Pregnancy Duration and Choice of Ante-Natal and Delivery Care

1.0 Introduction

1.1 Background of Study

Historically, pregnancy duration and maternal healthcare dates back to ancient civilizations when childbirth was primarily managed by traditional birth attendants (TBAs) and midwives. Early medical records from ancient Egypt, Greece, and China indicate that pregnancy was closely monitored using traditional knowledge and herbal remedies to ensure safe delivery (Soran, 2020). Midwifery was a common practice in these societies, and the role of birth attendants was passed down through generations. However, there was limited scientific understanding of pregnancy duration, and maternal deaths were common due to the lack of medical interventions (Loudon, 2016).

Today, pregnancy duration is well understood, with clear guidelines on gestational age classifications, including preterm (before 37 weeks), term (37–40 weeks), and post-term pregnancies (after 42 weeks) (Cunningham et al., 2018). Advances in obstetric care, such as ultrasound imaging, fetal monitoring, and emergency obstetric procedures, have further improved pregnancy outcomes. However, disparities in access to quality antenatal and delivery care persist, particularly in developing countries where financial, cultural, and infrastructural barriers hinder maternal health services (Adedokun et al., 2022). Pregnancy is a crucial period in a woman's life, requiring adequate medical supervision to ensure maternal and neonatal well-being. The duration of pregnancy, typically around 40 weeks, significantly influences the choice of antenatal and delivery care services. Proper antenatal care (ANC) is essential for monitoring maternal and fetal health, identifying complications, and preparing for childbirth (World Health Organization [WHO], 2020). The quality and timing of antenatal visits play a crucial role in determining pregnancy outcomes.

According to Adedokun et al. (2022), the choice of antenatal and delivery care varies across different socio-economic and cultural contexts. In many low- and middle-income countries, factors such as financial constraints, limited healthcare facilities, cultural beliefs, and lack of awareness influence pregnant women's decisions regarding maternal healthcare (Adedokun et al., 2022). Studies have shown that women with early and consistent antenatal visits are more likely to choose skilled delivery care, reducing the risk of maternal and neonatal complications (Babalola & Fatusi, 2020). However, despite global efforts to improve maternal health, many expectant mothers still rely on traditional birth attendants or home deliveries due to inadequate healthcare access and systemic barriers (UNICEF, 2021).

Healthcare policies and intervention programs have emphasized the need for early antenatal enrollment and skilled birth attendance to reduce maternal mortality rates. Research indicates that pregnancies reaching full term (37–40 weeks) with proper medical supervision have significantly lower risks of complications compared to preterm or post-term deliveries (Cunningham et al., 2018). Ensuring that women receive comprehensive antenatal care and choose skilled delivery services is essential for achieving global maternal and child health goals.

Pregnancy Duration according to Cunningham et al. (2018) refers to the period from conception to childbirth, typically lasting about 40 weeks, divided into three trimesters (Cunningham et al., 2018). Pregnancy duration plays a crucial role in determining maternal healthcare choices, including the type of antenatal and delivery care received. Proper antenatal care significantly reduces pregnancy-related complications, while skilled delivery care lowers maternal and neonatal mortality rates (WHO, 2019). The choice of antenatal and delivery care is influenced by various factors, such as socio-economic status, cultural beliefs, education level, and availability of healthcare facilities (Adedokun et al., 2022). Therefore, this study seeks to explore how pregnancy duration influences the selection of antenatal and delivery care services while identifying the challenges that hinder access to quality maternal healthcare.

1.2 Statement of Problems

Investigation revealed that the duration of pregnancy is one of the most critical factors influencing maternal healthcare decisions, yet many expectant mothers do not receive adequate antenatal and delivery care. While medical advancements have improved pregnancy outcomes, disparities in access to quality maternal healthcare persist, particularly in low-resource settings (WHO, 2020). Some women delay or entirely forgo antenatal visits due to financial constraints, cultural beliefs, or a lack of awareness about the importance of regular check-ups (Adedokun et al., 2022).

In many communities, the decision about where and how to give birth is influenced by social and economic factors rather than medical necessity. Some pregnant women still rely on traditional birth attendants due to deep-rooted cultural preferences or distrust of formal healthcare systems (Babalola & Fatusi, 2020). The inconsistency in antenatal care attendance also affects the ability of healthcare providers to monitor fetal development, detect complications early, and provide necessary interventions. It is against the backdrop that this study seeks to examine the relationship between pregnancy duration and the choice of maternal healthcare services.

1.3 Aim and Objectives of Study

The aim of this study is to examine the relationship between pregnancy duration and the choice of antenatal and delivery care.

