1. INTRODUCTION:

In spite of important progress towards attaining the Millennium Development Goals (MDGs), maternal and neonatal mortality continue to figure as major public health problems in developing countries^(1,2). Improvements in maternal health and reductions in maternal mortality have been slower than anticipated and – despite isolated successes – remain far from the MDG5 target of a 75% reduction in the maternal mortality ratio (MMR) from 1990 to 2015⁽³⁾. Maternal mortality is a global burden, about 287,000 women died in 2010 due to pregnancy and childbirth related complications⁽⁴⁾. In India, Maternal Mortality Ratio is 212 per 100,000 live births⁽⁵⁾.

Morbidities related to pregnancy are related to medical causes which goes uncounted. Most maternal death occurs during delivery due to unpreparedness for childbirth and managing complications, which results in delivery by the mother itself or untrained attendant. These maternal deaths are unjust and avoidable if preventive measures are taken on time like ensuring antenatal care to all mothers, delivery by skilled birth attendant and timely referral to hospital. As in most rural and tribal areas, delivery takes place at home, far from emergency obstetric services or without access to skilled attendant, there is more risk associated with mother and child life⁽⁶⁾. Pregnancy and giving birth to a child are normal physiological process, but the circumstances both internal and external, in which the child is conceived and born, affect the life of mother and child. Every pregnancy is associated with certain amount of unpredictability of risk of complication. Socio-cultural beliefs and lack of awareness in mothers and family members on how to recognize danger signs and symptoms, where to go when complication occurs, results in delay in seeking care and unprepared families waste time in recognizing problem, getting organized, getting money, finding transport and reaching the appropriate referral facility⁽⁷⁾.

Birth preparedness is a strategy to promote utilization of maternal healthcare services and to ensure safe motherhood. Birth preparedness concept is based on the theory that preparing for childbirth and being ready to deal with complications reduces the delays in obtaining timely care and addressing the three delays of deciding to seek care, reaching health facility and receiving care ⁽⁸⁾.

Many birth preparedness programmes widely promoted by governments and international agencies to reduce maternal and neonatal health risks in developing countries; however, their overall impact is uncertain. Thus investigator felt need to assess whether pregnant women have adequate knowledge on antenatal, Intranatal and postnatal preparedness.

REVIEW OF LITERATURE:

Anita Shankar Acharya, Ravneet Kaur, Josyula Gnana Prasuna, and Nazish Rasheed (2015) conducted a cross-sectional study on "Making Pregnancy Safer—Birth Preparedness and Complication Readiness Study Among Antenatal Women Attendees of A Primary Health Center, Delhi". study included 417 antenatal attendees at a primary health center, Palam, New Delhi from January to April 2012. Knowledge about danger signs, planning for transport, place, and delivery by skilled birth attendant, financial management, and outcome were assessed. BPACR index was calculated. Results: study revealed that the BPACR index was very low (41%) although the preparedness level was high. Majority (81.1%) had identified a skilled attendant at birth for delivery. Nearly half of the women (48.9%) had saved money for delivery and 44.1% women had also identified a mode of transportation for the delivery. However, only 179 (42.9%) women were aware about early registration of pregnancy. Only one-third (33.1%) of women knew about four or more antenatal visits during pregnancy. Overall, only 27.8% women knew about any one danger sign of pregnancy. conclusion: The level of awareness regarding BPACR was very low (41%). Efforts should be targeted to increase the awareness regarding components of BPACR among pregnant women and their families at the Primary Health Center (PHC) as well as at the community level. This will indeed go a long way in reducing morbidity as well as mortality in pregnant women, thus enabling us to reach the millennium development goal.⁽⁹⁾

Furaha August, Andrea B. Pembe, Edmund Kayombo, Columba Mbekenga, Pia Axemo and Elisabeth Darj (2014) conducted a study on Birth preparedness and complication readiness – a qualitative study among community members in rural Tanzania. A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyze the data. The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favor of a positive outcome. Community recognized that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilization of skilled care^.(10)

Desalegn Markos and Daniel Bogale (2014) conducted a community based cross sectional study was conducted in Goba woreda, Oromia region, Ethiopia. Multistage sampling was employed. Descriptive, binary and multiple logistic regression analyses were used. Only 29.9% of the respondents were prepared for birth and its complications. And, only 82 (14.6%) study participants were knowledgeable about birth preparedness and complication readiness. Variables having statistically significant association with birth preparedness and complication readiness of women were attending up to primary education (AOR = 3.24, 95% CI = 1.75, 6.02), attending up to secondary and higher level of education (AOR = 2.88, 95% CI = 1.34, 6.15), the presence of antenatal care follow up (AOR = 8.07, 95% CI = 2.41,27.00), knowledge about key danger signs during pregnancy (AOR = 1.74, 95% CI = 1.06,2.88), and knowledge about key danger signs during the postpartum period (AOR = 2.08, 95% CI = 1.20,3.60). conclusion: Only a small number of respondents were prepared for birth and its complications. Furthermore, the vast majority of women were not knowledgeable about birth preparedness and complication readiness. Residence, educational status, ANC follow up, knowledge of key danger signs during pregnancy and the postpartum period were independent predictors of birth preparedness and complication readiness.⁽¹¹⁾

