J Korean Med Sci.  2023 May;38(17):e164. 10.3346/jkms.2023.38.e164.

A Maternity Waiting Home Is an Alternative Approach for the Accessibility of Pregnant Women in an Obstetrically Underserved Area of Korea

• Kim YJ
• Li L
• Hwang JY

• KMID: 2542026
• DOI: http://doi.org/10.3346/jkms.2023.38.e164

Abstract

Background
We analyzed whether a maternity waiting home (MWH) for pregnant women in an obstetrically underserved area of Gangwon-do in Korea, which has been in operation since August 2018, has improved the accessibility of a maternity hospital and pregnancy outcomes.
Methods
We compared and analyzed the accessibility of maternity hospitals for 170 pregnant women who applied for the MWH from August 2018 to May 2022. Among the 170 participants, 64 were MWH users and 106 non-users. The effect on pregnancy outcomes between MWH users and non-users was analyzed in the 160 people who achieved a pregnancy outcome.
Results
Although the average distance and travel time from the pregnant women’s residence in the obstetrically underserved area to a maternity hospital were 56.4 ± 1.6 km and 63.4 ± 1.4 minutes, respectively, the average distance between the MWH and the MWH users’ maternity hospital was 2.7 ± 0.2 km, and the travel time was 10.7 ± 0.6 minutes. The distance was 55.6 km closer on average and the travel time 54.1 minutes shorter. MWH users gave birth at a significantly later gestation age (38.9 ± 0.2 vs. 38.3 ± 0.15 weeks, P = 0.024) and to infants with heavier birth weights (3,300 ± 60 vs. 3,100 ± 50 gm, P= 0.024) compared with non-users. The rate of Cesarean section was significantly higher in the MWH users (47.5% vs. 44.6%, P = 0.047). The MWH users tended to be associated with a lower rate of neonatal intensive care unit admission (5.1% vs. 11.0%, P = 0.204), lower birth weight (< 2.5 kg) (1.7% vs. 8.0%, P = 0.155), and lower fetal death rate in the uterus (0% vs. 1.0%, P = 1.0) compared with non-users, but the differences were not significant.
Conclusion
The MWH helped pregnant women in obstetrically underserved areas by improving accessibility to a maternity hospital and lengthening gestation. As a result, neonatal birth weight was heavier for MWH users than non-users. MWHs in Korea can provide an alternative way to improve accessibility to maternity healthcare for pregnant women in obstetrically underserved areas, where it is difficult to establish maternity hospitals, and thereby will improve their pregnancy outcomes.

Keyword

Maternity Waiting Home; Maternal Health; Neonatal Health; Obstetrically Underserved Area

Reference

1. Se JL, Kim YJ, Shin H, Lee T, Lee B, Hong HJ, et al. Current status of the delivery rate within the jurisdiction of local government in Korea. J Korean Soc Matern Child Health. 2022; 26(2):112–119.

2. Lee SJ, Li L, Hwang JY. After 20 years of low fertility, where are the obstetrician-gynecologists? Obstet Gynecol Sci. 2021; 64(5):407–418. PMID: 34265193.

3. Hwang JY. Limitation and improvement plan of maternity healthcare delivery system in Korea. J Korean Soc Matern Child Health. 2021; 25(4):250–259.

4. Kwak MY, Lee SM, Lee TH, Eun SJ, Lee JY, Kim Y. Accessibility of prenatal care can affect inequitable health outcomes of pregnant women living in obstetric care underserved areas: a nationwide population-based study. J Korean Med Sci. 2018; 34(1):e8. PMID: 30618515.

5. World Health Organization. Pregnant women must be able to access the right care at the right time, says WHO. Updated 2016. Accessed July 16, 2022. https://www.who.int/news/item/07-11-2016-pregnant-women-must-be-able-to-access-the-right-care-at-the-right-time-says-who .

6. World Health Organization. Maternity waiting homes: a review of experiences. Updated 1996. Accessed Jun 16, 2022. https://apps.who.int/iris/handle/10665/63432 .

7. van Lonkhuijzen L, Stekelenburg J, van Roosmalen J. Maternity waiting facilities for improving maternal and neonatal outcome in low-resource countries. Cochrane Database Syst Rev. 2012; 10(10):CD006759. PMID: 23076927.

8. World Health Organization. Essential elements of obstetric care at first referral level. Updated 1991. Accessed June 16, 2022. https://apps.who.int/iris/handle/10665/41740 .

9. Choi YH, Na BJ, Lee JY, Hwang JH, Lim NG, Lee SK. Obstetric complications by the accessibility to local obstetric service. J Agric Med Community Health. 2013; 38(1):14–24.

10. Kwak MY, Lee SM, Kim HJ, Eun SJ, Jang WM, Jung H, et al. How far is too far? A nationwide cross-sectional study for establishing optimal hospital access time for Korean pregnant women. BMJ Open. 2019; 9(9):e031882.

11. Ahn TG, Hwnag JY. Maternity care system for high risk pregnant women in obstetrically underserved area. J Korean Med Assoc. 2016; 59(6):438–442.

12. Spong CY, Mercer BM, D’Alton M, Kilpatrick S, Blackwell S, Saade G. Timing of indicated late-preterm and early-term birth. Obstet Gynecol. 2011; 118(2):Pt 1. 323–333. PMID: 21775849.

13. Poovan P, Kifle F, Kwast BE. A maternity waiting home reduces obstetric catastrophes. World Health Forum. 1990; 11(4):440–445. PMID: 2092704.

14. Smith S, Henrikson H, Thapa R, Tamang S, Rajbhandari R. Maternity waiting home interventions as a strategy for improving birth outcomes: a scoping review and meta-analysis. Ann Glob Health. 2022; 88(1):8. PMID: 35087708.