FACTORS ASSOCIATED WITH PROLONGED LABOUR AMONG WOMEN: AGE 32-45 YEARS IN EDO SPECIALIST HOSPITAL, BENIN CITY

TOPIC: FACTORS ASSOCIATED WITH PROLONGED LABOUR AMONG WOMEN: AGE 32-45 YEARS IN EDO SPECIALIST HOSPITAL, BENIN CITY

THIS TOPIC IS ALSO SUITABLE FOR: 
1. Department of Nursing Science

2. Department of Midwifery

3. Department of Public Health

This research material contains:

1-Chapter One to Five

2-Recent References/citations

3-Tables/Charts/Graphs in Chapter Four

4-Accurate Data Analysis

5-Table of Contents

6-Questionnaire

ABSTRACT
The aim of this study is focused on the factors associated with prolonged labour among women aged 32-45 years in Edo Specialist Hospital, Benin City, Edo State. The study specifically was carried out to ascertain factors contributing to prolonged labour among women aged 32-45 years in Edo Specialist Hospital, Benin City, Edo State; assess the level of knowledge in prolonged labour among women aged 32-45 years in Edo Specialist Hospital, Benin City, Edo State; and identify sociocultural practices that delay timely medical intervention in prolonged labor among women aged 32-45 years in Edo Specialist Hospital, Benin City. The research adopted the  descriptive survey research design, utilizing a structured questionnaire to collect data. The study targeted 126 women who had been admitted to Edo Specialist Hospital for labor and delivery. Simple random sampling was used to select the participants. The study made use of descriptive analysis and inferential statistics, where data from the field survey was analyzed using simple percentages, means, and standard deviations presented in frequencies and tables. Findings of the study revealed that factors such as delayed hospital presentation (X̄ = 4.15, S.D. = 0.94), advanced maternal age (X̄ = 3.87, S.D. = 1.05), and inadequate antenatal care (X̄ = 3.68, S.D. = 0.92) were significant contributors to prolonged labor. Furthermore, the women demonstrated a relatively high level of knowledge about prolonged labor, though some gaps were identified in specific areas like hydration during labor. Sociocultural factors such as financial constraints (X̄ = 4.32, S.D. = 0.91) and preference for traditional birth attendants (X̄ = 3.92, S.D. = 0.85) were found to delay timely medical intervention. Therefore, the study recommended that health authorities should implement targeted awareness campaigns focused on the risks and signs of prolonged labor, emphasizing the importance of early hospital presentation and timely medical intervention. Thus, nurses and healthcare providers should undergo training to understand and address the cultural barriers that influence healthcare-seeking behavior, such as the reliance on traditional birth attendants and belief in spiritual causes of complications.

Keywords: Prolonged labor, advanced maternal age, antenatal care, sociocultural practices, medical intervention, healthcare access

CHAPTER ONE
INTRODUCTION (Preview)
1.1 Background to the Study
For women of reproductive age, being pregnant can be exciting at inception and a bit scary as the expected delivery date draws near, of which the pregnant woman anticipates the birth of her child with hope that all goes well. A qualitative review by Ängeby, Sandin-Bojö, Persenius, et al. (2024) shows that most women want a positive birth experience, one that fulfills or exceeds their prior personal and socio-cultural beliefs and expectations. Due to this anticipation by every pregnant woman, the World Health Organization (WHO) has issued a guideline that raises a positive birth experience as a critical feature when providing high-quality intrapartum care. However, Chilee (2020) argued that even though this guideline acknowledges a positive childbirth experience as being a significant goal for women in labor, somehow the process of childbirth and undefined circumstances like prolonged labor annul the expectations.

Globally, prolonged labor accounts for a considerable proportion of maternal and neonatal mortality, particularly in low- and middle-income countries where access to timely and quality healthcare services is often limited (Gaudernack et al., 2020). According to WHO expressed in Fehn, Dahlø, Nielsen, Laache, & Vanky (2020), prolonged labor is a primary cause of maternal and perinatal mortality and morbidity, and this failure in labor progression has become one of the leading indications for primary cesarean section, particularly in first-time mothers. In sub-Saharan Africa, prolonged labor remains a significant challenge due to inadequate health infrastructure, insufficiently trained medical personnel, and delayed decision-making during childbirth. In 2020, approximately 800 pregnant women die as a result of pregnancy or childbirth daily, and almost 95% of these maternal deaths occur in low- and lower-middle-income countries, most of which could have been prevented if appropriate interventions were put in place (World Health Organization [WHO], 2024).

