International Journal of Nursing, Midwife and Health Related Cases

Vol.2, No.3, pp.47-61, December 2016

___Published by European Centre for Research Training and Development UK (www.eajournals.org)
ASSESSMENT OF THE FACTORS INFLUENCING BIRTH PREPAREDNESS
AND COMPLICATION READINESS AMONG PREGNANT WOMEN: A CASE
OF SELECTED HEALTH CARE FACILITIES IN ELDORET, KENYA

Jackline Morara
Kisii University, Department of Nursing
P. O. Box 2340 – 30100
Eldoret, Kenya

ABSTRACT: Evitable mortality and morbidity remains a formidable challenge in many developing
countries, Kenya among them. Countering this challenge due to birth complications then becomes a
critical area of concern. The principle and practice of Birth Preparedness and Complication
Readiness (BP/CR) in resource-poor settings have the potential of reducing maternal and neonatal
morbidity and mortality rates. This paper aims to assess the factors that influence BP/CR among
pregnant women attending Antenatal care in selected Health Care Facilities in Eldoret, Kenya. The
current maternal mortality ratio is 488 maternal deaths per 100,000 live births (KDHS 2008-9).
Most of these deaths occur due to the five leading causes: severe bleeding/hemorrhage (25%),
infections (13%), unsafe abortions (13%), eclampsia (12%), obstructed labor (8%), other direct
causes (8%), and indirect causes (20%). It is important to note that most of these deaths can be
prevented by proper ANC attendances and ensuring the presence of a skilled birth attendant during
delivery and/or in case of any complications (Omolo & Kizito, 2010). The study used a descriptive
cross sectional approach. Pregnant women seeking antenatal services in 3 health care facilities
(Eldoret West Health Centre, Huruma and Uasin Gishu District Hospitals) formed the target
population from which a sample size of 273 was obtained using fisher’s formula. Data collection
was done using questionnaire and analyzed using the SPSS software. Results are presented in tables
and narratives. Among the factors established to be the most predictors included maternal
education, source of income, pregnancy planning and attendance of Antenatal Care. The study
recommends emphasis of Antenatal care education on birth preparedness and complication
readiness to improve access to skilled and emergency obstetric care.

KEYWORDS: Antenatal Care, Birth Preparedness, Complication Readiness, Kenya.

INTRODUCTION

Research has shown that majority (52%) of Kenyan women do not seek antenatal care services early
in their pregnancy, this provides little or no time for appropriate screening and management of risk
factors, if detected, as well as timely referral (Rogo et al., 2001). As a midwife, over time, the author
has observed that although pregnant women attend the Antenatal Care (ANC) throughout their
pregnancy, most of them lack knowledge on birth and complication readiness. This makes them ill
equipped to meet both their needs and that of their unborn baby. This is common in Uasin Gishu
district hospital and many other hospitals around the country (KDHS 2008-9).

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Vol.2, No.3, pp.47-61, December 2016
___Published by European Centre for Research Training and Development UK (www.eajournals.org)
It is for the above reasons that this paper explores what influences the BP/CR among pregnant
women in the selected health care facilities. With this information, appropriate plans can be made to
ensure that women served in Eldoret town health facilities will have adequate information to make
informed decisions regarding their pregnancy, delivery and post delivery.

If a woman is not emotionally ready, she may find it difficult to cope with pregnancy changes, giving
her more feelings of anxiety, fear, and unhappiness during pregnancy. Financial readiness, on the
other hand, is important because pregnancy requires a series of prenatal visits, vitamin and other
supplements, as well as preparation for baby’s arrival which of course means additional expenses
(Fiset, 2005). Getting fit before pregnancy is also essential. The woman’s weight and diet is also
assessed before conception because these may have significant effects on pregnancy (Fiset, 2005).