The specific objectives of the study are to:

1. Assess the influence of pregnancy duration on the timing and frequency of antenatal care visits.
2. Identify the factors that determine pregnant women's choice of antenatal and delivery care services.
3. Examine the role of socio-economic and cultural factors in maternal healthcare decision-making.
4. Investigate the impact of antenatal care utilization on pregnancy outcomes, including preterm and post-term deliveries.
5. Explore the barriers to accessing skilled maternal healthcare and suggest strategies for improving maternal and neonatal health outcomes.

1.4 Research Questions

Based on the objectives of the study, the following research questions are formulated:

• How does pregnancy duration influence the timing and frequency of antenatal care visits?
• What are the key factors that determine pregnant women's choice of antenatal and delivery care services?
• In what ways do socio-economic and cultural factors affect maternal healthcare decision-making?
• What impact does antenatal care utilization have on pregnancy outcomes, particularly preterm and post-term deliveries?
• What are the major barriers to accessing skilled maternal healthcare, and what strategies can be implemented to improve maternal and neonatal health outcomes?

1.5 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

• H₀1: Pregnancy duration has no significant influence on the choice of antenatal and delivery care.
• H₀2: Pregnancy duration significantly influences the timing and frequency of antenatal care visits.
• H₀3: Socio-economic and cultural factors play a significant role in determining pregnant women's choice of antenatal and delivery care services.

1.6 Significance of Study

The outcome of this research will assist policymakers in designing effective maternal health programs that address the barriers to accessing quality antenatal and delivery care. It will contribute to improving healthcare policies aimed at reducing maternal and neonatal mortality rates by promoting early and regular antenatal care visits.

Furthermore, the research study will benefit pregnant women by increasing awareness of the importance of antenatal care and its role in ensuring a safe delivery. It will provide evidence-based recommendations that encourage informed decision-making regarding maternal healthcare services.

Lastly, healthcare professionals will find this study useful in developing targeted interventions that improve maternal and neonatal health outcomes.

1.7 Scope of Study

This study will focus on pregnancy duration and the choice of antenatal and delivery care among pregnant women in Lagos State, Nigeria. The research will be conducted in both public and private healthcare institutions, including Lagos University Teaching Hospital (LUTH), General Hospital Ikeja, and Randle General Hospital, Surulere.

1.8 Limitations of the Study

During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
3. Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.

1.9 Definition of Terms

Pregnancy Duration:

Pregnancy duration refers to the length of time a woman carries a pregnancy, typically measured from the first day of the last menstrual period to the time of delivery. Full-term pregnancies usually last around 40 weeks, but variations can occur. Preterm pregnancies refer to deliveries before 37 weeks, while post-term pregnancies extend beyond 42 weeks (American College of Obstetricians and Gynecologists, 2021).

Ante-Natal Care (ANC):

Ante-natal care refers to the regular medical and healthcare services provided to a pregnant woman to ensure the health and well-being of both the mother and the fetus. It includes health education, screening, vaccinations, and monitoring the progression of the pregnancy. Effective ANC can significantly reduce pregnancy-related complications and improve maternal and neonatal outcomes (World Health Organization, 2020).

Delivery Care:

Delivery care encompasses the medical services provided during labor, delivery, and the immediate postpartum period. This includes skilled assistance from healthcare professionals such as obstetricians or midwives, access to emergency care if necessary, and post-delivery care to ensure the health of both the mother and newborn (World Health Organization, 2018).

Antenatal and Delivery Care Services:

These services represent a range of healthcare interventions aimed at ensuring the safety of both mother and child during pregnancy, labor, and delivery. They include regular check-ups, diagnostic tests, vaccinations, and delivery assistance by trained professionals in a health facility (WHO, 2018).

Preterm Birth:

Preterm birth refers to a birth that occurs before 37 weeks of pregnancy, as opposed to a full-term pregnancy, which lasts approximately 40 weeks. Preterm birth increases the risk of complications for both the mother and the newborn, including respiratory distress, infections, and developmental challenges (March of Dimes, 2020).

Post-Term Pregnancy:

A post-term pregnancy is one that extends beyond 42 weeks. Such pregnancies often require closer monitoring to prevent complications like fetal distress, excessive birth weight, and increased risk of stillbirth (American Pregnancy Association, 2021).

Socio-Economic Status:

Socio-economic status refers to the social and economic factors that influence an individual's or group's position in society. These factors, including income, education, and occupation, significantly impact a person's access to healthcare, including antenatal and delivery care services (Rao et al., 2019).

Healthcare Accessibility:

Healthcare accessibility refers to the ease with which individuals can obtain necessary medical care. This includes proximity to healthcare facilities, financial barriers, availability of skilled healthcare providers, and the availability of maternal health services in a given area (Nigerian National Health Policy, 2016).