CASE HISTORY – September 2019

The closure of obstetric units – opinions, attitudes and perceived information deficit of newly parents

Authors: Olav Tammik, Hele Everaus

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Background and aims. The news about the closure of obstetric units in Valga ja Põlva created active resistance from local municipalities, doctors and members of community. The resistance was likely surprising for political and economic decision-makers – similar situation in early 2000’s did not cause any reactions and smaller obstetric units were closed smoothly raising no need to consider civic activism, including in health political changes. The aim of present research is to examine information needs and perceived information deficit about pregnancy, childbirth and labour-related transportation related to the process of centralization. The study analyses the meanings of used terms (e.g. near home and safety).

Methods. 226 respondents who became or were about to become parents during last year answered web-based questionnaire in eFormular environment. The invitations were sent via thematic baby-groups in Facebook. Informed consent was placed at the beginning of the questionnaire. Data was analysed by SPSS and MS Excel software. Open-ended answers passed thematic textual analysis. This study was granted ethical approval from Tallinn Medical Research Ethics Committee (approval’s decision number 2480, Oct. 09, 2018).

Results. Respondents were rather active information seekers preferring to get information from a variety of sources. The thematic textual analysis of open-ended answers revealed a fundamental difference in terminology: safety is understood as a personal approach and availability of emergent medical help during the labour. „Near home“ ranges from up to 5 to 20 kilometres for 72% of respondents, an additional 17% find an obstetric unit in the range of 30 km to be near home. In general, people evaluate that information about pregnancy, childbirth and labour-related transportation is available and sufficient. The analysis of open-ended answers shows that the perceived lack of information is related to the aspects of labour-related transportation. Information is evaluated as contradictory and confusing, people are not sure if, when and on which case they should call an ambulance when they should go to the hospitals etc.

Conclusions. The planning and implementation of centralization process require substantial involvement of local community on all levels (e.g. municipality, doctors, local inhabitants) and efficient communication plan, including elaborated messages regarding alternative approaches for labour and labour-related transportation.