Date of Conferral

8-21-2024

Date of Award

August 2024

Degree

Doctor of Human Services (D.H.S.)

School

Health Services

Advisor

Cheryl Cullen

Abstract

Childbirth poses a significant risk, with many intrapartum stillbirths worldwide. In Lesotho, 35% of stillbirths occur during labor, predominantly due to birth asphyxia. Low midwife-to-laboring mother ratios result in insufficient adherence to standardized protocols for intrapartum fetal heart rate monitoring. In the intrapartum period, quality and respectful care during birth are crucial. The purpose of the study was to examine intrapartum outcomes and the impact of self-monitoring of electronic fetal heart rate on laboring mothers' use of a doppler. Catastrophe theory and the theory of access proposed by Penchansky and Thomas served as the theoretical frameworks. Logistic regression analysis revealed that women attending four or more antenatal care check-ups experienced a 73.1% reduction in the risk of intrapartum adverse birth outcomes (Adj OR: 0.158; 95% confidence interval (CI): 0.047 – 0.536). Conversely, individuals encountering obstetrical complications during labor had approximately four times higher odds of intrapartum stillbirths (Adj OR: 3.786; 95% CI: 1.143 – 12.536). There was a significant association between self-monitoring and abnormal fetal heart rate pattern detection (OR = 3.918, 95% CI (1.493, 10.282). Adherence to the protocol for fetal heart rate monitoring and a partogram cut the risk of poor outcomes during labor by 77.3% and 95.1%, respectively (Adj OR: 0.227, 95% CI: 0.060 – 0.856; and Adj OR: 0.049, 95% CI: 0.006 – 0.390). Implications for positive social change include promoting women's engagement, reducing health disparities, and enhancing patient-provider relationships that can lead to improved maternal and neonatal health.

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