Recognition of and response to prolonged labor among Bangladeshi women

Background: Maternal death, in which prolonged labor is the third leading cause, accounts for 20% of deaths among women in Bangladesh. This study describes the process which Bangladeshi women, their family members, and birth attendants recognize and respond to prolonged labor.

Methods: Integrated illness history interviews were conducted with women identified as having experienced prolonged labor from three sites in Bangladesh (N=30). Interviews elicited participants' recognition of symptoms, cognitive reactions, and care-seeking behaviors. Participant narratives were confirmed and/or supplemented by family members and/or birth attendants present during the labor process. Information was recorded in time-by-event matrices. Interviews were conducted in Bangla, recorded, transcribed, and translated into English. Preliminary results (N=3) are presented here; analysis of the entire sample is underway.

Results: Participants did not recognize onset of pain as indication of labor; instead, participants looked for discharge or change in the location of pain. Modesty prevented some women from revealing labor pains, and a belief that verbalization would invite negative birth outcomes motivated some to avoid discussing labor pain. Male authority figures who disagreed about the gravity of symptoms influenced delays in care-seeking. Participants preferred to deliver at home in part because they were averse to caesarean deliveries.

Conclusions: Bangladeshi women experiencing prolonged labor and their family members or attendants often did not recognize prolonged labor as a complication of delivery. Strategies to encourage lay recognition and response to prolonged labor should consider health beliefs and constraints on women's autonomy that influence delays in care-seeking for this complication.