Birth Practices in Port Harcourt, Nigeria: A Retrospective Case Study Review

Introduction: During a student nurse-midwives portfolio review in 2013, it was noted that a high proportion of women had a caesarean section and that all vaginal births were performed in a lithotomy position. The lithotomy birthing position is associated with increased risk of an episiotomy. This instigated the undertaking of a retrospective review of maternity case notes of 569 women, who gave birth at the two maternity hospitals in Port Harcourt, Nigeria in July, 2012. Aim and objectives: The aim of this case study was to confirm recorded birth data in student nurse-midwives portfolios and review some birth practices. The objectives were to explore whether lithotomy position for birth and the common use of episiotomy practices were supported by evidence. In addition, to justify the need to undertake research to explore mothers, midwives and obstetricians’ perspectives regarding these birth practices in Port Harcourt, Nigeria. Findings: The review confirmed the recorded data in student nurse-midwives portfolios, a high rate of caesarean sections being performed (46%) and that vaginal births were undertaken in the lithotomy position.The review reported that all (100%) of the women who had a spontaneous vaginal birth did so in the lithotomy position. No justification for adopting a lithotomy position was documented in any of the women’s casenotes reviewed. This review demonstrates that the lithotomy position is a routine practice, women are not given any alternative options and therefore women are led to believe that lithotomy is the accepted and standard position when giving birth. From the sample of 306 women who had a vaginal birth, 142 had perineal injuries. Majority (n = 90, 63%) of the women gave birth with an episiotomy performed, whilst (n = 52, 37%) sustained spontaneous perineal tears. Of the women who had episiotomy, the majority (n = 73, 81%) were primiparous. The severity of the perineal tear was not recorded and some of the case notes (n = 36, 12%) did not document the perineal outcome. Conclusions: This retrospective case study review confirms a high proportion of caesarean section and episiotomy being performed and lithotomy position being used for birth. These practices are not based on evidence. Therefore, there is a clear justification to undertake a research study to explore further why these birth practices are not based on evidence and to gain an insight into mothers, midwives and obstetricians perspectives regarding birth practices.