethical procedures were considered as well.
- The purpose of the study was made known to all participants. Also, the expected outcomes of the study were explained to all participants.
- Participants required to append their signature on printed sheets or forms to show that they were not forced in any way to take part in the research.
- The interviewer informed participants that they can choose for the interview to be carried out without any of the data collection tools specified in the study.
- Participants were made certain of the confidentiality of every detail they provided
- Participants were informed that the details provided will not be for personal gains or benefit purpose
PRESENTATION OF FINDINGS
Table 4.1: socio-demographic findings
VARIABLES
|
FREQUENCY
|
AGE
|
|
19-23
|
3
|
24-28
|
6
|
29-33
|
5
|
34-38
|
3
|
TOTAL
|
17
|
|
|
OCCUPATION
|
|
Unemployed
|
7
|
Self-employed
|
4
|
Government employed
|
6
|
TOTAL
|
17
|
|
|
RELIGION
|
|
Islam
|
5
|
Christianity
|
12
|
TOTAL
|
17
|
|
|
EDUCATION
|
|
JHS
|
1
|
SHS
|
7
|
Tertiary
|
9
|
TOTAL
|
17
|
|
|
MARITAL STATUS
|
|
Married
|
14
|
Single
|
3
|
TOTAL
|
17
|
|
|
CHILD’S AGE
|
|
0-5mths
|
5
|
6-10mths
|
9
|
11+
|
3
|
TOTAL
|
17
|
The study was conducted among 17 primiparous mothers where they were interviewed on their experiences on support during pregnancy, labour and post-delivery and the challenges they faced as well. The age range of the mothers who responded to the questions were between 19- 38years. Out of the 17 mothers, 9 of them were in their early 20s whilst 8 were in their 30s. 7 participants were unemployed, 4 were self-employed and 6 were employed by the government. Out of the 17 mothers, 5 of them were Muslims and 12 were Christians by faith. Most mothers who responded to the questions had completed tertiary, 7 of them had completed senior high school and 1 was a junior high school graduate. Out the 17 mothers that were interviewed, 14 of them were married women and 3 were single mothers. 5 mothers’ children were between the ages of 0-5months, 9 mothers’ children were between the ages of 6-10months and 3 mothers’ children were 11months and above.
Table 4.2: Code frame
MAIN THEMES
|
SUB-THEMES
|
1.SUPPORT DURING
PREGNANCY/DELIVERY/POSTDELIVERY
|
- support during pregnancy
- support during labour
- support during post-delivery
|
2. CHALLENGES DURING
PREGNANCY/DELIVERY/POSTDELIVERY
|
- challenges during pregnancy
- challenges during labour/delivery
- challenges during post-delivery
|
Source: Field Data (2022)
The findings were presented according to the sub-themes and supported with verbatim quotations from participants.
4.1 Support during Pregnancy/Delivery/Post-Delivery
Support during Pregnancy
This refers to the support mothers received during pregnancy and it covers physical support, emotional, financial and medical support.
For the physical support, participants expressed varied supports received from family members and in-laws including household chores, escort to hospital and assisted in bathing. Participants echoed the support received during pregnancy as;
“…sometimes I will even leave bowls for my husband to come back from work and wash which was not something that I intended to do but because I was not feeling that well, I will leave it for him to come and do. Sometimes I will send him to just go to the market and buy stuff and come…” (Participant 2, 29years TTH)
“…there are some days that I will not be able to even walk and go to the bathroom and bath, sometimes my husband will assist me and walk me to the bathroom” (Participant 2,
According to the participants, emotional support was in the form of consolation, pampering and encouragement from family members/ relatives.
…’’During the pregnancy I used to get angry easily, at any trivial issue, I will be angry. So, my husband will calm me and talk to me...’’ (Participant 6, 21years TCH)
While some participants got angry easily during pregnancy, others expressed happiness and even felt becoming pregnant more often.