Rajib Saha, Aditya Prasad Sarkar, Indranil Saha, Raghunath Misra, Samir Dasgupta and Supantha Chatterjee, (2014) conducted a survey on to assess Status of Birth Preparedness and Complication Readiness among Rural Indian Mothers. Thirty villages with homogenous characteristics were identified by cluster sampling methods from a rural block (Bhatar, Burdwan district, West Bengal) of India on April 2013 to November 2013. From every cluster 7 mothers who had delivered baby within the last year and were available first, interviewed consecutively using a guided questionnaire adapted from JHPIEGO Maternal and Neonatal Health Programme survey tools. Multivariate logistic regression was applied in analysis to predict how much the independent variables influenced the birth preparedness of mothers. Results 62.4% mothers were found to be well prepared. Trained birth attendants and health facilities were identified before delivery in 81.9% and 78.1% cases respectively. Mode of transportation for complication management or delivery was pre-decided by about 60% of family. Only 35.7% family saved money for the same purpose. Logistic regression revealed that well preparedness increased 11 times with every new pregnancy, but it did not depend on caste and education status of the mothers. Conclusions The overall birth preparedness status of the rural mothers is poor and they acquire more knowledge regarding birth preparedness from their self experience rather than from existing health system.⁽¹²⁾

Mesay Hailu, Abebe Gebremariam, Fissehaye Alemseged, Kebede Deribe (2011) Birth Preparedness and Complication Readiness among Pregnant Women in Southern Ethiopia. This study was conducted to assess practice and factors associated with BPACR among pregnant women in Aleta Wondo district in Sidama Zone, South Ethiopia. A community based cross sectional study was conducted in 2007, on a sample of 812 pregnant women. Data were collected using pre-tested and structured questionnaire. The collected data were analyzed by SPSS for windows version 12.0.1. The women were asked whether they followed the desired five steps while pregnant: identified a trained birth attendant, identified a health facility, arranged for transport, identified blood donor and saved money for emergency. Taking at least two steps was considered being well-prepared. Among 743 pregnant women only a quarter (20.5%) of pregnant women identified skilled provider. Only 8.1% identified health facility for delivery and/or for obstetric emergencies. Preparedness for transportation was found to be very low (7.7%). Considerable (34.5%) number of families saved money for incurred costs of delivery and emergency if needed. Only few (2.3%) identified potential blood donor in case of emergency. Majority (87.9%) of the respondents reported that they intended to deliver at home, and only 60(8%) planned to deliver at health facilities. Overall only 17% of pregnant women were well prepared. The adjusted multivariate model showed that significant predictors for being well-prepared were maternal availing of antenatal services (OR = 1.91 95% CI; 1.21–3.01) and being pregnant for the first time (OR = 6.82, 95% CI; 1.27–36.55). BPACR practice in the study area was found to be low. Effort to increase BPACR should focus on availing antenatal care services. ⁽¹³⁾

Jerome K Kabakyenga, Per-Olof Östergren, Eleanor Turyakira, and Karen O Pettersson (2011) conducted a study on Knowledge of obstetric danger signs and birth preparedness practices among women in rural Uganda. The study included 764 recently delivered women from 112 villages in Mbarara district. Community survey methods were used and 764 recently delivered women from 112 villages in Mbarara district were included in study. Interviewer administered questionnaire were used to collect data. Logistic regression analyses were conducted to explore the relationship between knowledge of key danger signs and birth preparedness. Fifty two percent of women knew at least one key danger sign during pregnancy, 72% during delivery and 72% during postpartum. Only 19% had knowledge of 3 or more key danger signs during the three periods. Of the four birth preparedness practices; 91% had saved money, 71% had bought birth materials, 61% identified a health professional and 61% identified means of transport. Overall 35% of the respondents were birth prepared.

The relationship between knowledge of at least one key danger sign during pregnancy or during postpartum and birth preparedness showed statistical significance which persisted after adjusting for probable confounders (OR 1.8, 95% CI: 1.2-2.6) and (OR 1.9, 95% CI: 1.2-3.0) respectively. Young age and high levels of education had synergistic effect on the relationship between knowledge and birth preparedness. The associations between knowledge of at least one key danger sign during childbirth or knowledge that prolonged labor was a key danger sign and birth preparedness were not statistically significant. The prevalence of recently delivered women who had knowledge of key danger signs or those who were birth prepared was very low. Since the majority of women attend antenatal care sessions, the quality and methods of delivery of antenatal care education require review so as to improve its effectiveness. Universal primary and secondary education programmes ought to be promoted so as to enhance the impact of knowledge of key danger signs on birth preparedness practices. ⁽¹⁴⁾

Ekabua JE, Ekabua KJ (2011) conducted a cross-sectional descriptive study in Nigeria to assess the awareness of birth preparedness and complication readiness in multi-centre among 800 women. Educational status was the best predictor of awareness of birth preparedness (but not a good predictor of intention to attend four antenatal clinic sessions (P=0.0029). Parity was a better predictor of knowledge of severe vaginal bleeding as a key danger sign during pregnancy than educational level (P=0.0009 and P=0.3849, respectively). Plan to identify a means of transport to the place of childbirth was related to greater awareness of birth preparedness (c²=0.3255; P=0.5683). Parity was a highly significant predictor (P=0.0089) of planning to save money. Planning to save money for childbirth was associated with greater awareness of community financial support system (c²=0.8602; P=0.3536). The proportion of women residing in rural area was 55.1%. Hospital delivery was recorded in 48.8%. The commonest danger sign experienced was prolonged labour (22.4%). Although awareness of the concept of birth preparedness was high (70.6%), knowledge of specific key danger signs was poor. Plan to use maternity services during pregnancy and access skilled attendance in child birth was positive (69.5%-83.5%).⁽¹⁵⁾

