Why Nigerian mothers and their babies die – Experts

When the Lagos State Government released its 2010 Maternal Mortality Rates Survey penultimate Friday, experts called on governments to redefine the role of Traditional Birth Attendants to reduce infant and maternal mortality rate in the state.

 

The debate on who is qualified to take delivery of a pregnant woman in labour has been renewed as the Lagos State Government released its 2010 maternal mortality health survey conducted by Ipas, a sexual reproductive health organisation on Friday.

Stakeholders in the medical profession, including gynaecologists, nurses and obstetricians, who were present at the presentation called on the state government to reverse its policy that allows Traditional Birth Attendants trained by the state to take delivery of pregnant women.

According to them, the move is practically endorsing unskilled personnel to attend to pregnant women. This, they warned, could

increase maternal and infant mortality rates in the country.

Presently, the World Health Organisation rates Nigeria second only to India in maternal mortality rate.  The nation accounts for over 10 per cent of the world’s total estimate of maternal deaths.

The experts criticised the state government’s initiative which had seen over 1,264 TBAs trained in the past two years in primary health care centres to offer midwifery services in local government areas in the state.

In his view, the Country Director of Ipas, Dr.  Ejike Oji, said though TBAs are a relevant chain in the maternal and child care system of the country, they lacked the knowledge and skills to save a mother and her baby from dying during delivery.

According to him, TBAs can not recognise and also intervene medically in the five leading causes of maternal deaths during child birth which include obstructed labour, unsafe abortions, Enclampsia, haemorrhage (bleeding) and infections.

He said, “When a woman obstructs, and the baby cannot come out, the woman can only be helped by a caesarean section. Now this woman is being managed by a TBA, 200 kilometres from a health centre, how will the TBAs help that woman, is that not death penalty for the woman?

“If a woman has post abortion complications, what will a TBA do for her? Can she evacuate her uterus?  If it is an abortion done by quacks and her abdomens have been removed, would a TBA be able to repair that? When a woman is bleeding during delivery like a tap that some doctors even run from, would the TBA be able to remove the placenta and stop the bleeding?

“They would not be able to. Does a TBA know the antibiotics to prescribe for a mother with post-partum bleeding? They do not.”

According to him, previous programmes   that championed the training of TBAs to take deliveries in Africa had been scrapped after research showed that maternal mortality had increased as a result of such training.

Oji stated that research had shown that 80 per cent of pregnant women would have normal deliveries with or without the intervention of TBAs or skilled health workers while all maternal deaths during deliveries arose from the 20 per cent that were complicated.

He noted that the misuse of TBAs in rural areas and even cities had significantly contributed to the maternal mortality rates that Nigeria records.

 “Eighty per cent of pregnant women would deliver safely without the help of a TBA or skilled attendant. Those are the success stories we attribute to them. What happens when a TBA is attending to a complicated case that they cannot handle or did not predict? That is the 20 per cent that is killing our women.

 “We are saying a midwife not even a nurse, who would be able to provide the minimal care and also refer her to the appropriate quarters, should be required. What we see in most cases is that the TBAs will not even know that the woman is in trouble in the first instance.”

President of the Neonatal Society of Nigeria, Prof. Angela Okolo, also said the use of TBAs as birth attendants was a major factor responsible for Nigeria’s high infant mortality in the world.

Okolo said surveys had revealed that 60 per cent of babies were born at home by unskilled personnel and according to WHO and the medical profession, only a skilled birth attendant, a professional trained in an orthodox way, that is a doctor, a midwife, an obstetrician or gynaecologist should take deliveries.

She warned that trained TBAs lacked medical orientation to recognise tell-tale signs of complications, including prematurity, neo-natal jaundice, lack of cry and infections that could lead to death or mental disabilities in babies if not detected early.

Okolo said, “We know why mothers and their babies die and TBAs cannot contribute to saving their lives at that point in time.

“We can predict that a woman would have post- partum haemorrhage (excessive bleeding) how do I teach a traditional birth attendant to avoid that. Does she know what group of blood to give the dying mother? How do I teach her to do foetal heart monitoring or know that a baby would be born prematurely? The life of the mother is at risk too when the baby does not come out.”

She, however, suggested that state governments should define the roles of TBAs such that they are used as community health resource persons who identify the pregnant women in the communities and bring them to heath centres.

Okolo said, “We are not completely rejecting TBAs. In our country, most women first disclose to TBAs that they are pregnant in the first instance because they believe in witchcrafts that could hurt their babies before it is visible. But they should bring their clients to the hospital.

“This has worked in reducing maternal deaths significantly in Sierra Leone where TBAs get a $5 reward for each pregnant woman they bring to the hospital. TBAs should educate women in the communities that delivering babies in their backyards or bedrooms is a dangerous practice.”

Policy makers in the field of traditional medicine however rose in defense of the TBAs, saying that their duties go beyond identifying pregnant women to come to health facilities.

They stated that the presence of skilled TBAs who are usually grass roots people reduce maternal and infant deaths in rural areas that do not have health care providers and facilities.

The Chairman of the Lagos State Traditional Medicine Board, Dr. Olubunmi Omosehindemi, said the integration of TBAs into maternal health care services in communities would increase the number of skilled providers at the grass roots and reduce the load on health care facilities.

Omosehindemi said, “This is an age-long argument that even the World Health Organisation is yet to resolve. In Nigeria, most births take place in the homes and our mothers would patronise TBAs whether they have the skills or not. So why don’t we train and equip them with the knowledge they require.

“How many doctors or nurses are available to the population of our pregnant women in Nigeria?  Most of them cannot access quick care at hospitals when they are in labour because of patients’ overload.  The presence of trained TBAs would save mothers and their children from dying. “

However, the State Commissioner for Health, Dr. Jide Idris, said the initiative to integrate TBAs into the maternal health care services of the state was aimed at increasing access to care and referral to health care centres in the state.

Idris noted that activities of some faith-based organisations that discourage women from delivering in hospitals, in addition to poor attitude of health workers, had increased the population of women who deliver at home.

He said in order to curb the excesses of some TBAs or organisations in the state, the state government would not hesitate to sanction anyone found wanting.

Idris said, “We have realised that pregnant women are referred at a very late stage to our hospitals when complications that cannot be helped have occurred. We will sanction any establishment, organisation or persons that continue to engage in practices that are killing our women and children.”

To save women and children from dying from preventable deaths and also increase pregnant women’s access to quality care, the experts called on the governments at all tiers to train more midwives and deploy them in rural areas.

Oji said that monitoring and evaluation of maternal health care services could change poor attitude of health workers to pregnant women.

“If a woman dies in the hands of a TBA, they say it is an act of God but if it is in the hands of a midwife, they call her a witch. So they prefer the TBA who will care but not give the treatment rather than the midwife that would provide the needed treatment and not the care. There is need to build confidence of pregnant women in our health care providers, else they would continue to patronise TBAs,” he noted.

-Punch