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Table 2 Representative Quotes from Respondents regarding the Pillars of Clean Delivery and Overarching Themes

From: Clean delivery practices in rural northern Ghana: a qualitative study of community and provider knowledge, attitudes, and beliefs

TOPIC

REPRESENTATIVE QUOTES

 

Health Care Provider

Traditional Birth Attendant

Community Member

Hand Washing/Glove Usage

“(If) we can’t get gloves, then you wash your hands very well with soap and water. And then you do what you have to do. And the incidence of cord sepsis, septicemia, other infections, will be much, much lower.” – IDI with physician

“When you are called and you get there, you first ask if her water is broken, or better still you wash your hands and wear gloves (to) check her cervix to see if the baby has turned…” – IDI with TBA

“In the house delivery, the women who have been trained to assist in delivery do not wear anything on their hands to protect their hands and the baby. If they come they just use their bare hand like that to hold the baby. Assuming there is a cut on her hand she can infect the baby if she has any disease.” –IDI with woman with newborn infant

Delivery Surface

“Immediately the midwife removes the child, she places the child on the mother’s tummy before the cord will be cut and then all that.” – IDI with nurse

“At home birth they deliver on the floor which contains dirt and that can affect the baby with diseases, but in the clinic where you deliver on a bed it doesn’t have dirt and the floor is clean also” – IDI with TBA

“If you deliver in the filthy place the baby will get all kids of disease when the baby is still small and you will not know what to do, but when she deliver in a clean place you pick your baby very clean and bath for the baby.” FGD with Nankam grandmother

Cord Cutting and Cord Tying

“There’s a problem with the home deliveries, they may use all kinds of non-sterile things to cut the cord, or to tie the cord.” - IDI with physician

“(The cord was cut) just immediately after I delivered. It didn’t take more than 5 min.They tied it with the rag.” – IDI with TBA

“Usually they cut the umbilical cord with a blade and tie it well to stop the blood. Bath (the baby) and wrap it with rags and put it by the mother’s side on the bed for it to suck the breast milk.”- IDI with woman with newborn infant

Who Cuts the Cord?

“The cord is cut by the attending midwife or the assistant.” – IDI with physician

“The nurse will cut the umbilical cord and clean it and give it medicine.” – IDI with TBA

“It depends on those who are around to support you to deliver. If there is a nurse she will cut the cord with a scissor and if there is a TBA, she will also use a blade to cut the umbilical cord.” – IDI with woman with newborn infant

Cord Dressing

“We try to tell them to clean it. They should always clean it, make it dry… And it should be dry, it should not be wet… they should let air to it so it can dry.” – IDI with nurse/midwife

“We normally clean it and use clean Shea-butter to apply on it, is not all batter you can apply on it.” – IDI with TBA

“They use shea butter because they said if you do not use the shea butter, water will enter the sore and it will swell up.” – IDI with woman with newborn infant

Bathing/Cleanliness

“We tell them to bathe these babies twice a day, to keep the baby, the cord dry, and to wear protective clothings for the child, to sleep under ITN, and to feed this baby on demand. She should always clean her hands well when she does any work and before touching that baby.” – IDI with healthcare provider

“It is true no one wants to be dirty, how less to deliver at a dirty environment, that (is) why the hospital delivery is best. The baby is normally delivered with dirty water, and after cleaning and bathing when you place and cover the baby with dirty things, what have you done?” – IDI with TBA

“The first week if the baby is not well catered for, if it is been laid in dirty places, and if mother doesn’t bath well and clean the nipples well for the baby to suck, I think this can make the baby sick.” - IDI with assembly woman

Increasing Facility-Based Delivery

“We tell them the home, there are so many hazards. Because you can deliver and start (getting) dizzy, and then they don’t know how to arrest the hemorrhage. You may deliver the child and the child may not be breathing, or maybe if there is some placenta or cord around the, um, they will not identify it. So when they come here we identify all those things. And these days there are so many conditions, diseases.” - IDI with healthcare provider

It is better to give birth in the hospital than giving birth in the house. Because in the hospital they have everything like beds, water, drugs for delivery… Most (women) know because we have spoken to them and they understand us that the hospital have benefits for them. For that matter, they don’t call me before they go to the hospital and give birth. – IDI with TBA

“For us in the olden days we will stay in the house and will be commanding the woman to push and all of a sudden you will see the woman is lying dead and we will carry her to go and bury. So this is the reason why we have accepted the hospital for women to go and deliver there.” – FGD with Nankam grandmother

The role of Grandmothers

“Usually they don’t even allow the mother to bathe her own baby. … Because her own mother, the baby’s own mother, is not supposed to be experienced enough.” – IDI with healthcare provider

(For women who won’t breast feed) “Grandmother should see to it that they will force such women to breastfeed their children.” – IDI with TBA “It is the grandmother who is always with the baby so if the baby is not well, the grandmother will tell the mother of the baby to inform the baby’s father about it, or today I want you to take the baby to the hospital.” – IDI with TBA

“We grandmothers know how to bath the babies because their mothers don’t know, especially mothers who have delivered for the first time.” –FGD with Kassena grandmother

Disconnect between health care providers and community members

The other issue too also has to do with the perceived attitude of health workers to, to these, to these women. They (the women) feel they don’t, they, they, they get treated like equals. They don’t want to come into the hospital. Health workers are perceived to be judgmental, so a lot of people stay away from, from these hospitals.” - IDI with physician

“The baby could have ‘weni-niila’ (fit) the way the baby’s neck is turning backwards… for the ‘weni-niila’ one can go to hospital many times but western medicine cannot cure it unless the fellow uses traditional medicine…” –IDI with TBA

“Within one week you have to give a name to the baby in case the VAST worker comes around. Secondly, there are also people who come to register the babies for the birth certificates so the moment you give birth these people are around to take the name of the baby.”* – IDI with woman with newborn infant

  1. * Traditionally, babies are not named immediately. It may take anywhere from a few days to more than a month before some families will name their infants.