‘’… anytime I feel sleepy, he (husband) will pamper me to sleep, so I was always happy about that and I feel like getting pregnant soon after giving birth …” (Participant 4, 23years TWH)
“… My husband was not staying with me; he was staying far away and he calls. I would call him and tell him what l was going through like unable eat, vomiting every morning when l woke up. So, anytime l call and tell him, he would also tell me ‘Ooh…, l should take it easy it would go off so, l shouldn't be much worried about it’. So, he would call and give me encouraging words like; ‘ooh you tap cool sweety! all will be over soon. It's just about being pregnant and very soon, you would be a mother. We hope that, after giving birth you will be ok’. So, these were the encouraging words he used to give me…’’ (Participant 11, 24 years TTH)
SUPPORT DURING DELIVERY/LABOUR
During delivery/labour, participants reported that they received physical support, emotional support and medical support. The various supports that have been reported appeared of importance to mothers as they were inspired and encouraged to carry on.
Physical support
Physical support was received in different ways from relatives, family members and staffs
‘’the nurses too, some would be rubbing my stomach and encouraging me to take it easy’’
(participant 1, 19years TTH).
“The midwife that sends me from the house she was by me the whole time her hand was on my waist when the pain was coming, she will be rubbing her hand on my waist which was given me a little bit of relieve, the care was good and it was ok.’’ (Participant 2, 32years TTH).
According to participant, emotional support was given to her by parents/relatives who were physically present, calming her down and giving her words of encouragement.
… ‘‘the care my relatives rendered was that, whenever the contractions were coming, my parents are always by my side asking me to calm down and take it easy’’ (participant 1,19yrs, TTH)
‘’my relatives too were around to give me that emotional and moral support. They gave me words of encouragement, just to take my mind off the distress that l was going through’’. (Participant 8,34years, TWH)
One participant had an infusion due to her incapacity to push, while the other received an infusion due to the foetal non-reassuring heart rate.
…’’the time they were saying l should push and l wasn't able to push harder like the way they wanted, they gave me infusion. So, when the infusion was in-situ, I realized that I was having strength to push small and after the baby came, I was given medicine’’ (participant 11 TTH, 24years).
Support during postnatal
This is the care/support rendered to mothers after birth. Some of these support mothers received include physical and medical support.
According to participants, they were supported physically in different forms from family members and from staff of the hospital.
‘’ my family di3, they're very caring so when we went home, they washed my things, they always take my baby and they (family members) prepare food for me to eat’’ (participant 5,27years, TCH).
‘’…When I delivered, my husband friends and relatives brought me gifts like, soap, baby dresses…’’ (Participant 12, 35 years TTH).
“…I wanted to breastfeed in fact I didn’t know how to hold the baby to breastfeed the midwife came and showed me how to hold the baby” (Participant 2, 29 years TTH)
Some mothers also received medical support from staffs
‘’… after delivery when the baby was suckling, I was having abdominal pain so l went to complain to the midwife and she gave me two paracetamol tablets to take’’ (Participant 10, 29years TTH).
‘’…they quickly got the one (community health nurse) who take care of the babies to come and immunize the child immediately…’’ (Participant 2, 29 years TTH)
Challenges during Pregnancy/Delivery/Labour/Post Delivery
Challenges during Pregnancy
This refers to difficulties that mothers faced which were reported in the form of physical, financial, emotional, and transportation.
Physical challenges during pregnancy
These are the difficulties that mothers faced in terms of personal cleanliness, medications and it consequences, and mobility.
Personal cleanliness
‘’when I was pregnant, and the abdomen was growing big, I can't even bend down and bath. My bathing was a big problem, so when I want to bath, I have to sit down and bath because the tummy was big on me. After bathing I have to sit down and smear my pomade… (Participant 12,
35 years TTH)
‘’…I was very happy but during the pregnancy there were lot of challenges that I was facing. At times, bathing is difficult because of stress and other things like tiredness…’’ (Participant 4, 23 years TWH).
