By Olabisi Olaleye
At a herbal home in Akaran village, Ibadan, Oyo State, Aliya, a teenage girl, was having a hard time pushing out her baby. Both the girl and Iya Abiye, a traditional birth attendant and owner of the herbal home, had been on the process for hours.
Aliya laboured hard, crying and cursing, but her efforts yielded no success before she became exhausted.
The teenager’s mum, Madam Beludan, had elected to have her first grandchild born in a herbal home because of paucity of funds. The elderly woman had been responsible for Aliya and her unborn baby, as her daughter’s pregnancy was rejected by the family of the youth who allegedly impregnated her.
Suddenly, a gush of water escaped from Aliya. Something slipped out of her but stopped midway. The baby’s legs and buttocks were out, but the head remained stuck. All efforts to get the rest of the baby out were fruitless.
Aliya was rushed to a government hospital an hour later but it was too late. By the time she got to the hospital, both mother and baby were pronounced dead.
Toro, a young woman excitedly expecting her first baby, couldn’t fathom why the gynaecologist insisted that she should undergo a caesarean section (CS) because she had placenta praevia, a condition in which the placenta partially or wholly blocks the neck of the uterus, thereby interfering with the normal birth process of a baby.
A fervent Christian, Toro promptly declared that CS was not her portion, insisting that there was nothing impossible, with God. Supported by her husband and family, Toro got herself discharged from the hospital, against the doctors’ advice. She was deposited at her church, where several deliverance sessions couldn’t bring the baby out. By the time she was returned to the hospital, she was barely conscious. She escaped death by the whiskers, but the baby died.
Apathy toward hospitals
All over the world, the arrival of a baby is usually greeted with happiness and conviviality. In many African societies, the belief is that a new baby brings good fortunes to the family.
In the past, most hospitals in Nigeria recorded many births annually. However, recently, many more women have started to avoid having their babies in hospitals, preferring churches or herbal homes.
Investigations by Daily Sun showed that the number of hospital births has been dwindling due to several reasons. These include attitude of medical practitioners, poverty and the insistence by some doctors on CS, allegedly for financial gains.
Immediate past chairman, Nigerian Medical Association (NMA), Oyo State, Dr. Muideen adduyOlatunji, explained the various reasons women adduce for opting to give birth outside the hospital system. The reasons vary from lack of trust in health care providers, inhibition from husbands or family members, especially the mothers-in law, long distance from health facilities and financial impediments. Olatunji also stated that some women’s religious inclinations prevent them from accessing hospital services.
He said further: “Some women are found to have delivered outside the hospitals, sometimes by the roadside, because they were caught unawares. In a survey done in the South-West of Nigeria, it was found that about 24.2 per cent of the 4,360 women surveyed delivered outside the hospital while only 35.4 per cent delivered in government hospitals.
“The practice of home delivery, according to the 2013 survey, was least in the South-East, with 19.9 per cent of the deliveries done at home. This did not indicate improved access to government hospitals, though, because only 33.9 per cent of the deliveries were done in government hospitals, while the rest were in other facilities. The situation is worse in the North-West, where we had only 11.0 per cent of the surveyed deliveries done in government hospitals and a huge 87.5 per cent of the deliveries were done in homes. This is not acceptable in the 21st century. We need to put up concerted efforts to halt the slide.”
Olatunji regretted that some churches, traditional birth attendants and herbal homes, authorised to run some form of maternity service, often go beyond their brief. They are trained to handle simple deliveries that would have been identified as low-risk cases but, in practice, these groups of providers go beyond the rules of engagement and often come down with complications.
“The fact that most of these unorthodox delivery homes use various concoctions or ‘holy water’ and ‘anointing oils’ shouldn’t make them jettison the routine drugs of pregnancy or other ancillary cares. The magnitude of morbidity and mortality from these homes is a direct consequence of these unwholesome practices.