By description, Gaudernack, Michelsen, Egeland, Voldner, & Lukasse (2020), citing the World Health Organization (WHO), defined prolonged labor as labor lasting more than 12 hours for primiparas and over eight hours for multiparous women. This condition can result in maternal exhaustion, increased risk of infection, uterine rupture, and adverse neonatal outcomes such as asphyxia and birth injuries. According to Okunlola, Bolarinwa, Alawode, & Adetutu (2020), approximately 25% of maternal deaths are associated with complications arising from prolonged labor, which is more than 20 hours in nulliparous women and more than 14 hours in multiparous women, posing serious health risks to both mother and child, especially in countries where the healthcare systems often face limitations in infrastructure, personnel, and resources. Olamide, Omowaleola, & Abosede (2021) expressed that for mothers having their first baby, they are expected to be in labor for a longer period of time, so prolonged labor may not be declared until 22 to 24 hours, whereas for second- or third-time mothers, labor may be considered prolonged after 16 to 18 hours.

Medically, there are myriad causes of prolonged labor, which include but are not limited to fetal malpresentation, cervical dystocia or stenosis, and cephalopelvic disproportion and inefficient uterine contractions (Wikipedia, 2023). However, the commonest cause of prolonged labor, according to the study of Kissler and Hurt (2023), is inefficient uterine contractions, coupled with the fact that most women, especially first-time mothers, lack knowledge on birth and complication readiness. This makes them ill equipped to meet both their needs and that of their unborn baby. Pergialiotis, Bellos, Antsaklis, Papapanagiotou, et al. (2020) opined that prolonged labor is associated with an increased risk of complicated deliveries and intervention such as operative delivery, postpartum hemorrhage, anal sphincter injury, chorioamnionitis, and transfer to a neonatal intensive care unit. Ringqvist, Bergqvist, Brezicka & Lundgren (2022) assert that prolonged labor is put at risk for developing cerebral palsy. Although why this is true is not completely understood or may not be known in every case, there are several likely possibilities. Because if labor is prolonged but the baby is already in the birth canal, the doctor may use instruments to pull the baby out. The use of forceps or a vacuum extractor can cause damage to a baby's skull. Literally, by crushing it with too much force, this can easily lead to brain damage that causes cerebral palsy. Since prolonged labor has severe implications for both maternal and fetal health, it is for this reason that this study aims to explore factors that contribute to prolonged labor, providing insights to inform targeted interventions and improve maternal health outcomes.

1.2 Statement of the Problem

Over the years, maternal mortality in Nigeria has remained a critical public health issue, with prolonged labor being a major contributing factor, where women aged 32-45 years, often classified as advanced maternal age, are at increased risk of complications during labor, including prolonged labor. According to Oni, Ilesanmi, & Yinusa et al. (2021), this is due to physiological changes, pre-existing health conditions, and a higher likelihood of obstetric complications such as uterine atony, cephalopelvic disproportion, and reduced uterine contractility. Olamide, Omowaleola, & Abosede (2021) pointed out that although there have been advancements in obstetric care, many women face prolonged labor due to a combination of biological, environmental, and healthcare-related factors. These challenges are exacerbated by inadequate antenatal care, late hospital presentations, and cultural practices that delay timely medical intervention.

Bizarrely, a study by Okoronkwo & Oprah (2024) revealed that some people are either aware or ignorant of the damaging effect on their health due to prolonged labor. Prolonged labor presents a picture of mental anguish and physical morbidity, which often leads to surgical intervention and may produce a permanent revulsion to childbirth, expressed by the mother as voluntary infertility; it constitutes a danger to the survival and subsequent neurological development of the infant. The harrowing experience, as stated by Okunola et al. (2020), is shared by relatives and by doctors and nurses to the extent that few complications tarnish the image of obstetrics. Also, Obijiofor, Enete, & Nnonyelu et al. (2020), in their study, pointed out that for women who are second or their moms, prolonged labor has an impact on both the mother and the fetus. The impact on the mother is to increase the incidence of life-threatening postpartum hemorrhage, whereas in the fetus it can increase the incidence of asphyxia or lack of oxygen, consequently increasing the risk of death.

Although, existing studies have examined effects and factors contributing to prolonged labour among women especially on general populations of women of reproductive age, there is a notable gap in understanding the specific challenges faced by women aged 32-45 years with refrence to Edo Specialist Hospital, Benin City. This demographic is particularly vulnerable due to advanced maternal age, which is associated with increased obstetric risks. For instance, delayed uterine contractions, comorbidities such as hypertension and diabetes, and a higher likelihood of abnormal foetal presentations are more common in this group. In order to fill this gap, the study seeks to investigate the factors associated with prolonged labour among women aged 32-45 years in Edo Specialist Hospital, Benin City, Edo state.