Agarwal S, Sethi V, Shrivastsav K. (2010) conducted a cross-sectional study with 312 mothers of infants aged 2-4 months in 11 slums of Indore, India. The sample was selected using purposive sampling technique. They were interviewed to assess birth preparedness and complication readiness (BPACR). One hundred forty-nine mothers (47.8%) were well-prepared. Factors associated with well-preparedness were maternal literacy [odds ratio (OR) = 1.9, 95% CI 1.1-3.4] and availing of antenatal services (OR = 1.7, 95% CI 1.05-2.8). Deliveries in the slum-home were high (56.4%). Among these, skilled attendance was low (7.4%); 77.3% of them were assisted by traditional birth attendants. Skilled attendance during delivery was three times higher in well-prepared mothers compared to less-prepared mothers (OR: 3.0, CI 1.6-5.4). Antenatal outreach sessions can be used for promoting BPACR. It will be important to increase the competency of slum-based traditional birth attendants, along with promoting institutional deliveries.⁽¹⁶⁾

Kamini J (2007) conducted an evaluatory study on the effectiveness of PTP on knowledge, attitude and practice of pregnant woman on selected aspects of antenatal care. The research design used was one group pre-test post-test pre-experimental design. Thirty samples were chosen using non-probability convenience sampling technique and the data were collected using structured interview schedule. There was inadequacy of knowledge, attitude, and inappropriate practice toward antenatal care. The planned teaching was effective. Assessment of knowledge attitude and practice of antenatal mothers on antenatal care 40% lacked basic knowledge about antenatal care. The overall knowledge improvement mean value was 5.6 (100%) after planned teaching programme and attitude was 5.4 (23%) and practice was 0.6 (77%).⁽¹⁷⁾

Alam AY, Qureshi AA, Adil MM, Ali H (2005) conducted a comparative study in Islamabad to compare the knowledge, attitude and practices among antenatal care facilities utilizing and non-utilizing 200 married women in the age range 15-49 years. A cross-sectional survey was conducted between October 2003 and April 2004. Pallor was significantly lower among women utilizing antenatal care (57%) as compared to those who were not (77.6%). (OR 0.38 95% CI 0.18-0.81, p value 0.02). Tetanus toxoid coverage was higher among women utilizing antenatal care (92%) compared to those who were not (59.2%) (OR 10.8 95% CI 4.5-26.2). Knowledge about danger signs in pregnancy and realization of the importance of eating a healthy diet during pregnancy was significantly higher among women utilizing antenatal care. Lesser prevalence of anemia and better tetanus toxoid coverage was seen among women attending antenatal care facilities. Identification of danger signs in pregnancy and recognition of nutritional demands of pregnancy were better understood by women utilizing antenatal care `1facility.⁽¹⁸⁾

Mutiso SM, Qureshi Z (2008) conducted a descriptive cross-sectional study to evaluate birth preparedness and complication readiness among antenatal clients attending antenatal clinic in Kenya. By systemic sampling technique 394 clients were selected for the study. In that over 60% of the respondents were counseled by health workers on various elements of birth preparedness, 87.3% knew about expected date of delivery, 84.3% had set aside funds for transport to hospital, 67% of the respondent knew at least one danger sign in pregnancy, while only 6.9% knew the three or more danger signs. Levels of education positively influenced birth preparedness.⁽¹⁹⁾

PROBLEM STATEMENT:

A cross sectional survey to assess knowledge on birth preparedness among antenatal woman attending antenatal clinic of selected municipal hospital.

OBJECTIVES:

· To determine knowledge of pregnant women on various elements of birth preparedness.

· To identify association of demographic variables with birth preparedness.

ASSUMPTIONS:

The study assumes that

— The pregnant mothers will be knowledgeable about birth preparedness.

— There will be association of demographic variables with birth preparedness.

INCLUSION CRITERIA:

— Registered pregnant Mothers

EXCLUSION CRITERIA:

— Mothers not willing to participate.

RESEARCH METHODOLOGIES:

— Research approach: Quantitative

— Research design: Cross sectional survey

— Sample : Primigravida Pregnant women

— Sample technique: Non probability Purposive Sampling

— Sample size: 425

ETHICAL CONSIDERATIONS:

— The study proposal was sanctioned by ethical committee of the SVCON.

— Permission was obtained from the concerned authority of the selected municipal hospital, Pune.

— Informed consent was taken from the participants.

TOOL:

The tool consisted of Semi structured interview and Structured Questionnaire

This had 2 sections-

Section I-

Socio demographic profile of mother

Section II-

Knowledge regarding birth preparedness ( Antenatal + Labor + Postnatal preparedness) Total of 32 questions were included among which 10 were antenatal, 10 Intranatal and 12 were postnatal.

VALIDITY AND RELIABILITY:

— To ensure the content validity of the prepared tool, it was given to experts.