LITERATURE UNDERPINNING

Childbirth preparation has long been recognized as having many benefits. Some of the benefits
include increased knowledge and acquisition of skills for coping with labor (Schotts, 2003), reduced
anxiety on the birthing process, promotion of a positive birth experience (Nichols & Zwelling,
1997), increased health promotion behaviors and the use of fewer medications during labor (Nichols
& Zwelling, 1997). Preparations for childbirth will also assist individuals and their families to make
informed decisions about their pregnancy and childbirth (Schotts, 2003).

Various factors have been found to influence birth preparations around the world. In Kenya
childbirth depends on the level of knowledge of the pregnant woman, husband or in laws (MOH,
UON and NCPD, 2002).

Antenatal preparedness involves:

a. ANC attendance to monitor the progress of both the mother and baby
b. Making adequate provisions for proper maternal nutrition.
c. Financial savings for the mother and baby
d. Arranging for transport to the hospital when labor is perceived
e. Choosing a birth attendant
f. Knowledge on danger signs during pregnancy, being ready for any complication and taking
appropriate action.

Intra partum preparations include:

a. Having made preparations for transport
b. Having identified a health facility and skilled birth attendant
c. Knowledge on danger signs during labor (Lowdermikl & Perry, 2004).

Post partum preparedness:

a. Because life-threatening complications can also occur during the early postpartum period,
postpartum preparedness is of absolute importance. It involves knowledge of danger signs
i.e. (excessive vaginal bleeding, convulsions, loss of consciousness, high fever) and adequate
rest. It is also important that mothers provide six completed months exclusive breast feeding

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and be familiar with post natal care, childhood immunizations, family planning, and maternal
nutrition (Lowdermikl & Perry, 2004).

Focused Antenatal Care

In 2001 the WHO issued guidance on a new model (Focused Antenatal Care) FANC for
implementation in developing countries (MOH, 2004). FANC is a type of antenatal care that focuses
on ensuring, supporting, and maintaining maternal and fetal well being throughout normal pregnancy
and childbirth. It is goal oriented, timely, friendly and simple (MOH, 2004). In FANC the pregnant
woman is expected to attend at least four visits during the entire pregnancy and each visit should be
goal oriented where specific items such as client assessment, education, prevention, birth plan,
detection and management of complications are discussed and documented (MOH, 2004). FANC
has 5 objectives, that is; i) Health promotion and disease prevention, ii) Detection and treatment of
existing diseases and conditions, iii) Early detection and management of complications, iv) Birth
preparedness and v) Complication readiness.

Findings from a study on missed opportunities indicated that though the pregnant women attended
ANC services, they lacked knowledge on essential elements of FANC (Anya et al., 2008). This study
also indicated that if missed opportunities are addressed it will greatly improve maternal health and
reduce maternal deaths (Anya et al., 2008).

In the African culture, knowledge on birth preparedness and complication readiness was passed on
by mother in laws and grandparents early in pregnancy. As pregnancy progressed, pregnant women
were sent back to their parents for delivery. During this time more knowledge was imparted.
Traditional birth attendants were also very useful in childbirth preparations (Maestes, 2003).
Nowadays childbirth preparations includes; visits to health care providers, seeking information from
media or attending childbirth and parenting classes (MOH,UON and NCPD, 2002), hence this study
on Birth Preparedness and Complication Readiness (BP/CR) as the currently adopted strategy.

Factors Influencing Birth Preparedness and Complication Readiness

Pregnant women and newborns need timely access to skilled care during pregnancy, childbirth, and
postpartum periods. Too often, their access to care is impeded by delays in deciding to seek care,
reach care or receive the care they require (Thaddeus & Maine, 2004). These delays May be due to;
logistical and financial concerns, unsupportive health care policies, gaps in services delivery or
inadequate community and family awareness of birth preparedness and complication readiness.

Delays in seeking care for pregnant women may be caused by:

a. failure to recognize danger signs of pregnancy and complications, failure to perceive the
severity of illness, financial implications, previous negative experiences with the healthcare
system, and transportation difficulties.
b. the distance from a woman’s home to the health facility or health care provider, the condition
of roads, and lack of emergency transportation.