“The implication of this would be that the country will keep recording high maternal and infant mortality and morbidity, which will show abysmal health indices for the country. There is a need for us to curb the avoidable loss of human lives,” said the medical practitioner.
Scary statistics
According to the National Demographic Health Survey 2013, the World Health Organisation (WHO) asserted that the average life expectancy at birth in Nigeria has increased from 46 in 2008 to 52.62 in 2013. Also, under-five mortality declined 31 per cent from 201 deaths per 1,000 live births in 2003 to 128 deaths in 2013, while infant mortality declined from 100 deaths per 1,000 live births in 2003 to 69 in 2013. At the current mortality levels, one in every 15 Nigerian children dies in their first year, and one in every eight does not survive to their fifth birthday. The neo-natal mortality rate, at 37 deaths per 1,000 live births, has not declined at the same rate as the infant and under-five mortality, as revealed in the same survey of 2013.
Maternal mortality, death of women related to childbirth, accounts for 32 per cent of all deaths among women between ages 15 and 49. The maternal mortality ratio was 576 deaths per 100,000 live births for the seven-year period preceding the survey. The lifetime risk of maternal death indicates that one in 30 women in Nigeria will die during pregnancy or childbearing. In 2008, maternal mortality was estimated at 545 deaths per 100,000 live births. The worse case was in 2003 when it was estimated at 1,000 deaths per 100,000 live births.
Between delivery and deliverance
Chief medical officer, Subol Hospitals, Idimu, Lagos, Dr. Olayiwola Mudashiru Bello, asserted that hospitals are equipped for delivery while churches and native homes are equipped for ‘deliverance.’
Hear him: “Abandoning the hospital for any other place during childbirth is essentially abandoning delivery for deliverance. While a baby is the product of delivery, same cannot be said about deliverance. Delivery is meant to be conducted by skilled health providers in order to guarantee the health of mother and baby. Abandoning this safety net is essentially an invitation for complications for both mother and child. In many instances, the act of delivery is not as important as the processes leading to the delivery and the quality of baby delivered.
“Unfortunately, in our setting, people care less about the quality of the baby delivered, as long as the baby comes out through the vagina. Many of these children suffer complications such as cerebral palsy and birth injuries, which will take its toll on the intellectual and physical capabilities of the child in the near or distant future. This can eventually have multiplier, negative effects on the nation at large.
“Vaginal delivery should be the aim for every woman, as long as there is no factor in the woman or unborn child precluding such. This is because, despite all the advances in medical science and the refinement in the procedure of CS, vaginal delivery is still five to 20 times safer than CS. Despite this relative safety, there are women who will not be able to deliver via the vagina.”
Daily Sun learnt that 814 deaths per 100,000 were recorded by Indexmundi.com in 2015 for Nigeria.
Reasons for caesarean sections
Bello further explained that: “It has been discovered that inequalities in health outcomes also exist between dwellers in rural and urban areas, between the northern and southern regions of Nigeria, and across income groups. Childhood mortality rates are higher in rural areas than in urban areas, and higher in the northern zones than the southern zones. This may be a correlation of the prevalence of educated people in these regions. Also, childhood mortality is positively correlated with the wealth quintile as well as the level of mother’s education.”
According to the doctor, success or otherwise of vaginal delivery is determined by an inter-play of some major factors known as the three ‘Ps.’
“These are power, adequacy of uterine contraction; passage, adequacy of the maternal birth canal and soft tissues; and passenger, relative size of the baby.
“The three factors must be favourable for successful vaginal delivery. In situations where one or more of the factors are sub-optimal, it is safe to conduct a CS on the mother in order to prevent problems in the mother and/or child,” he said.
Bello explained that indications for a CS could either be relative or absolute: “Absolute indications refer to situations where vaginal delivery must not be attempted for the safety of the mother and her unborn child. An example is a woman who has undergone two previous caesarean sections. Relative indications refer to situations where CS is advised but vaginal delivery can be attempted (with some level of risk) under well-controlled supervision.