1.3 Aim

The aim of this study is to investigate the factors associated with prolonged labour among women aged 32-45 years in Edo Specialist Hospital, Benin City, Edo state.

1.4 Objectives of the Study

i.Ascertain factors contributing to prolonged labour among women aged 32-45 years in Edo Specialist Hospital, Benin City, Edo state.

ii.Assess the level of knowledge in prolonged labour among women aged 32-45 years in Edo Specialist Hospital, Benin City, Edo state.

iii.Identify sociocultural practices that delay timely medical intervention in prolonged labour among women aged 32-45 years in Edo Specialist Hospital, Benin City.

Other parts of chapter one include:
1.5 Research Questions

1.6 Significance of the Study

1.7 Scope of the Study

1.8 Definition of Key Terms

CHAPTER TWO
REVIEW OF LITERATURE (Preview)
This chapter critically examines relevant literature that would assist in explaining the research problem and, furthermore, recognizes the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps. This chapter therefore focuses on the concept of child-birth, concept of prolonged labour, factors contributing to prolonged labour, maternal factors contributing to prolonged labour in women aged 32–45 Years, etc. The chapter is sub-grouped into the following major headings:
Conceptual Framework

Theoretical Review

Empirical Review

Summary of Literature Review

CHAPTER THREE
METHODOLOGY (Preview)
Presented below is a snapshot of key areas of the study methodology, the full and detail chapter three methodology is contained in the instant download document.

Research Design: The study adopted a descriptive quantitative research design.

Population of the Study: The population of the study comprises women aged 32–45 years who experienced prolonged labour at Edo Specialist Hospital, Benin City, Edo State.

Sample Size Determination: The study adopted the Taro Yamane (1967) formula to determine a sample size of 126 participants, with an additional 10% buffer, making a total sample size of 139 participants.

Sampling Technique: The study employed simple random and convenience sampling techniques to select the individual respondents.

Research Instrument: The study utilized a structured questionnaire comprising four sections as the instrument for data collection.

Methods of Data Analysis: The collected data were analyzed using frequencies, percentages, means, and standard deviations to summarize and present the demographic characteristics of the respondents and their responses. Inferential statistics, such as logistic regression, were used to test the hypotheses.
Full outline for chapter three;
3.1 Research Design

3.2 Research Setting.

3.3 Target population

3.4 Sample Size

3.5 Sampling Technique

3.6 Instruments for data collection.

3.7 Validity of the instrument.

3.8 Reliability of the instrument

3.9 Method of data collection.

3.10 Method of data analysis

3.11 Ethical Considerations

CHAPTER FOUR: RESULT 
MAJOR FINDINGS (Preview)
The analysis results were presented in tables and charts. Based on the results obtained from the analysis, the following major findings were made:

i. The study found that several factors contribute to prolonged labour among women aged 32–45 years in Edo Specialist Hospital, Benin City, as evidenced by a mean range of 4.15–4.45 and a grand mean of 4.25, which is above the acceptance benchmark of 3.0. This implies that lack of timely medical intervention, poor antenatal attendance, advanced maternal age, inadequate birth preparedness, poor nutrition during pregnancy, and delayed hospital presentation are significant factors contributing to prolonged labour among women in the study area.

ii. The study found that women aged 32–45 years in Edo Specialist Hospital, Benin City, have a high level of knowledge about prolonged labour, as evidenced by a mean range of 4.15–4.55 and a grand mean of 4.35, which is above the acceptance benchmark of 3.0. This implies that the women understand the complications associated with prolonged labour, the importance of regular antenatal care, the risk associated with advanced maternal age, the role of poor uterine contractions, the importance of proper hydration, and the increased risk of postpartum haemorrhage.

iii. The study found that sociocultural practices contribute to delays in timely medical intervention for prolonged labour among women aged 32–45 years in Edo Specialist Hospital, Benin City, as evidenced by a mean range of 4.15–4.45 and a grand mean of 4.25, which is above the acceptance benchmark of 3.0. This implies that preference for traditional birth attendants, beliefs in spiritual causes of labour complications, family decision-making, cultural stigma surrounding hospital delivery, lack of spousal support, and financial constraints associated with sociocultural norms can delay access to appropriate medical care during labour.

CHAPTER FIVE: DISCUSSIONS OF FINDINGS
This chapter covers the following outline:

5.1 Identification of Key Findings

5.2 Implications of the Findings to Nursing

5.3 Limitations of the Study

5.4 Summary

5.5 Conclusions

5.6 Recommendations

5.7 Suggestion for Further Findings

Reference
Appendix

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