By Angela Success

 

Maternal mortality rate is high in Nigeria. The World Health Organization(WHO), says“a woman’s chance of dying from pregnancy and childbirth in Nigeria is 1 in 13. Presently, only 35 per cent of all the deliveries are handled by skilled birth attendants”
One of the factors that raise the maternal mortality rate is the handling of pregnant women, birth and delivery by unskilled traditional birth attendants. A traditional birth attendant(TBA) has been defined by WHO as a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through an apprenticeship to other TBA’s”.
Daily Sun spoke with Dr Michael Uche-Obasi, a Consultant Obstetrician/Gynecologist on birth attendants. Excerpts;

Who is a skilled birth attendant?
A skilled birth attendant is someone that has received the necessary training and has acquired the capacity to help women deliver safely. You can talk about an obstetrician, a midwife who has worked under obstetricians and has received the necessary training to deliver babies.

What will you call women who are not trained but help women deliver babies in the villages?
They are unskilled because they cannot handle complications that may arise during pregnancy and delivery of babies. Issues like high blood pressure, infection, bleeding, breech presentation, obstructed labor may come up in the course of pregnancy and delivery. The unskilled birth attendant can only handle labor that is not complicated.  If she cannot handle complication, then she is unskilled. She has no knowledge or capacity to respond appropriately to situations that may arise during pregnancy and deliveries.  Complicated cases are actually the ones that cause maternal and child deaths. For example a traditional birth attendant brought in a patient who delivered vaginally but was faint and losing strength. Baby was fine. She did not know that this woman was bleeding inside. There was no blood coming out but when she came we were able to diagnose that she was bleeding, we had to remove all the blood and put on an infusion and canola on her. We had to give her an injection to increase her blood pressure which had dropped dangerously and gave her blood which helped her to survive. This birth attendant delivered her but she couldn’t handle the complications.

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How will a pregnant woman differentiate between a skilled birth attendant and one that is not skilled?
Sometimes it is difficult for them because they are naïve and ignorant. All they know is that this person delivers children for women for many years now. For them that is enough reason to go there. Any organization that has no functional theatre that can handle obstetrics emergencies is a death trap. A patient can start bleeding before they rush her to any place, she might die. The hospital or facility should also have requisite man power, obstetricians, surgeons, pediatrician, midwives, anesthetics and those who can operate equipments in the theatre, if there is an emergency. Once that is not there, the place is not safe. Someone should look out for a surgeon, a theatre, a pediatrician and other requisite staff.

During antenatal, women are not told all these. Should she ask questions?
Yes, women should ask questions. Before they register, they should ask for all these mentioned in the previous passage. Ask to see the theatre, surgeon and others. Find out whether they have the capacity to handle complications.  You should ask because your life is at stake. If you go to a place, maternity or clinic and complications set in, there will be confusion which may lead to the loss of the baby, mother or both. Death occurs because of complications that are not properly handled. . A situation whereby any one can take delivery without proper training and government is not checking them is bad. Government should regulate these practices and make sure that where the women go are up to date, able to take care of complications that may arise.

Do we have unskilled attendants only in Nigeria?
No, they are not limited to Nigeria and Africa. The Swedish people understood this issue early enough in the 1800s and decreed that every woman must pass through a professional midwifery course. And there maternal mortality rate dropped to almost zero. Now they have almost the lowest maternal mortality rate in the world because they have followed that policy for over 200 years. If the government can put such a policy in place and make sure that women deliver in safe places, maternal mortality rate in Nigeria will drop. Ignorance on the part of men and women increases this mortality rate. Some husbands do not know where their wives go to for ante natal. A case came up in Lagos where a wife picked up an infection that lead to the death of the baby and the wife was supposed to go for a caesarian section but her husband was nowhere to be found. Another lost his wife during delivery in a maternity when the placenta couldn’t come out she bleed to death and the man came later after she died. Men need also need to be more responsible during pregnancy, know where your wife is delivering and be sure that they can handle complications. The responsibility lies with both men and women that is why in safe motherhood we encourage both partners to look out for one another.

What are the things that will indicate that a place is not safe for delivery?
Unskilled birth attendants can give a woman problem that she did not come with. Some of them give women infection which can kill the baby and the mother. Patients who go there can end up with blocked tubes, secondary infertility, painful menstruation, painful coitus, pelvic abscess and the rest of them. Some of these unskilled attendants examine women with bare hands and unsterilized gloves.  Some allow themselves to be examined with gloves that have been washed and hung on the wall. Some use mat or put women on bare floor or use pumpkin leaves to deliver women. They don’t use apron, booths, or wear masks that can prevent infections. Definitely that will tell you that it is an unsafe centre. They don’t put cannula to facilitate giving of drips or blood when necessary. If you use ordinary needle to put drip, it may shift and cause more problems but if you use cannula, it will protect the woman and help in the case of collapse of the veins.

What are skilled birth care givers doing to reduce the death rate?
That is why the safe motherhood initiative is educating people on this issue. It is a response to what we have seen over years. The most important thing is that somebody should be able to respond appropriately to the challenges of birth otherwise you have no business in child birth. Ignorance has been identified as the most important factor in this case. Covetousness, greed is another important factor. They know that someone who had a previous caesarian section should not be encouraged to give birth through the normal process because of attendant dangers but because they want the woman to deliver in their facility they give hot drink, hot injection and the womb ruptures and the woman starts bleeding or possibly bleed to death. If a woman knows that she has a previous scar or surgery sight from fibroid or caesarian section, she has no business to be induced for labor. The result will always result in uterine rupture which may lead to death. Information is important in this business. And again I think we should scrap this idea of traditional birth attendant. People that have no capacity to handle complications should not be involved maternal care. Agreed that you have delivered our women over the years but for now you have to stop. The issue with the unskilled ones is that they are still at hidden corners sending more women and children to their early grave.
If you are pregnant, you can only ask questions when you are alive. If you are an unskilled traditional birth attendant and you are passionate about it go and get trained from recognized professionals and institutions that way the high maternal mortality rate will reduce in Nigeria.