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Vol.2, No.3, pp.47-61, December 2016
___Published by European Centre for Research Training and Development UK (www.eajournals.org)
c. unprofessional attitudes of providers, shortages of supplies and basic equipment, a lack of
healthcare personnel and poor skills of healthcare providers.

The causes of these delays are common and predictable. However, in order to address this problem;
women, families, the communities, care providers, and facilities that surround them must be
prepared in advance for rapid emergency action (Thaddeus & Maine, 2004).

Knowledge of the danger signs is the first step to timely referral for essential obstetric care. Mona
Moore et al. (2002), in a Homabay study to investigating factors influencing women’s use of skilled
care concluded that, poor knowledge on key danger signs indicated poor awareness. This was due
to absence of relevant intervention within the health facilities that would promote BP/CR, poor
utilization of available health care services and poor information given to the pregnant women during
ANC visits (Sjogren, 1996).

Mihret and Mesganaw in a study assessing knowledge and practices on BP/CR in Ethiopia identified
poor comprehensive knowledge and practices on birth preparedness and complication readiness in
the area. From the study, community based education on BP/CR and pregnant women empowerment
through expansion of educational opportunities are important steps in reducing maternal mortality.
Therefore, it is our responsibility as health care providers to give due emphasis to BP/CR (Mihret &
Mesganaw, 2008).

A Ghanaian study identified the following service-related problems influencing BP/CR; no

provision for medicine or intravenous fluids, absence of doctors at delivery centers, fear of referral
to hospital, fear of surgery and ignorance regarding delivery center care. Patient-related factors
included the following; the mothers preferred delivering at their parent’s home in the village, others
were inhibited by mothers-in-law or mothers, labor pains started at night and therefore, did not get
time to go to the hospital as delivery happened quickly (Banza et al., 2004).

Being pregnant at a planned or unplanned time could also affect a woman’s reaction towards having
her baby (Klerman, 2001). Results from an Ethiopian study indicated that, a woman who had planned
for the pregnancy was more likely to prepare for childbirth. The study also revealed that married
women were more likely prepare for childbirth and its complications compared to non married
women. This may be because married women may have wanted and planned for the pregnancies,
which enables them to demand for better services and preparations. Another explanation could be
that the unmarried women may not want to be known as pregnant (Mihret & Mesganaw, 2008).

A woman’s perception of her pregnancy is one of the most important factors which could affect her
personal health and well-being, her feelings towards her baby and her thoughts and childbirth
preparations (Klerman, 2001). In most normal pregnancies, women experience anxiety and
depression as well as positive feelings of excitement and hopefulness. Women with marital
problems, those with inadequate social support and those with conflict about their own identity, will
experience greater emotional stress and will not prepare for birth adequately (Inyangala, 2008).

Support provides a sense of security in pregnancy and childbirth. Social support, positive prenatal
care experiences, support from one’s partner and positive stories from previous experiences, created
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Vol.2, No.3, pp.47-61, December 2016
___Published by European Centre for Research Training and Development UK (www.eajournals.org)
a sense of security to pregnant women (Melender & Lauri, 2002). The study also explored causes of
fear during pregnancy and childbirth and the following were identified; fears based on uncertainty,
lack of experience with childbirth, inadequate knowledge, or negative experiences during pregnancy
and childbirth. Coping with fear occurred through talking to people in their social networks,
healthcare professionals or through seeking information from books. Professional support and
childbirth education were especially helpful (Melender & Lauri, 2002).

Satisfaction with prenatal care and subsequent utilization of those services, were found to be
important (Handler et al., 2003). In a Uganda study, women preferred to deliver in health facilities,
however, they did not do so because of the following barriers; the expensive mamma kits that were
required, labor starting at night in absence of transportation and inaccessible health units that are
often closed at night. Other barriers cited were health workers' rudeness, corrupt tendencies and
absenteeism from work. Given these barriers in accessing the formal health system, the possibility
of getting services on credit from traditional birth attendants (TBAs) to offset delivery expenses was
considered an easier option (Handler et al., 2003). If the clients are satisfied with care, they will
prepare for pregnancy and delivery better (Waiswa et al., 2008).

