Quality of intrapartum care for healthy women with spontaneous onset of labour in Rwanda: A health facility-based, cross-sectional study

Abstract

OBJECTIVE: To investigate the quality of intrapartum care provided at Rwandan healthcare facilities to women undergoing normal pregnancy and spontaneous full-term labour. METHODS: A cross-sectional study was conducted over eight weeks during 2014-2015 in 18 healthcare facilities in Kigali City and the Northern Province: eight health centres, seven district hospitals, one provincial hospital, one private hospital, and one referral hospital. Data were collected from medical records and a questionnaire including the Bologna score with its five variables: presence of a companion, use of partograph, no augmentation of labour, birth in a non-supine position, and skin-to skin contact. RESULTS: Among the 435 women who fulfilled the inclusion criteria during the study period, mean age was 27.4 years and 41.8% were primiparous. The assisting healthcare professionals were midwives (49.4%), nurses (28.8%), and physicians (22%), and birth occurred at health centres (29%), district hospitals (40%), and the referral hospital (31%). Mean Bologna score was 2.03 of the maximum 5 (range: 0-4). Only one woman (0.2%) had a companion present (her husband). A partograph was used for the majority (84.8%), and 88.0% had no augmentation of labour with oxytocin. Few (6.2%) gave birth in a non-supine position, and few (12.4%) had early skin-to-skin contact with their newborn. CONCLUSION: There are several areas for improving childbirth care according to the Bologna score. Healthy newborns should be placed skin-to-skin with their mothers shortly after birth, non-supine birthing positions should be encouraged, and the importance of a companion during labour and birth should be considered.