Determinants of Incomplete Neonatal Stabilization in Obstetric Emergencies at Primary Healthcare Facilities: Evidence from Retrospective Records and Family Perspectives
Keywords:
decision-making, neonatal stabilization, obstetric emergency, primary healthcare, self-efficacyAbstract
Incomplete neonatal stabilization during obstetric emergencies remains a significant contributor to neonatal morbidity and mortality, particularly in primary healthcare settings where early intervention is critical. This study aimed to identify determinants of incomplete neonatal stabilization by integrating clinical records and family-reported factors. A descriptive-analytic study with a retrospective record review and post-event family survey was conducted in 14 primary healthcare centers in Kabupaten Seluma, Indonesia. A total of 120 eligible cases were selected using total sampling from cases meeting inclusion criteria. Data were collected using structured extraction forms and validated questionnaires assessing response time, knowledge of neonatal danger signs, self-efficacy, and perceived barriers. Instrument validity was established through expert review, and reliability testing showed acceptable internal consistency (Cronbach’s alpha >0.70). Bivariate analysis and multivariate logistic regression were performed to identify associated factors. The results showed that 41.7% of cases experienced incomplete neonatal stabilization. Multivariate analysis revealed that decision-making delay (AOR = 4.21; 95% CI: 1.95–9.08), low self-efficacy (AOR = 3.12; 95% CI: 1.44–6.78), delayed response time (AOR = 2.85; 95% CI: 1.32–6.14), and inadequate knowledge (AOR = 2.47; 95% CI: 1.15–5.29) were significant determinants. Structural barriers such as transportation, financial constraints, and distance were not statistically significant but showed increased risk tendencies. Incomplete neonatal stabilization is predominantly influenced by family-level behavioral and cognitive factors. Strengthening community awareness, improving emergency preparedness, and promoting timely decision-making, alongside enhancing primary healthcare capacity and referral systems, are essential to improve neonatal outcomes.
References
Ali, Noorjahan, and Taylor Sawyer. 2024. “Beyond the Delivery Room: Resuscitation in the Neonatal Intensive Care Unit.” Seminars in Perinatology 48(8): 151984. doi:https://doi.org/10.1016/j.semperi.2024.151984.
Annan, Emma et al. 2025. “Cultural Beliefs and Health-Seeking Practices Among Postnatal Mothers in Ghana, Bono East Region, Regarding Newborn Danger Signs.” Sage Open Nursing 11: 23779608251401820. doi:10.1177/23779608251401820.
Anthony, Ross, and Christopher J D McKinlay. 2023. “Adaptation for Life after Birth: A Review of Neonatal Physiology.” Anaesthesia & Intensive Care Medicine 24(1): 1–9. doi:https://doi.org/10.1016/j.mpaic.2022.11.002.
Babarimisa, Oluwatoyin, and B M Ohaeri. 2022. “Identifying and Managing High-Risk Obstetric Conditions with Prompt Referral as an Approach to Improving Pregnancy Outcomes.” Int J Med Nurs Health Sci (IJMNHS) 2(4): 45–56.
Balarezo, Jose D, Nicolai J Foss, and Bo Bernhard Nielsen. 2024. “Organizational Learning: Understanding Cognitive Barriers and What Organizations Can Do about Them.” Management Learning 55(5): 741–68. doi:10.1177/13505076231210635.
Benzies, Karen M, Anmol Shahid, Natasha L Cholowsky, and Deborah McNeil. 2026. “Healthcare Professional Perspectives on Optimizing Patient- and Family-Centered Care in Canadian General Inpatient Pediatrics.” Journal of Clinical Medicine 15(2): 596. doi:10.3390/jcm15020596.
Chaulagain, Dipak Raj et al. 2022. “Service Readiness and Availability of Perinatal Care in Public Hospitals - a Multi-Centric Baseline Study in Nepal.” BMC Pregnancy and Childbirth 22(1): 842. doi:10.1186/s12884-022-05121-z.
Dida, Nagasa et al. 2024. “Awareness and Healthcare Seeking Behavior of Neonatal Danger Signs, and Predictor Variables among Mothers/Caregivers in Four Developing Regional State of Ethiopia.” BMC Pediatrics 24(1): 188. doi:10.1186/s12887-024-04656-8.