In many societies in the world, cultural beliefs and lack of awareness inhibit preparation in advance
for delivery. Since no action is taken prior to the delivery, the family tries to act only when labor
begins. The majority of pregnant women and their families do not know how to recognize the danger
signs of complications. When complications occur, the unprepared family will waste a great deal of
time in recognizing the problem, getting organized, getting money, finding transport and reaching
the appropriate referral facility (Moore et al., 2002).

The poor are defined as those who cannot afford basic needs; food and non food items. In Kenya
more than half of the Kenyan population is poor and women are the majority. Given that most of the
Kenyan population lives below the poverty line, it is consequently difficult to pay health care fees
at one go (UN, MDG, 2008). Poor women are more likely to die of pregnancy or childbirth because
they tend to live further away from health facilities due to lack of money, lack of money and
transportation is a barrier to seeking care and identifying and reaching medical facilities. To tackle
this problem and reduce maternal mortality, a significant step towards poverty eradication must be
taken (UN, MDG, 2008). As a BP/CR strategy it is recommended by the WHO that savings be made
in advance, this will cater for food and non food items and meet the hospital bill.

Delivering carefully developed messages through the mass media, especially the radio is an
attractive and feasible strategy that has proven successful with HIV/AIDS in the country (Waiswa
et al., 2008). Another vital part of the strategy would be to clearly identify the barriers to individual
counseling at the clinic level and institute appropriate interventions to ensure that the peculiar
circumstance of each pregnant woman is dealt with (Waiswa et al., 2008). On the other hand,
pregnant women would be unable to make optimal use of the information they have been provided
if services are not readily available. Therefore, improving access to services that they have been
advised to make use of is vital. In our context, this would mean improving the access to skilled
attendance at delivery particularly for rural women.

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METHODOLOGY

In this study, the author considered three health care facilities Maternal and Child Health units of
level 4 (Uasin Gishu District Hospital, Huruma District Hospital) and level 3 (West Health Centre)
located in Eldoret town.
The study population comprised of pregnant women of reproductive age group (15-49) yrs, who had
attended two or more antenatal visits during the data collection period. This is because health
education on birth preparedness and complication readiness is first introduced during the first visit
and emphasized during subsequent visits. A descriptive cross sectional design in a quantitative
approach was used.
The sample size was calculated using Fischer’s formula, with a 95% confidence interval and a
sampling error of 0.05. From the health facilities records, the population of pregnant women that
had attended the ANC between the months of 1st august 2009 to 31st July 2010 was as follows:
N = No. of ANC attendance for one year
12 months
West health centre: 1537 pregnant women had attended ANC throughout the year with an
average of 129 women per month
1537/12 = 129
Huruma District hospital: 2800 pregnant women had attended ANC throughout the year with
an average of 233 women per month.
2800/12 = 233
Uasin Gishu District hospital: 6917 pregnant women had attended ANC throughout the year
with an average of 576 women per month.
6917/12 = 576
The target population from the three health facilities was:
N = 129 + 233 + 576
N = 938
Since the sampling population was less than 10000, the sample size was adjusted using Fisher’s
recommendation formula:
n1 = n/ 1+n/N
383 = 1+ 383/938
n = 273
Sample size = 273 women.
To determine the number of participants in each health facility, proportional sampling was done as
shown below:

n = No. of ANC attendance per month x Sample Size

Target population

1. West Health Centre = 129 x 273 = 37 women participated in the study.

938
2. Huruma District Hospital = 233 x 273 = 68 women participated in the study.
938
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3. Uasin Gishu District Hospital = 576 x 273 = 168 women participated in the study.
938
Data collection was done by help of questionnaires which were administered in a private room
provided by the unit in charges of the various health facilities, this guaranteed utmost confidentiality
and privacy during the data collection period. The questionnaires were administered prior to the
ANC check up to ensure that the results obtained were accurate and not influenced in any way by
the care givers.
Data was then coded and entered into SPSS data software for analysis. The SPSS was used to
calculate the mean value for continuous variables and frequencies for categorical variables. A p-
value of < 0.05 was considered statistically significant.

