Postpartum morbidity is common among women in Bangladesh. A national survey showed that 24% of women reported at least one complication during the postpartum period (1), while two studies in urban slum areas of Dhaka, Bangladesh, demonstrated that approximately 75% of women reported at least one postpartum morbidity (2,3). The World Health Organization (WHO) currently recommends that all births are assisted by a skilled attendant to address unacceptably high levels of maternal mortality and morbidity (4). In Bangladesh, although women living in urban slum areas of Dhaka reside in close proximity to facilities with skilled care, 70% of women in urban areas give birth at home with non-medically trained providers (5) which is likely to be even higher in urban slums.
Postpartum morbidity can be attributed to (a) maternal heath status prior to pregnancy; (b) conditions which develop during pregnancy; and (c) complications or conditions which occur as a result of childbirth. Other factors that influence postpartum morbidity include maternal traits, such as primiparity, grand-multiparity, and short stature, and socioeconomic factors, such as poverty, access to care, and low education (6–11).
The level of training of birth attendants and the management of complications by both home and facility-based attendants can contribute to postpartum morbidity (7,9–11). Harmful practices for childbirth include: giving birth on a dirty surface; lack of hand-washing by the birth attendant; guarding the perineum with the foot; frequent vaginal examinations; and traditional methods commonly used to stop bleeding, such as pressure on the abdomen with hand, knee, stool, or other objects, and methods to hasten delivery of the infant or to expel the placenta (12–16). Other delivery practices, such as using oxytocic drugs to augment labour, internal version to re-position malpositioned infants, and manually removing the placenta, are considered unsafe if used by untrained persons (12–16).
Previously, a high incidence of self-reported delivery-related complications was documented among 1,506 women living in urban Dhaka (2). In this paper, the types of delivery-care providers used by these women, their training and experience, and reported birthing practices are described. Specifically, the associations among place of delivery, training and experience of home-delivery providers, childbirth practices, and postpartum morbidity were explored.