Medications and its consequences
“… It affected me because, throughout the pregnancy my blood level has been low and because I could not tolerate the medications and the food to increase my HB, I was always worried so when I delivered, the baby’s weight was 2.5 which was almost low birth weight which was obvious because I couldn’t tolerate the drugs and some other foods’’ (Participant 2, 29years, TTH).
‘’ Sometimes, when l takes some of the drugs, l feels like vomiting. So sometimes, l do forgo it. Better still, l has to manage and take it so l'll just try my best and take it but not all the time that l do take it. (Participant 9, 28years TWH).
“…vomiting was my challenge. Every morning, I have to vomit, so because I was vomiting like that, every morning I can't eat unless getting to like 11 to 12pm that l can take something”. (Participant 11,24years TTH).
‘’ I didn't like the scent (fersolate) and any time I take it, I always vomit so i wasn't taking it at all’’ (participant 11, 24years TTH).
‘’When I smell the scent of it (folic acid) am always vomiting because of that I don’t take it’’ (Participant 1,19years, TTH).
‘’... I don't like taking medicine so when I became pregnant it was a big challenge for me even though I don’t vomit. However, I always put it in TZ or the food I’m about to eat and swallow.
One of the drugs I used not to like is the malaria medicine… (Participant 12, 35years, TTH)’’ Mobility
Participant has challenge in doing her household chores
‘’… getting to a time, you find it difficult to bend down and do things.’’ (Participant 15, 26years TTH).
Financial challenges during pregnancy
The participants complained about not having enough money to pay for medical services provided by the hospital in the form of laboratory tests.
‘’I was having challenge because by that time, I can’t sit for long but am a trader so if I go to the market, I can’t make any money. And if I come and my husband too don’t give me, you know these local men, if he doesn’t give me money, I can’t go for antenatal...’’ (Participant 14, 36 years TTH).
‘’sometime when they ask me to do laboratory investigations and I don’t have money I have to postpone it to my next visit to do it.’’ (Participant 1, 19 years TTH).
Emotional challenges during pregnancy
According to the participant, she was often irritated during her pregnancy, especially with her spouse.
‘’…Sometimes, l will not feel like talking to him (husband) so if he talks to me, I will start shouting…’’ (Participant 7, 27years TWH).
Loneliness was expressed as a challenge as it was indicated to cause sadness in a participant.
‘’…when I just woke up, I felt so sad because I was the only person staying in the room. If something happened to me, what would I do? I can't do anything so, I was always thinking about it…’’ (Participant 11, 24years TTH).
Transportation challenge
Bad roads, long distance and use of bikes and “yeloyelo/keke” by pregnant mothers caused some of them to have waist pains during pregnancy. The long distance and bad roads to the hospitals have resulted in late arrival to hospitals and so joining long waiting queues to receive maternal health care.
‘’…I have slight waist pains because we used a motor bike and the road is not good...’’ (Participant 13, 32years TTH).
“… the hospital is far from the village, by the time you get there, it will be late and you have to join a very long queue. You end up wasting the whole day there and when you come to the house, you’ll become tired and you can't do anything” (participant 11, 24years TTH).
4.3 Challenges during Labour/Delivery
These are the challenges that pregnant women encounter during labour/delivery and are grouped into Physical and emotional challenges
Physical challenges during labour/delivery
This comes in the form of dilatation issues and mistreatment according to the participants.
‘’…the challenge was that my cervix wasn’t opening and they ask me to go to theatre. When I got there, my heart was beaten and I was just wondering what will happen there so after that, they operated me’’. (Participant 1, 19 years TTH)
‘’…the baby’s condition too wasn’t fine and they said my cervix too was not dilating so they have to send me to theatre…’’ (Participant 12, 35 years TTH)
‘’Sometime the nurses are very harsh especially when they want you to do something and you don’t understand what they were saying, when you want to find out from them, will be shouting on you. They were also harsh on me because when the contractions were coming l was always crying and making noise so they will say; are you the first person to give birth and you are making noise?” (participant 1,19 years TTH)
Emotional challenges
Emotional challenges have to do with the fear of outcome of labour
‘’ when I entered and saw the new environment, the machines, the tools and way the doctors dressed and covered their faces, I was afraid. I don’t know whether they were going to kill me there or what will happen to me’’ (Participant 1,19 years TTH).
