Abstract:
BACKGROUND : Risks of severe, avoidable maternal and neonatal complications at birth are increased if the birth occurs
before arrival at the health facility and in the absence of skilled birth attendants. Birth Before Arrival (BBA) is a preventable
phenomenon still common in modern-day practice despite extensive improvements made in obstetric care and in
accessibility to healthcare in South Africa. This study aimed to determine the risk factors and outcomes in mothers and
babies associated with being born before arrival at hospitals.
METHODS : A prospective case control study design was conducted. All BBAs presenting to the hospitals in Nkangala
District between November 2015 and February 2016 were included and compared to a consecutive hospital delivery
occurring immediately after the arrival of each BBA. T-tests and chi square tests were used to analyse the differences
between the groups and a binary logistic regression analysis used to determine predictors of BBAs. All statistical analysis
were done using STATA version 14 using a 5% decision level and a 95% confidence interval.
RESULTS : During the study period, 4397 in-facility births and 201 BBAs were recorded, 78 BBAs and 75 controls were
investigated in this study. The district BBA prevalence was 4.6%. Risk factors identified in mothers of BBAs were: single
mothers (83.3% vs 69.3%; p = 0.04); residing in an informal settlement (23.1% vs 5.3%; p = 0.002); and higher gravidity
with plurigravida significantly more (60.3% vs 32.5%; p < 0.0001). A prevalent maternal complication in cases was
haemorrhage due to retained placenta. Most neonates were born alive with a higher proportion of cases experiencing
perinatal complications such as respiratory distress, hypothermia and asphyxia. No significant differences in maternal
age, employment status and immediate birth outcomes were found. Residing in informal settlements, higher gravidity,
unplanned pregnancy, low birth weight and unbooked were found to predict the occurrence of BBAs.
CONCLUSION : Although no significant numbers of mortalities were recorded in this study, service delivery interventions
targeting the reduction of BBAs are needed so as to minimise the morbidity experienced by the group.
