Abstract
This study investigated the maternity services, particularly those in county hospitals and rural areas, to explore the contributing factors to birth outcomes, especially maternal deaths, in Shanxi Province, China. The study was linked to a larger study: Improving Birth Outcomes in China: Consequences and potentials of policy, state and professional interactions jointly funded by the Australian Research Council, The Second Hospital of Shanxi Medical University and Western China Second Hospital Sichuan University between 2004 and 2007.A combination of quantitative and qualitative data was collected from nine hospitals in nine counties, ranging across high, medium and low maternal mortality ratios. Data collected included medical records (n=1,067), obstetricians and midwives interviews (n=17), personnel file audits (n=52), interviews with postpartum women (n=92), interviews with hospital leaders (n=12), interviews with maternal and child health workers (n=6) and labour observations (n=8). The Chinese maternal deaths reporting and review system was carefully examined with a case study of 40 maternal deaths undertaken analysing secondary data.
The study found that the obstetricians and midwives in the hospitals were poorly trained with insufficient skills and knowledge and minimal on-going professional development. Some of the maternity practices in the hospital were not evidence based and the absence of Chinese language evidence based textbooks or protocols were contributing factors. The antenatal care women received was poor, with excessive ultrasound scanning but insufficient physical assessment.
Contrary to the previous studies, interview data found that women did not avoid hospital services because they had an illegal birth but because of financial difficulty. Women who had illegal births however, gave birth at home, and had a much higher risk dying in childbirth. Unskilled birth attendants, combined with poor quality emergency obstetric care when transferred to county hospitals, were the underlying reasons for those deaths. The bottom tier of maternal and child health care, within the three-tiered Chinese system, is severely challenged. An increase in human resources with appropriate skills and knowledge, is necessary as part of a system wide investment. The new health insurance and other subsidies for rural women were still insufficient to allow many to obtain a hospital birth. Expenditure on excessive ultrasounds would be better spent on hospital cost. Further research on strengthening the bottom tier of care to ensure skilled attendance throughout pregnancy, childbirth and post partum period is desirable. Evidence based practice should be introduced into all levels of the system.
| Date of Award | Aug 2008 |
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| Original language | English |
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| Supervisor | Lesley Barclay (Supervisor) |