‘’…there's this particular guy who came and was just shouting at me to look straight onto my stomach so that, they will prick me. So, he shouted and l became angry and shouted back at him never to shout at me…’’ (Participant 8, 34 years TWH).
Post-delivery challenges
The participant informed the interviewer on the physical, financial, emotional and social challenges she experienced after delivery.
Physical challenges
This aspect has to do with the growth and development of participants and their babies after delivery. Mothers reported experiencing pain after they received episiotomy during childbirth. This posed a serious challenge to them during breastfeeding their babies.
“… Where they sutured (episiotomy) and it heals, it's like the scar, when you put your hand at that side, it feels like not being normal as compare to the other side. And sometimes too, l feel some pains there like the sore is not properly healed but l don’t know whether there's something wrong or that's the issue.” (Participant 9, 28years, TWH)
“… if I’m in the market and during my sales and the baby is hungry and crying, he will cry for some time and after my sales before I will pick him and feed him...’’ (Participant 14, 36years TTH)
‘’…because I wasn’t taking my medications, after delivery he falls sick all the time, when he is sick today, tomorrow you see him healthy the next day he will be sick and it was something else…’’ (Participant 1,19years, TTH)
‘’…you'll not have enough sleep oooo, you have to wake up and breastfeed the baby, then you'll sleep again...’’ (Participant 10, 29years TTH)
‘’…I've resumed work and at his age, sending him to school is no! By my profession, am not supposed to bring the child to work. My mother too passed on, so l wished my mother was alive. She would have been with the grandson whilst l goes to work…’’ (Participant 8,32years, TWH) Financial challenges
Participant complained of monetary challenge in caring for her baby.
‘’compared to the time I was not having a child, anytime l don’t have money I am not much worried, but now that you have a child, he has to eat, he has to bath and all that. So, it’s a challenge to me’’. (Participant 15, 26years TTH)
Emotional challenges
According to the participant the feeling and thought of advancing especially in the aspect of education after child birth is restricted.
‘’The only challenge that I have was, what to do to this child because I wanted to further my education, so I have been thinking what was I going to do with the child before I can go to school. Because my husband is also staying alone, and I can’t leave this child with him and go to school. My mother-law too is not strong enough to take care of this small child. So, I have been thinking of what to do, but am praying that, I get a solution to this problem’’ (Participant 12, 35years TTH)
Other mothers reported of shyness in breastfeeding babies in public because of exposing their breast in the full glare of people.
‘’…I like wearing dresses that will cover my neck but when l gave birth, l cannot wear it again because l have to remove my breast for the baby to suckle in public. l feel shy removing my breast…’’ (Participant 11, 24years, TTH)
Social challenge
This has to do with restriction of attending social gathering after given birth and also the involvement in recreational activities.
‘’ I used to roam anyhow, if you don’t even go to the house, nobody cares but because of your child, you have to be inside, bath him early and he will sleep’’ (participant 15, 26years TTH)
“…, when I delivered all my clothes that I used to wear and slay with, none of them were entering me again, so I have to change them and send some for alteration because I couldn’t wear them again. Even my brazier I used to wear, now it cannot fit me again so I have to change most of my clothes so that, they will fit me again. l have become big. My friends that I used to roam with, they will say see how your tummy has become big, sometimes I will feel shy, and sometimes too I will use the child to console myself”. (Participate 12, 35years, TTH) Participant complained of inability to enjoy pleasure due to busy life after delivery.
‘’ Life now is a busy life because first, when l get up I can watch TV till the time I wanted and I'll sleep. If I get up in the morning, I can decide not to wake up from bed. I would just be lying on my bed doing nothing. It can even be 12noon and I'll still be lying down. I like wearing dress that will cover my neck. But when l gave birth, l cannot wear it again because l have to remove my breast for my baby to suckle even in public’’. (Participant 12, 35years, TTH)