Delays in recognition of and care-seeking response to prolonged labor in Bangladesh.

Maternal death, in which prolonged labor is the third leading cause, accounts for 20% of deaths among women in Bangladesh. This study describes the process of recognition and response to symptoms during potential prolonged labor among 17 women in three sites in Bangladesh. In October-December 2008, integrated illness history interviews were conducted with women and confirmed and/or supplemented by family and/or birth attendants present during labor. Interviews elicited participants' recognition of symptoms and care-seeking reactions and recorded responses in time-by-event matrices. Interviews were conducted in Bangla, recorded, transcribed, and translated into English. The most frequent and usually first action was to seek care from untrained attendants at home, then from professional attendants outside the home. Care-seeking outside the home occurred a median of 19 h after perceived labor onset. Delays in care-seeking arose for reasons related to: (1) confusion over the onset of labor, (2) power processes inhibiting women's disclosure of labor symptoms, (3) the practice of "waiting for delivery," and (4) preferences for home delivery. Strategies to encourage lay recognition of and response to prolonged labor should consider women's misinterpretation and non-disclosure of labor pain, health beliefs surrounding the labor process, and fears of medical intervention.