Out of health facility delivery is highly challenging and competitive to health facility delivery in many communities in Bayelsa State, as most women continue to engage in the practice. Therefore, the study is to explore in-depth, the factors that influence mothers’ decision to deliver outside health facility where they booked in Bayelsa State. Objectives were to (1) determine personal factors that inform pregnant mother’s decision to deliver outside the health facility of booking, (2) identify family factors influencing out-of health facility delivery, (3) determine institutional factors responsible for their decision to deliver outside the health facility and (4) determine health care providers factors that inform out-of-health facility delivery by pregnant mothers. Transcendental phenomenological research design was adopted, using non-probability sampling technique and purposive sampling methods to obtain data from 15 participants. Validity and reliability was based on criteria for trustworthiness in a qualitative research. Instrument for data collection was semi-structured in-depth interview guide and tape recorder, with an in-depth face-to-face interview that lasted between 10-35minutes (each participant). Data were analyzed using Colaizzi’s seven steps of data analysis, presented in themes, codes and subcodes (Nvivo). Findings revealed interplay of health institutional factors such as attitude of health staff, previous experience of the women, lack of care and support during labour by health care provider, availability of TBA’s and the high cost of delivery services in health facilities. Other findings include socio factors such as distance to health facility, low educational level of respondent and religious beliefs. Significant finding was the women’s expression of fear of Caesarean Section. However, mothers expressed confidence in the antenatal care services where they receive information that both mother and baby is well and safe. Hence, better to deliver at home. Thus, the following recommendations: (i) Raised awareness on danger signs of pregnancy, labour and delivery, (ii) Improve relationship of health care providers and the women (iii) Proper and adequate management system, (iv) Quality assurance policy system and (v) Improving physical access (road access).



Background to the Study

A pregnant woman needs regular check-ups in a health facility where a midwife or a doctor will be in attendance. These check-ups are called antenatal care or antenatal visit (Iyaniwura & Yussuf, 2009). These check-ups end at delivery of the baby or babies, with post-natal care inclusive. More so, WHO, UNICEF, UNFPA and World Bank (2008), stated that each year about 6 million women become pregnant and 5 million of these pregnancies result in child birth. WHO (2014),  reported that about 16 million girls aged 15-19 and some one million girls under 15 give birth every year, most in low and middle income countries. According to the US Government poster on teen pregnancy, over 1100 teenagers mostly aged 18-19 give birth every day in the United State alone (Hamilton, Brady, Ventura & Stephanie, 2012).

However, pregnancy is complete with three trimester except otherwise. The 1st trimester is the first 13 weeks or 3 months of the pregnancy in which the baby develops at a very fast rate and becomes almost fully formed by the end of it. While the 2nd trimester, is from 4 – 6 months of pregnancy during which it becomes obvious that the mother is pregnant. And the 3rd trimester is from 7 – 9 months until the baby is born. During this period, the baby will build up fat stores, and continue growing rapidly (American Journal of Obstetrics and Gynecology, 2015).

Health Direct Australia (2013), defined antenatal care as the care received from healthcare professional during pregnancy. In light to this, antenatal care (ANC) attendance provides a unique opportunity to improve the health of women and infants. Also, the utilization of ANC provides opportunities of promoting services that may include weight and blood pressure measurement (WHO, 2010). However, distance to health facilities, inadequate Transportation, socio-cultural beliefs and the need for immediate and specialized services have hampered women’s ability to access these services in many less developed countries and northern Nigeria in particular (WHO, 2010).

Antenatal care includes early booking, regular clinic visits as structured and decision to deliver in a health facility at term or otherwise, while Booking is the term used to describe the first visit by the pregnant woman to the antenatal clinic. This first visit which is best during the first trimester provides the opportunity for detailed investigation on the status of both mother and baby. If the mother is expecting her first baby, she will have up to 10 antenatal appointments. If she has a baby before, she will have up to 7 antenatal appointments. Under certain circumstances for example, if you develop a medical condition, you have more visits, (NHS, 2015). Based on the results of a WHO antenatal care randomized trial, the standard measure of adequate antenatal care delivery is a minimum of four (4) antenatal visits (with the first occurring during the first trimester) for a woman and her fetus, if they are judged to be healthy following a standard risk assessment (NHS, 2015). This minimum of 4 antenatal clinic visits throughout full term pregnancy is the package explained in birth preparedness and complication readiness plan.