— Reliability of tool was checked by using Test Retest and split half method; the tool had scoring of more than 0.8.

— Pilot Study: The pilot study was conducted to assess feasibility and any problems faced.

DATA COLLECTION:

Phase I:

History collection (Section I)

Phase II:

Structured Questionnaire (Section II)

Procedure:

All participants fulfilling the criteria were approached, consent was taken and data was collected. The average time taken to fill the questionnaire in the antenatal OPD was almost 15-20 minutes.

ANALYSIS:

— Descriptive Statistics, Inferential statistics were used for analysis.

RESULT:

Questions On Antenatal Preparedness:

Table No. 1 Knowledge on Expected date of delivery

Adequate Knowledge	319	75.05%
Fair Knowledge	74	17.41%
No Knowledge	32	7.52%

Majority of the pregnant women 319 (75.05%) were having adequate knowledge, 74 (17.41%) were having fair knowledge whereas 32 (7.52%) were having no knowledge at all about expected date of delivery.

Table No. 2 Knowledge on No. of antenatal visit to be performed by antenatal mother

Adequate Knowledge	310	72.94%
Fair Knowledge	67	15.76%
No Knowledge	48	11.29%

Majority of the pregnant women 310 (72.94%) were having adequate knowledge, 67 (15.76%) were having fair knowledge whereas 48 (11.29%) were having no knowledge at all about No. of antenatal visit to be performed by antenatal mother.

Table No. 3 Knowledge on No. of Inj. TT to be received by antenatal mother

Adequate Knowledge	398	93.64%
Fair Knowledge	20	4.70%
No Knowledge	7	1.64%

Majority of the pregnant women 398 (93.64%) were having adequate knowledge, 20 (4.70%) were having fair knowledge whereas 7 (1.64%) were having no knowledge at all about No. of Inj. TT to be received by antenatal mother.

Table No. 4 Knowledge on Essential laboratory tests and VCT

Adequate Knowledge	123	28.94%
Fair Knowledge	100	23.52%
No Knowledge	202	48%

Majority of the pregnant women 123 (28.94%) were having adequate knowledge, 100 (23.52%) were having fair knowledge whereas 202 (48%) were having no knowledge at all about Essential laboratory tests and VCT

Table No. 5 Knowledge on Blood group of antenatal mother

Adequate Knowledge	246	57.88%
Fair Knowledge	121	28.47%
No Knowledge	58	13.64%

Majority of the pregnant women 246 (57.88%) were having adequate knowledge, 121 (28.47%) were having fair knowledge whereas 58 (13.64%) were having no knowledge at all about Blood group of antenatal mother.

Table No. 6 Knowledge on Antenatal exercises

Adequate Knowledge	116	27.29%
Fair Knowledge	88	20.70%
No Knowledge	221	52%

Majority of the pregnant women 116 (27.29%) were having adequate knowledge, 88 (20.70%) were having fair knowledge whereas 221 (52%) were having no knowledge at all about Antenatal exercises.

Table No.7 Knowledge on Diet and adequate rest

Adequate Knowledge	322	75.76%
Fair Knowledge	64	15.05%
No Knowledge	39	9.17%

Majority of the pregnant women 322 (75.76%) were having adequate knowledge, 64 (15.05%) were having fair knowledge whereas 39 (9.17%) were having no knowledge at all about Diet and adequate rest.

Table No.8 Knowledge on Medications

Adequate Knowledge	362	85.17%
Fair Knowledge	50	11.76%
No Knowledge	13	3.05%

Majority of the pregnant women 362 (85.17%) were having adequate knowledge, 50 (11.76%) were having fair knowledge whereas 13 (3.05%) were having no knowledge at all about Medications to be taken during antenatal period.

Table No. 9 Knowledge on Breast care and Hygiene

Adequate Knowledge	212	49.88%
Fair Knowledge	124	29.17%
No Knowledge	89	20.94%

Majority of the pregnant women 212 (49.88%) were having adequate knowledge, 124 (29.17%) were having fair knowledge whereas 89 (20.94%) were having no knowledge at all about Breast care and Hygiene.

Table No. 10 Knowledge on Awareness of warning signs during pregnancy

Adequate Knowledge	108	25.41%
Fair Knowledge	109	25.64%
No Knowledge	208	48.94%

Majority of the pregnant women 208 (48.94%) were having no knowledge , 109 (25.64%) were having fair knowledge whereas 108 (25.41%) were having adequate knowledge on awareness of warning signs during pregnancy.

QUESTIONS ON INTRANATAL PREPAREDNESS

Table No.11 Labor and stages of labor

Adequate Knowledge	12	2.82%
Fair Knowledge	8	1.88%
No Knowledge	405	95.29%

Majority of the pregnant women 405 (95.29%) were having no knowledge, 8(1.88%) were having fair knowledge whereas only 12 (2.82%) were having adequate knowledge about Labor and stages of labor.

Table No.12 Knowledge on Care during stages of labor

Adequate Knowledge	0	0%
Fair Knowledge	0	0%
No Knowledge	425	100%

All pregnant women 425 (100%) were having no knowledge on care during stages of Labor.

