Margaret C. Maimbolwa

The safe motherhood goals of being attended by a skilled attendant at birth have not been met in Zambia. Almost all (93%) of Zambian pregnant women attend antenatal care, though only 43% deliver in maternity units. This study was conducted to explore low-risk Zambian primigravidae's preparation for pregnancy including contraceptive use, content of antenatal care, preparation for childbirth and the extent of social support. Two hundred and ninety nine healthy primigravidae, who attended the antenatal clinic at the University Teaching Hospital (UTH), Lusaka, Zambia, were interviewed using a structured interview guide. The women's mean age was 20.7 years; 41% were adolescents. The adolescent group had significantly less years of education (p < 0.0000). In total, 78% had never used any contraceptive method. The main source of information on sexual issues was friends and the mass media. Only 2% of the women had received information on sexual and reproductive health matters from health staff. Nearly half did not want the pregnancy. Sixty three per cent of the women had made their first antenatal visit during the second trimester. There had been no antenatal preparation of the women for parturition and their parenting role. Eighty five per cent of the pregnant women had identified a social support person to assist them during pregnancy and after childbirth. The results suggest that preparation for parenthood had a low priority as part of the antenatal care. We recommend that as part of the integrated reproductive health approach, parenthood classes should be organised and social support network should be utilised and involved in the care.

Background. Zambia, one of the world's poorest countries, also has one of the highest maternal mortality rates in the world. Most pregnant women in Zambia (96%) attend antenatal care, while 53% deliver at home. This may be related to socio‐economic and cultural factors, but cultural childbirth practices and beliefs in Zambia have been little documented.Aim. The aim of this study was to explore cultural childbirth practices and beliefs in Zambia as related by women accompanying labouring women to maternity units. These social support women were also interviewed about their views on providing companionship to labouring women.Methods. Thirty‐six women accompanying labouring women to urban and rural maternity units in Zambia were interviewed A thematic guide with closed and open‐ended questions was used. EPI INFO, an epidemiological statistical software package, was used to analyse the quantitative data; qualitative data were analysed using content analysis.Findings. Eighteen of the women considered themselves to be mbusas, or traditional birth assistants and the rest said that they followed labouring women to maternity units. Those who considered themselves traditional birth assistants advised childbearing women on appropriate cultural childbirth practices and assisted with deliveries at home. They also advised women on the use of traditional medicine, for example, to widen the birth canal and to precipitate labour. If something went wrong during labour, they relied on traditional beliefs and witchcraft to explain the mishap and expected the woman in labour to confess her purported ‘bad’ behaviour. Twelve of the women were in favour of providing support to labouring women in maternity units and learning about childbirth care from midwives.Conclusion. These social support women, including those who considered themselves as mbusas, lacked understanding of the causes of obstetric complications during childbirth, and had inadequate knowledge of the appropriate management of labour. Culturally‐specific knowledge from this study should be used to guide policy‐makers and health planners in the future development of safe motherhood initiatives in developing countries. Midwives have a unique opportunity to ensure that care given during childbirth is clinically safe and culturally sensitive.