RESULTS AND DISCUSSION

Factors That Influence Birth Preparedness

Bivariate Analysis
A bivariate analysis was carried out on selected demographic characteristics to assess for factors that
influence birth preparedness. Planned/perception of pregnancy P(0.001), education level P (0.005),
source of income P (0.013) and number of times attended ANC in the current pregnancy P (0.001)
were found to be significantly associated with birth preparedness (P < 0.05) as shown in table 1.

Table 1: Factors that influence birth preparedness

Variable Birth preparedness

Yes No P -value
Marital Status
Single /divorced
Separated 27 22
Married 0 1
114 109
0.582
Education level
None
Primary 1 0
Secondary 30 55
post secondary 63 49
47 28

0.005
Employment status
Formal employment
Self employed 26 25
Unemployed 42 35
20 21 0.925
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Housewife 48 48

Source of income
Wages
Business 31 50
Farm outputs 51 35
Relatives 08 06
Others 38 32
0.013
10 5
Religious affiliations
Christian
Non-Christian 138 120 0.248
8 0
Number of ANC attendance
Once
Twice 13 18
Thrice 40 58
More than four times 49 33
37 14

0.001
Parity 1(0,2) 1(0,2) 0.330
Perception of pregnancy
Planned
Not Planned 113 49 0.001
25 73

Multivariate Analysis
Factors found to be associated with birth preparedness in the bivariate analysis were then settled into
a multivariate analysis model for further analysis. According to the multivariate logistic regression
analysis, level of education (P=0.014), source of income (P=0.008), number of ANC attendance
(P=0.004), perception of pregnancy (P= 0.000) were found to be significant predictors of birth
preparedness as shown in table 2.

Planning/perception of pregnancy (P= 0.000), number of ANC attendance (P=0.004), level of

education (P=0.014) and source of income (P=0.008) were found to be significant predictors of birth
preparedness. Pregnant women with planned pregnancies were six times more likely to prepare for
birth than their counterparts (OR=5.544, 95 % CI= 2.783, 11.044). Those who had attended ANC
three or more times were more likely to be prepared (OR=0.529, 95 % CI=0.214, 1.303) than those
with less than three times ANC attendance (OR=0.227, 95 % CI 0.062, 0.828). Those with tertiary
education were more likely to be prepared for birth compared to those with primary and secondary
education. From this analysis, those whose source of income was wages were less likely to be
prepared for birth compared to those with relatives as source of income as shown in table 2.

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Table 2: multivariate analysis of factors that influence birth preparedness

B S.E. Sig. OR 95.0% C.I. for

OR
Lower Upper
Source of income (Ref-relatives) .008
Wages - .416 .002 .279 .124 .632
1.275
Business -.070 .392 .858 .932 .432 2.011
Farm output .383 .789 .627 1.466 .313 6.878
Education(Ref- primary) .014
Secondary .041 .337 ..913 1.042 .497 2.183
Tertiary .285 .34 .40 1.33 .683 2.592
0 2 0
Perception of pregnancy(planned) 1.713 .352 .000 5.544 2.783 11.044

No. of times attended ANC(Ref-4 or .004

more times)
Once - .660 .025 .227 .062 .828
1.483
Twice - .455 .001 .220 .090 .537
1.513
Thrice -.637 .460 .166 .529 .214 1.303
Constant 1.208 .624 .053 3.348

In this study maternal education was found to be a strong predictor in birth preparedness. A
multivariate analysis showed that those with tertiary education were more likely to be prepared for
birth compared to those with primary and secondary education (P value 0.014). Findings from this
study concur with those from Ekabua’s Nigerian study where maternal educational status was found
to be the best predictor of awareness of birth preparedness (Ekabua et al., 2011). Similar findings
were seen in a study carried out in an Ethiopian study (Cronin & McCarthy, 2003), where literate
pregnant women were found to be more likely to be prepared for birth than the illiterate pregnant
women (Mihret & Mesganaw, 2008). A study by (Sood et al., 2004) indicated that the Birth Prepared
Index increased with level of knowledge, those with secondary education (p value 0.000) were more
prepared than those with primary education (P value of 0.003).

