Risk and Resilience: Obstetric Fistula in Tanzania - EngenderHealth

Preparation for the Baby
The majority of the women did not prepare for the
baby in any way. One of the common reasons
expressed was that preparing for a baby was
against their customs and that they wanted to wait
until the baby was born because they did not
know if the baby would be born alive. According
to one woman, it is taboo in her ethnic group to
make preparations before the baby is born. A
minority of the women prepared for the baby in
some way, either by buying clothes for the baby,
buying powder, and/or buying bleach to wash the
baby’s clothes.
D. Labor, Delivery, and Referral
Trajectory
Onset of Labor
Nearly all of the women started labor at home; of
these, the majority went into labor in the evening
or at night, when it was more difficult to access
assistance. A few started labor while outside the
home, either while doing chores, while at church,
or while visiting relatives. A few also started labor
when they were in transit to the hospital or when
they were already at the hospital.
Delivery Trajectory
Nearly all of the women who began their labor at
home had to make at least one move. Their move
was based on seeing that there was a delay or
problem that needed appropriate care. Only seven
women delivered where they started labor - five at
home 8 and two at the hospital. Table 4 shows the
number of moves made by women from the
initiation of labor until the delivery of the baby.
Table 4: Number of Moves Made by Women from
Initiation of Labour to Final Delivery
No. of moves No. of women
0 7
1 30
2 19
3 4
>3 1
Of the women who had to make a move to
receive appropriate care, about half made only one
move; of these women, nearly all went from their
home to a hospital where they received the
necessary help.
Fewer than half of the women had to make at
least two moves from the place where labor began
to where they completed delivery. Among these
women, nearly all had to go to a hospital before
receiving appropriate care. (See Annex 2 for
further details on where the women sought care
after initiation of labor.)
Of the women who started their labor at home,
fewer than half were assisted by a TBA, while the
rest were generally assisted by family or friends. In
two cases, women were assisted by communitybased
providers (a pharmacy assistant and a nurse)
who were not TBAs. Of those women who were
assisted by a TBA, nearly all had to seek care
elsewhere after experiencing labor and delivery
problems.
Reasons for Moving
The most common reason for making the first move
was because the woman or her family realized that
substantial time had passed in labor without
progress. The second most common reason was
because the TBA realized she could not help. 9
Who Made the Decision to Move
The majority of women were helped by others to
make the decision to move to another place for
labor or delivery. Only five women with fistula
made the decision to move during labor totally by
themselves. Once a woman was in labor, family
and friends were the primary decision makers. Of
these, the husband was the most frequent decision
maker, followed by the woman’s parents. In-laws
and neighbors/friends also played a role in making
the decision to move the woman to another place
for delivery. In one case, the woman experienced
difficulty in getting to the hospital because of a
family member; as she explained: “I was delayed in
getting to the hospital because my mother-in-law
wanted me to deliver at home.” (Patient at
Bugando, age 17)
16
8 Four of these women received help from TBAs.
9 More detailed information related to the delivery process is offered in the next section.