Table No.13 Knowledge on warning signs during labor

Adequate Knowledge	167	39.29%
Fair Knowledge	43	10.11%
No Knowledge	215	50.58%

Majority of the pregnant women 215 (50.58%) were having no knowledge ,43(10.11%) were having fair knowledge whereas 167 (39.29%) were having adequate knowledge on warning signs during labor.

Table No. 14 Knowledge on Planning of place to deliver the baby

Adequate Knowledge	78	18.35%
Fair Knowledge	187	44%
No Knowledge	160	37.64%

Majority of the pregnant women 187 (44%) were having fair knowledge, 160 (37.64%) were having no knowledge whereas only 78 (18.35%) were having adequate knowledge on Planning of place to deliver the baby.

Table No.15 Knowledge on Approximate distance of the planned place of delivery

Adequate Knowledge	56	13.17%
Fair Knowledge	57	13.41%
No Knowledge	312	73.41%

Majority of the pregnant women 312 (73.41%) were having no knowledge, 57 (13.41%) were having fair knowledge whereas 56 (13.17%) were having adequate knowledge on Approximate distance of the planned place of delivery .

Table No. 16 Knowledge on Transportation facility for delivery

Adequate Knowledge	143	33.64%
Fair Knowledge	65	15.29%
No Knowledge	217	51.05%

Majority of the pregnant women 217 (51.05%) were having no knowledge, 143 (33.64%) were having adequate knowledge whereas only 65 (15.29%) were having fair knowledge on Transportation facility for delivery.

Table No. 17 Knowledge on Articles kept ready for hospital delivery

Adequate Knowledge	87	20.47%
Fair Knowledge	76	17.88%
No Knowledge	262	61.64%

Majority of the pregnant women 262 (61.64%) were having no knowledge, 87 (20.47%) were having adequate knowledge whereas only 76 (17.88%) were having fair knowledge on Articles kept ready for hospital delivery .

Table No.18 Knowledge on Accompany of chaperone for hospital delivery

Adequate Knowledge	348	81.88%
Fair Knowledge	65	15.29%
No Knowledge	12	2.82%

Majority of the pregnant women 348 (81.88%) were having adequate knowledge, 65 (15.29%) were having fair knowledge whereas 12 (2.82%) were having no knowledge at all on accompany of chaperone for hospital delivery

Table No. 19 Knowledge on Financial arrangements for delivery

Adequate Knowledge	112	26.35%
Fair Knowledge	43	10.11%
No Knowledge	270	63.52%

Majority of the pregnant women 270 (63.52%) were having no knowledge, 112 (26.35%) were having adequate knowledge whereas 43 (10.11%) were having fair knowledge on Financial arrangements for delivery.

Table No. 20 Knowledge on Blood donors for emergency

Adequate Knowledge	32	7.52%
Fair Knowledge	42	9.88%
No Knowledge	351	82.58%

Majority of the pregnant women 351 (7.52%) were having no knowledge, 42 (9.88%) were having fair knowledge whereas only 32 (7.52%) were having adequate knowledge on Blood donors for emergency.

QUESTIONS ON POSTNATAL PREPAREDNESS

Table No. 21 Knowledge on Awareness of mother for post natal warning signs

Adequate Knowledge	182	42.82%
Fair Knowledge	134	31.52%
No Knowledge	109	25.64%

Majority of the pregnant women 182 (42.82%) were having adequate knowledge, 134 (31.52%) were having fair knowledge whereas 109 (25.64%) were having no knowledge at all on Awareness of mother for post natal warning signs.

Table No. 22 Knowledge on Birth control measures after delivery

Adequate Knowledge	233	54.82%
Fair Knowledge	156	36.70%
No Knowledge	36	8.47%

Majority of the pregnant women 233 (54.82%) were having adequate knowledge, 156 (36.70%) were having fair knowledge whereas 36 (8.47%) were having no knowledge at all on Birth control measures after delivery.

Table No.23 Knowledge on Diet during post natal period

Adequate Knowledge	139	32.70%
Fair Knowledge	117	27.52%
No Knowledge	169	39.76%

Majority of the pregnant women 169 (39.76%) were having no knowledge,139 (32.70%) were having adequate knowledge, whereas 117 (27.52%) were having fair knowledge on Diet during post natal period.

Table No.24 Knowledge on Awareness about episiotomy care

Adequate Knowledge	35	8.23%
Fair Knowledge	42	9.88%
No Knowledge	348	81.88%

Majority of the pregnant women 348 (81.88%) were having no knowledge, 42 (9.88%) were having fair knowledge whereas 35 (8.23%) were having adequate knowledge about episiotomy care.

Table No. 25 Knowledge on Awareness about post natal exercises

Adequate Knowledge	63	14.82%
Fair Knowledge	54	12.70%
No Knowledge	308	72.47%

Majority of the pregnant women 308 (72.47%) were having no knowledge, 63 (14.82%) were having adequate knowledge whereas 54 (12.70%) were having fair knowledge on Awareness about post natal exercises.

Table No.26 Knowledge on Articles kept ready for baby

Adequate Knowledge	168	39.52%
Fair Knowledge	100	23.52%
No Knowledge	157	39.94%

Majority of the pregnant women 168 (39.52%) were having adequate knowledge, 100 (23.52%) were having fair knowledge whereas 157 (39.94%) were having no knowledge on Articles kept ready for baby.