In a study by Mihret and Mesganaw (2008), maternal education was a strong predictor in preparation
for birth, Literate mothers were about two times more likely to be prepared for birth than illiterate
women (OR= 2.25, 95% CI=1.31, 3.88). Findings from this study may mean that the more education
one has the more empowered one is to prepare for birth.

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Planning for pregnancy in this study was found to be a strong predictor of birth preparedness (P
value 0.000). Those with planned pregnancies were almost six times more likely to prepare for birth
than those with unplanned pregnancies. Similar findings were seen in a study by (Mihret &
Mesganaw, 2008), where the respondents with planned pregnancies were more prepared for
childbirth than those who had not planned their pregnancy. In a study carried out in Kakamega PGH,
(Inyangala, 2008), women who had planned their current pregnancy were well prepared for birth
than their counterparts. This study reveals that those with planned pregnancies may have wanted the
best for themselves than those without planned pregnancies, thus influencing the preparations
undertaken.

From this study, respondents who had attended four or more ANC visits were more likely to be
prepared for birth than those with less than 4 times ANC attendance (P value of 0.004). Similar
findings were observed in a study by Mihret and Mesganaw (2008), where mothers who received
advice during ANC follow up were more likely to prepare for birth than those who did not attend
ANC more than once. Similar findings were also observed in a study carried out at Kenyatta National
Hospital (KNH) Mutiso and Quresh (2008), where majority of the respondents were not prepared
for complications due to the fact that the majority of pregnant women do not attend ANC as required.

Similar findings were also observed in a study conducted in India (Agarwal et al., 2010) where
pregnant women who attended antenatal care service were well prepared for birth than those who
did not seek ANC services and those by (Allysin et al., 2006),where pregnant women with more
antenatal care visits were more likely to prepare for birth (p=0.003). This may be because it is
assumed that during ANC visits knowledge on birth preparedness is imparted, therefore the more
one attend ANCs the more prepared they will be.

Source of income in this study was found to be a strong predictor of birth preparedness with a (P
value of 0.008). In studies carried out by (Mihret & Mesganaw, 2008) and by (Sood et al., 2004), it
was revealed that source of income was a significant predictor of birth preparedness. These findings
indicate that source of income empowers the woman to save and plan for childbirth.

Factors that influence complication readiness

To assess for factors that influence complication readiness both the bivariate and multivariate
analysis was carried out on the selected demographics as presented in this section

The bivariate analysis showed that education level (P= 0.013), employment status (P= 0.008) and
perception of pregnancy (P= 0.021) were found to be significantly associated with complication
readiness as shown in table 3.

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Table 3: Factors that influence complication readiness

Variable Complication Readiness

Yes No P-value
Marital Status
Single
Separated /divorced 36 11
Married 1 0
158 61 0.717
Education level
None
Primary 1 0
Secondary 56 27
Post secondary 75 35
63 9
0.013
Employment status
Formal employment
Self employed 43 8
Unemployed 57 20
33 8 0.008
Housewife
58 38
Source of income
Wages
Business 54 28
Farm outputs 62 25
Relatives 10 4
11 15
0.141
Religious affiliations
Christian
Non-Christian 192 72 0.564
3 0
Number ANC attendance
Once
Twice 27 4
Thrice 72 26
More than four times 58 24
32 19

0.119

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Parity(IQR) 1(0,2) 0(0.1) 0.104

Perception on this pregnancy
Planned
Not Planned 124 38
62 36
0.021

A multivariate logistic regression analysis showed that planning/perception of pregnancy

(P= 0.010) and employment status(P=0.023) were found to be a significant predictor of
complication readiness as shown in table 4.

