Delay phases and factors affecting use of delivery care and maternal mortality (adapted from Thaddeus & Maine). The three delays for emergency care-seeking are unchanged from the framework presented by Thaddeus and Maine. We conceptually separated preventive care-seeking. Only a first and second phase are relevant for receiving normal preventive delivery care. If a woman who is receiving such preventive care at a health facility then develops a complication, her survival will depend on whether she receives adequate and appropriate treatment in time (third delay of emergency care-seeking). Since she is already in a facility, skilled providers should be able to discover this quickly (no first emergency delay) and she does not need to travel far if it can be handled there (no second emergency delay). For those complications that cannot be handled at that facility and that require referral to a higher-level facility, she will need to travel to a referral facility, possibly with help from the first facility (second emergency delay).
Gabrysch and Campbell BMC Pregnancy and Childbirth 2009 9:34 doi:10.1186/1471-2393-9-34