Gooding, Kate, Maria Paola Bertone, Giulia Loffreda, and Sophie Witter. 2022. “How Can We Strengthen Partnership and Coordination for Health System Emergency Preparedness and Response? Findings from a Synthesis of Experience across Countries Facing Shocks.” BMC Health Services Research 22(1): 1441. doi:10.1186/s12913-022-08859-6.
Hill, Louise F et al. 2025. “Safety Reporting in Neonatal Clinical Trials: Reflections towards Optimal, Globally Relevant Approaches.” Trials 26(1): 46. doi:10.1186/s13063-025-08723-y.
Hullumani, S, M I Qureshi, and R Raghuveer. 2024. “Effect of Physical Rehabilitation Using Oromotor Stimulation, Manual Airway Clearance Technique, Positioning, Tactile and Kinaesthetic Stimulation (PROMPT) Protocol on Respiratory and Neuromuscular Function in Neonatal Respiratory Distress Syndrome (NRDS).” F1000Research 13(536). doi:10.12688/f1000research.149883.1.
Jack, Kathryn et al. 2022. “Identifying and Understanding the Non-Clinical Impacts of Delayed or Cancelled Surgery in Order to Inform Prioritisation Processes: A Scoping Review.” International Journal of Environmental Research and Public Health 19(9): 5542. doi:10.3390/ijerph19095542.
Malya, Rosemary M et al. 2025. “Simulation-Based Education on Initial Neonatal Care Knowledge among Nursing and Midwifery Students in Tanzania: Quasi Experimental Study.” International Journal of Africa Nursing Sciences 22: 100847. doi:https://doi.org/10.1016/j.ijans.2025.100847.
Mesele, Molalegn et al. 2023. “Mothers’ Health Care Seeking Behavior for Neonatal Danger Sign in Southern Ethiopia: Community Based Cross–Sectional Study.” PLOS ONE 18(7): e0280993. https://doi.org/10.1371/journal.pone.0280993.
Mohamed, Mossad Abdelhak Shaban et al. 2023. “Breathing at Birth: Neonatal Resuscitation in the Golden Minute of Life.” Bangladesh Journal of Medical Science 22(2 SE-Review Article): 272–79. doi:10.3329/bjms.v22i2.64984.
Patil, Crystal L et al. 2025. “Group Antenatal Care Positively Transforms the Care Experience: Results of an Effectiveness Trial in Malawi.” PLOS ONE 20(6): e0317171. https://doi.org/10.1371/journal.pone.0317171.
Saghafi, Samaneh. 2025. “A Neglected Dimension of Patient Experience: Reviewing Clinical and Non-Clinical Contributions in Healthcare Settings.” Preprints. doi:10.20944/preprints202511.1767.v1.
Saha, Usha. 2023. “General Anatomical and Physiological Considerations in the Newborn and Neonates BT - Clinical Anesthesia for the Newborn and the Neonate.” In ed. Usha Saha. Singapore: Springer Nature Singapore, 137–204. doi:10.1007/978-981-19-5458-0_10.
Tuladhar, Sabita et al. 2024. “Changes in Health Facility Readiness for Obstetric and Neonatal Care Services in Nepal: An Analysis of Cross-Sectional Health Facility Survey Data in 2015 and 2021.” BMC Pregnancy and Childbirth 24(1): 79. doi:10.1186/s12884-023-06138-8.
Usman, Fatima et al. 2022. “Facility and Care Provider Emergency Preparedness for Neonatal Resuscitation in Kano, Nigeria.” PLOS ONE 17(1): e0262446. https://doi.org/10.1371/journal.pone.0262446.
Yeboah, Evelyn, Emma Annan, Mary Ani-Amponsah, and Raina Dizoagl. 2025. “A Qualitative Study on Post-Natal Mothers’ Decision Making Processes and Barriers to Facility-Based Care for Newborn Danger Signs in Urban Setting in Ghana.” Journal of Neonatal Nursing 31(3): 101649. doi:https://doi.org/10.1016/j.jnn.2025.101649.