Those with planned pregnancies were two times more likely to be ready for the complications than
those with unplanned pregnancies (OR= 2.242, 95% CI =1.210, 4.157). Those who were
unemployed were three times more likely to be prepared for complications than their counterparts.

Table 4: Multivariate analysis of factors that influence complication readiness

B S.E. Sig. OR 95.0% C.I. for

OR
Lower Upper
Level of education (Ref- .214
primary)
Secondary .656 .481 .179 1.97 .741 5.031
2
Tertiary .801 .456 .079 2.22 .194 5.447
7
Employment status (Ref- .023
Student)
Formal employment .395 .514 .442 1.48 .542 4.066
5
Self employment .127 .593 .830 1.13 .355 3.629
6
Unemployed 1.203 .498 .016 3.33 1.255 8.834
0
Perception (planned) .808 .315 .010 2.24 1.210 4.157
2
Constant - .837 .003 .084
2.483

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Employment status (P value 0.008) of the pregnant woman is a strong predictor of complication
readiness. A multivariate analysis revealed that those who were unemployed were three times more
likely to be ready for complications than those who were employed (P value of 0.023). Similar results
in Burkina Faso (Allysin et al., 2006), show that employment status was a significant predictor of
complication readiness.

However, these study findings differ with those from KNH (Mutiso and Quresh) and Ethiopia
(Mihret and Mesganaw, 2008), where pregnant women who were employed were found to be more
prepared for complications than those who were not employed. This may be because the employed
pregnant women may have the funds to meet the cost of complications if they arise, therefore they
would not really bother to get prepared for complications.

Planning for pregnancy in this study was a significant predictor of complication readiness. The
multivariate analysis showed that those with planned pregnancies were twice likely to be prepared
for complications than those with unplanned pregnancies (P value 0.010). Similar findings were
observed in an Ethiopian study Mihret and Mesganaw, (2008) where women with planned
pregnancies were more likely to prepare for complication than those with unplanned pregnancies.
This finding may indicate that married women may have wanted the pregnancy and therefore may
have demand better services.

IMPLICATION TO RESEARCH AND PRACTICE

Proper ANC attendance by pregnant women plays a significant role in childbirth preparation. Several
factors influence preparations undertaken by pregnant women, among them: the social environment,
stresses experienced during pregnancy/delivery and culture. Additionally, pregnant women may be
uninformed about coping strategies and resources they can use to prepare themselves for delivery.
Thus, studying factors influencing birth preparedness and complication readiness among pregnant
women will lead to a better understanding of the issues pregnant women face, their impact on
preparedness for birth and complication, and the midwives expected role. An essential outcome of
this research is the discernment of midwifery practices which need change to improve services
offered to pregnant women within Eldoret town.

CONCLUSION

Clients who plan for the pregnancy are more likely to be ready for birth and its complications. This
may be because since they plan to get pregnant they may want the best services for their pregnancy.
From this study employed pregnant women were less prepared than those who were unemployed,
this finding may be attributed to fear of the unemployed to finance their care in-case of a
complication, and thus they are more prepared for complications. From this study it is unfortunate
to know that pregnant women lacked sufficient knowledge on birth and complication readiness. This
makes them ill- equipped to make informed choices that will contribute to the well-being of their
unborn child and themselves.

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 International Journal of Nursing, Midwife and Health Related Cases
Vol.2, No.3, pp.47-61, December 2016
___Published by European Centre for Research Training and Development UK (www.eajournals.org)
RECOMMENDATION

Women have BP/CR in place. However, emphasis should be placed on identifying target groups and
practice gaps, for intensified health education.

Learning institutions should incorporate birth preparedness and complication readiness in their
syllabus.
Antenatal care education should place emphasis on birth preparedness and complication readiness
to improve access to skilled and emergency obstetric care.

Future Research

The author recommends a study to assess the implementation level of birth preparedness and
complication readiness by the pregnant women.

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