Table No. 27 Knowledge on Awareness about exclusive breast feeding

Adequate Knowledge	123	28.94%
Fair Knowledge	96	22.58%
No Knowledge	206	48.47%

Majority of the pregnant women 206(48.47%) were having no knowledge ,123 (28.94%) were having adequate knowledge, whereas 96 (22.58%) were having fair knowledge on Awareness about exclusive breast feeding.

Table No. 28 Knowledge on Schedule of breast feeding the baby

Adequate Knowledge	71	16.70%
Fair Knowledge	54	12.70%
No Knowledge	300	70.58%

Majority of the pregnant women 300 (70.58%) were having no knowledge, 71 (16.70%) were having adequate knowledge whereas 54 (12.70%) were having fair knowledge about schedule of breast feeding the baby.

Table No.29 Knowledge on Awareness about importance of colostrum

Adequate Knowledge	134	31.52%
Fair Knowledge	76	17.88%
No Knowledge	215	50.58%

Majority of the pregnant women 215 (50.58%) were having no knowledge, 134 (31.52%) were having adequate knowledge, whereas 76 (17.88%) were having fair knowledge on Awareness about importance of colostrum.

Table No.30 Knowledge on Awareness about new born warning signs

Adequate Knowledge	38	8.94%
Fair Knowledge	51	12%
No Knowledge	336	79.05%

Majority of the pregnant women 336 (79.05%) were having no knowledge, 51 (12%) were having fair knowledge, whereas 38 (8.94%) were having adequate knowledge on Awareness about new born warning signs.

Table No. 31 Knowledge on Knowledge about new born care

Adequate Knowledge	163	38.35%
Fair Knowledge	124	29.17%
No Knowledge	138	32.47%

Majority of the pregnant women 163 (38.35%) were having adequate knowledge, 124 (29.17%) were having fair knowledge whereas 138 (32.47%) were having no Knowledge about new born care.

Table No. 32 Knowledge on Knowledge about vaccination schedule of baby

Adequate Knowledge	133	31.29%
Fair Knowledge	98	23.05%
No Knowledge	194	45.64%

Majority of the pregnant women 194 (45.64 %) were having no knowledge ,133 (31.29%) were having adequate knowledge, whereas 98 (23.05%) were having fair knowledge about vaccination schedule of baby.

DEMOGRAPHIC VARIABLES:

Table 33: Age wise distribution of samples

Age	Samples	%
18 - 22	184	43.29%
23- 27	129	30.35%
28 - 32	85	20%
33 and above	27	6.35%

In age wise distribution of samples majority of pregnant women (184) were from age group of 18-22 and very few pregnant women (27) were from age group of 33 and above

Table 34: Education wise distribution of samples

Education	Samples	%
Illetrate	28	6.58%
SSC and Below	187	44%
HSC	154	36.23%
Graduate and Above	56	13.17%

In education wise distribution of samples majority of pregnant women 187 (44%) are educated upto SSC and Below, 154 (36.23%) pregnant women are educated upto HSC, 56 (13.17%) pregnant women are educated upto graduate and above and 28 (6.58 %) pregnant women are Illiterate.

Table 35: Religion wise distribution of samples

Religion	Samples	%
Hindu	182	42.82%
Islam	106	24.94%
Christians	94	22.11%
Others	43	10.11%

In religion wise distribution of samples majority of pregnant women 182 (42.82%) were Hindu, 106 (24.94%) belong to Islamic religion, 94 (22.11%) belong to Christian religion and 43 (10.11%) belong to other religions.

Table 36: Weeks of gestation wise distribution of samples

Wks of gestation	Samples	%
I Trimester	98	23.05%
2 Trimester	210	49.41%
3 Trimester	117	27.52%

In weeks of gestation wise distribution of samples majority of pregnant women 210 (49.41%) were in second trimester, 117 (27.52%) were in third trimester and 98 (23.05%) were in first trimester.

Table 37: Occupation wise distribution of samples

Occupation	Samples	%
Housewife	304	71.52%
Service	121	28.47%
Business	0	0

In occupation wise distribution of samples 304 (71.52%) were housewife, 121 (28.47%) were doing service.

The chi-square statistic is 62.9365. The p-value is < 0.00001. The result is significant at p < .05. This means there is significant association of Religion with birth preparedness.

Table no 43: Distribution of knowledge regarding antenatal, Intranatal and postnatal preparedness

	Adequate Knowledge	Fair Knowledge	No Knowledge	Total
Antenatal	2516	1035	1482	5033
Intranatal	817	586	1102	2505
Postnatal	917	2629	2516	6062
Total	4250	4250	5100	13600

Thus we can identify that majority of pregnant women have adequate knowledge about antenatal period but have fair knowledge about postnatal period Intranatal and No knowledge about Intranatal.

Analysis of Demographic Variables:

Majority of pregnant women (184) were from age group of 18-22, majority of pregnant women 187 (44%) are educated upto SSC and Below, 154 (36.23%) pregnant women are educated upto HSC, 56 (13.17%) pregnant women are educated upto graduate and above and 28 (6.58 %) pregnant women are Illiterate. In gestation wise distribution of samples majority of pregnant women 210 (49.41%) were in second trimester, 117 (27.52%) were in third trimester and 98 (23.05%) were in first trimester and in occupation wise distribution of samples 304 (71.52%) were housewife, 121 (28.47%) were doing service.

