Complications of home delivery: our experience at Nepal Medical College Teaching Hospital.

A prospective study was conducted at Nepal Medical College Teaching Hospital to find out the complications of home delivery, maternal and fetal outcome and the main factors leading to home delivery. Among the 114 women who were brought to the hospital after home delivery, one was brought dead and one more died shortly after arrival. Sixty point five percent were housewives with no formal occupation, 68.4% were illiterate, 64.0% were multipara, Maximum no. of women belonged to the age group 20-24 years, 15.8% were adolescents, Lasheta (Lama, Sherpa , Tamang) was the most common ethnic group, Most of the women delivered at full term, whereas preterm delivery occurred in 4 (3.6%). Majority (73.7%) of the women had attended antenatal care at least once and half of the women had attended 4 and more visits. More than half had been fully immunized with tetanus toxoid and taken iron supplementation. As the reasons to deliver at home: 32.5% stated to be due to financial limitations, 30.7% due to ignorance and 16.7% due to transport limitations, and rest due to 'other reasons' which were most commonly stated as to be lack of attendant at home, long distance to hospital or delivery occurring too quickly or too late at night to attend the facility of choice. Ninety four point seven percent delivered at home with no trained assistance. Majority of the women (72.8%) were brought with retained placenta or excessive bleeding per vaginum. Twenty one point nine percent of the women were brought in shock needing active resuscitation. Twenty seven point two percent had postpartum hemorrhage. It was found that antenatal services were well utilized, but mothers were less likely to access good quality delivery/postnatal care. Despite the availability of services however, women still went on to deliver at home without any trained assistance, and this effect was greatest for the t less educated, poorer women. Financial and transport limitations appear to be some of the most important factors in women's inability to access skilled care. This important barrier to care will need to be addressed if we intend to improve delivery service to the most vulnerable of women.