Exploring factors influencing adverse birth outcomes in a regional hospital setting in Ghana: A configuration theoretical perspective

Background: Understanding the complexity of factors that influence adverse childbirth outcomes at health facilities can be enhanced by the theoretical articulation of the interplay between external sociostructural and internal technical dynamics of the birthplace in context. Guided by configuration theory, this study explored the factors that influence adverse birth outcomes at a regional hospital setting in Ghana. Methods: Qualitative data were collected from the Upper West regional hospital in Ghana. In-depth interviews were administered to 30 purposively selected respondents comprising 20 postpartum mothers and 10 midwives. The data was electronically audio-recorded, transcribed and analysed using thematic analysis. Findings: The study revealed three key dimensions of socio-technical configurations shaping adverse birth outcomes within the hospital setting. These are mother-midwife personality and behavioral dynamics including personality clashes and poor communication; birth process dynamics consisting of diverse paradigms of safe birthing process and socio-technical conflicts on caesarean section; and birthplace context, comprising nature of the birthing environment, confidence in the safety of the birthplace and national health policy implementation challenges. These socio-technical interactions result in late reporting at facilities by mothers and delay in care delivery by midwives, contributing to adverse birth outcomes. Conclusion: In line with configuration theory, our study positions the influences of adverse birth outcomes in hospital settings in alignment with a subtle and iterative interplay of socio-technical factors. To comprehensively address adverse birth outcomes in hospital settings, health policymakers and practitioners need to understand and contextualise the socio-technical interactions that shape notable outcomes at specific hospital settings. (C) 2020 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.