Association of knowledge with demographic variables:

The chi-square statistic is 25.1094. The p-value is .000326. The result is significant at p < .05. This means there is significant association of knowledge on Birth Preparedness with maternal age, young age pregnant women are having more knowledge than those with increasing maternal age.

The chi-square statistic is 166.1146. The p-value is < 0.00001. The result is significant at p < .05. This means there is significant association of knowledge on birth preparedness with education.

The chi-square statistic is 401.994. The p-value is < 0.00001. The result is significant at p < .05. This means there is significant association of knowledge on birth preparedness with Trimester.

The chi-square statistic is 62.9365. The p-value is < 0.00001. The result is significant at p < .05. This means there is significant association of knowledge on birth preparedness with Religion.

The chi-square statistic is 24.7875. The p-value is < 0.00001. The result is significant at p < .05. This means there is significant association of knowledge on birth preparedness with Occupation.

CONCLUSION:

Age, education, trimester, religion and occupation shows a significant association with birth preparedness.

Analysis of knowledge on Antenatal Preparedness:

Majority of the pregnant women 319 (75.05%) were having adequate knowledge about expected date of delivery.

Majority of the pregnant women 310 (72.94%) were having adequate knowledge no. of antenatal visit to be performed by antenatal mother.

Majority of the pregnant women 398 (93.64%) were having adequate knowledge no. of Inj. TT to be received by antenatal mother.

Majority of the pregnant women 202 (48%) were having no knowledge at all about Essential laboratory tests and VCT

Majority of the pregnant women 246 (57.88%) were having adequate knowledge blood group of antenatal mother.

Majority of the pregnant women 221 (52%) were having no knowledge about Antenatal exercises.

Majority of the pregnant women 322 (75.76%) were having adequate knowledge diet and adequate rest.

Majority of the pregnant women 362 (85.17%) were having adequate knowledge about Medications to be taken during antenatal period.

Majority of the pregnant women 212 (49.88%) were having adequate knowledge about Breast care and Hygiene.

Majority of the pregnant women 208 (48.94%) were having no knowledge on awareness of warning signs during pregnancy.

CONCLUSION:

Thus out of 10 elements on antenatal preparedness pregnant women were not having knowledge on 3 elements ie essential laboratory tests and VCT, antenatal exercises andawareness of warning signs during pregnancy.

Analysis of knowledge on Intranatal Preparedness:

Majority of the pregnant women 405 (95.29%) were having no knowledge Labor and stages of labor.

All pregnant women 425 (100%) were having no knowledge on care during stages of Labor.

Majority of the pregnant women 215 (50.58%) were having no knowledge , on warning signs during labor.

Majority of the pregnant women 187 (44%) were having fair knowledge, 160 (37.64%) were having no knowledge on Planning of place to deliver the baby.

Majority of the pregnant women 312 (73.41%) were having no knowledge , Approximate distance of the planned place of delivery .

Majority of the pregnant women 217 (51.05%) were having no knowledge on Transportation facility for delivery.

Majority of the pregnant women 262 (61.64%) were having no knowledge Articles kept ready for hospital delivery .

Majority of the pregnant women 348 (81.88%) were having adequate knowledge on accompany of chaperone for hospital delivery

Majority of the pregnant women 270 (63.52%) were having no knowledge Financial arrangements for delivery.

Majority of the pregnant women 351 (7.52%) were having no knowledge Blood donors for emergency.

CONCLUSION:

Thus out of 10 elements on intranatal preparedness pregnant women were not having knowledge on 9 elements ie Labor and stages of labor, care during stages of Labor, warning signs during labor, Planning of place to deliver the baby, approximate distance of the planned place of delivery, Transportation facility for delivery, articles kept ready for hospital delivery, accompany of chaperone for hospital delivery, financial arrangements for delivery, Blood donors for emergency.

Analysis of knowledge on Postnatal Preparedness:

Majority of the pregnant women 182 (42.82%) were having adequate knowledge on Awareness of mother for post natal warning signs.

Majority of the pregnant women 233 (54.82%) were having adequate knowledge on Birth control measures after delivery.

Majority of the pregnant women 169 (39.76%) were having no knowledge Diet during post natal period.

Majority of the pregnant women 348 (81.88%) were having no knowledge about episiotomy care.

Majority of the pregnant women 308 (72.47%) were having no knowledge Awareness about post natal exercises.

Majority of the pregnant women 157 (39.94%) were having no knowledge on Articles kept ready for baby.

Majority of the pregnant women 206(48.47%) were having no knowledge Awareness about exclusive breast feeding.

Majority of the pregnant women 300 (70.58%) were having no knowledge schedule of breast feeding the baby.

Majority of the pregnant women 215 (50.58%) were having no knowledge Awareness about importance of Colostrum.

Majority of the pregnant women 336 (79.05%) were having no knowledge Awareness about new born warning signs.

Majority of the pregnant women 194 (45.64 %) were having no knowledge vaccination schedule of baby.

Majority of the pregnant women 163 (38.35%) were having adequate knowledge about new born care.

CONCLUSION:

Thus out of 12elements on postnatal preparedness pregnant women were not having knowledge on 9 elements ie Diet during post natal period, episiotomy care, awareness about post natal exercises, articles kept ready for baby, awareness about exclusive breast feeding. , schedule of breast feeding the baby, awareness about importance of Colostrum, awareness about new born warning signs, vaccination schedule of baby

CONCLUSION:

Age, education, trimester, religion and occupation show a significant association with birth preparedness.

In Birth preparedness there were 10 elements on antenatal preparedness and pregnant women were not having knowledge on 3 elements ie essential laboratory tests and VCT, antenatal exercises andawareness of warning signs during pregnancy.

In Birth preparedness there were 10 elements on intranatal preparedness and pregnant women were not having knowledge on 9 elements ie Labor and stages of labor, care during stages of Labor, warning signs during labor, Planning of place to deliver the baby, approximate distance of the planned place of delivery, Transportation facility for delivery, articles kept ready for hospital delivery, accompany of chaperone for hospital delivery, financial arrangements for delivery, Blood donors for emergency.

In Birth preparedness there were 10 elements on postnatal preparedness and pregnant women were not having knowledge on 9 elements ie Diet during post natal period, episiotomy care, awareness about post natal exercises, articles kept ready for baby, awareness about exclusive breast feeding. , schedule of breast feeding the baby, awareness about importance of Colostrum, awareness about new born warning signs, vaccination schedule of baby.

CONCLUSION:

As we are aware that birth preparedness includes antenatal, intranatal and postnatal preparedness, pregnant women needs to be prepared in all the three areas. But according to the survey it shows that pregnant women are Knowledgeable about antenatal preparedness but are fairly Knowledgeable about postnatal preparedness and absolutely not knowledgeable about intranatal preparedness. Thus there is a great need to make them knowledgeable about Intranatal preparedness too, it should not be left assumed that once they enter labour process they will be delivered as it is natural process and health care workers will take care of it.

RECOMMENDATIONS:

Based on the findings of the study the investigator wants to recommend further studies-

· Replicated using larger population of mothers on Primigravida and multigravida women.

· A comparative study in different hospital setup i.e. government and private can be done.

· A prospective study would be much more useful rather than retrospective.

· A study on Intranatal teaching with outcome of pregnancy should be done.

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Received on 28.12.2015 Modified on 15.01.2016

Int. J. Adv. Nur. Management. 2016; 4(3): 235-252.

DOI: 10.5958/2454-2660.2016.00047.8

	18-22 yrs	23-27 yrs	28-32 yrs	33 and above	Row Totals
Adequate Knowledge	2112 (2178.99) [2.06]	1580 (1527.66) [1.79]	1038 (1006.60) [0.98]	303 (319.74) [0.88]	5033
Fair Knowledge	1117 (1084.52) [0.97]	684 (760.34) [7.66]	510 (501.00) [0.16]	194 (159.14) [7.64]	2505
No Knowledge	2659 (2624.49) [0.45]	1864 (1840.00) [0.31]	1172 (1212.40) [1.35]	367 (385.12) [0.85]	6062
Column Totals	5888	4128	2720	864	13600 (Grand Total)

	Illetrate	SSC and below	HSC	Graduate and Above	Row Totals
Adequate Knowledge	339 (327.82) [0.38]	1980 (2038.56) [1.68]	1870 (1802.99) [2.49]	636 (655.63) [0.59]	4825
Fair Knowledge	209 (173.66) [7.19]	1259 (1079.91) [29.70]	690 (955.12) [73.59]	398 (347.32) [7.40]	2556
No Knowledge	376 (422.53) [5.12]	2507 (2627.53) [5.53]	2522 (2323.89) [16.89]	814 (845.05) [1.14]	6219
Column Totals	924	5746	5082	1848	13600 (Grand Total)

	I^stTrimester	II^nd Trimester	III^rd Trimester	Row Totals
Adequate Knowledge	1596 (1184.37) [143.06]	2307 (2516.70) [17.47]	1204 (1405.93) [29.00]	5107
Fair Knowledge	638 (584.65) [4.87]	1156 (1242.33) [6.00]	727 (694.02) [1.57]	2521
No Knowledge	920 (1384.98) [156.11]	3239 (2942.97) [29.78]	1813 (1644.06) [17.36]	5972
Column Totals	3154	6702	3744	13600 (Grand Total)

	House Wife	Service	Business	Row Totals
Adequate Knowledge	3651 (3592.48) [0.95]	1375 (1433.52) [2.39]	0	5026
Fair Knowledge	1690 (1790.52) [5.64]	815 (714.48) [14.14]	0	2505
No Knowledge	4380 (4338.00) [0.41]	1689 (1731.00) [1.02]	0	6069
Column Totals	9721	3879		13600 (Grand Total)

	Hindu	Islam	Christian	Others	*Row Totals*
Adequate Knowledge	2109 (2155.31) [0.99]	1267 (1255.29) [0.11]	1113 (1113.18) [0.00]	544 (509.22) [2.38]	5033
Fair Knowledge	1126 (1072.73) [2.65]	521 (624.78) [17.24]	539 (554.05) [0.41]	319 (253.45) [16.95]	2505
No Knowledge	2589 (2595.96) [0.02]	1604 (1511.93) [5.61]	1356 (1340.77) [0.17]	513 (613.33) [16.41]	6062
*Column Totals*	5824	3392	3008	1376	13600 (Grand Total)