Quack ‘doctors’
Even though every trained doctor is conversant with these indications, there have been allegations that some doctors would quickly recommend a CS for financial reasons.
Some doctors insist that Nigerians promote the practice of quackery by seeking cheap alternatives to standard care.
“In the long run, however, it is cheaper to seek one-spot, standard medical care than health window-shopping at the expense of one’s life,” Bello said.
Complications during childbirth
According to the National Demographic Health Survey, maternal mortality ratio in Nigeria has reduced over the past few years but it is noteworthy that the number of women dying during childbirth annually in Nigeria has remained virtually unchanged, 57,000 in 1990; 62,000 in 2000; 57,000 in 2010 and 58,000 in 2015.
Sadly, Nigeria’s profile is only comparable to crises-hit countries such as Afghanistan (1,340 per 100,000 live births), Chad (1,450 per 100,000 live births) and South Sudan (1,730 per 100,000 live births). Iraq has a maternal mortality ratio of 107 per 100,000 live births while Algeria has 216 per 100,000 live births.
Experts say the goal should be to attain what obtains in developed countries, where such rates as two deaths per 100,000 live births are recorded.
Poverty as a cause
General Overseer, World Evangelical Ministry of Christ, Cherubim & Seraphim, Shasha, Lagos, Bishop Amos Idowu, opined that lack of money was the reason many women deliver babies in church ‘clinics’ or herbal homes.
Olatunji concurred, noting that poverty and illiteracy were the most important factors. In his view, many are trapped in a vicious cycle of poverty, illiteracy and disease.
“When I say illiteracy, I do not mean lack of formal education. You would be surprised at the actions of many so-called educated individuals when it comes to health issues. There is the erroneous belief that hospital fees are out of the reach of the common man. Patients with this belief see religious organisations and places of worship as a cheaper alternative to formal health care, especially in our setting, where a spiritual dimension is attached to every health issue. This sense of spiritual security, coupled with the perceived free or cheap service by spiritualists, tends to give patients some level of confidence to give birth in places of worship,” he said.
Pastor (Mrs.) Bolanle Okeremi had all her children in church.
She said: “Some women do deliver in churches or other places, for spiritual reasons. I delivered all my four children in a church maternity home, to the glory of God. All of them are testimonies. But then, in all honesty, there was no money to attend ante-natal clinics then. So we decided to use the church clinic where they would always accept whatever was given to them, unlike in the hospitals where the bills were too high. But we were warned never to visit any herbal home.
“Church clinics are not against medical attention, as long as you have the money for it. What they don’t like is combining both herbs and prayers. Even now, church clinics have medical practitioners on standby in case of complications.”
Reverend Opemipo Adekola, whose wife gave birth to their children at the church clinic, explained that women shun hospitals for financial and spiritual reasons.
“Our General Overseer then made it mandatory for all ministers within the ministry to use the church clinic because of some issues associated with the regular clinics at that time.
“There were also financial considerations, especially for a family like ours that was not really well remunerated. We couldn’t afford our choice hospital at the time, based on my wages, and going for cheaper hospitals would have been compromising the safety of my wife and baby. So it was better to go with the church clinic that would give her the best care as a member and the wife of one of their ministers. The church clinic had less maternal mortality rate.
“My wife said the experience was great but quite demanding, as she had to attend ante-natal sessions, not just for medical purposes, but also for spiritual exercise in preparation for a safe delivery,” he said.
Attitude of medical practitioners
Investigations also showed that some women shun hospitals because of the unprofessional attitude of some medical practitioners.
Mrs. Faith Osaremem recalled a nasty experience she had in 2015: “The particular hospital is a private facility, and a well-known hospital in Ikorodu. The chief medical director (CMD), Dr. Kale, was aware that I had lost two babies in quick succession through miscarriages. Unfortunately, he was not available on that day, as he was bereaved. I met a wicked and uncaring female doctor, who was also a consultant at the hospital on my due day.
“I fell into labour, but I wasn’t managed well as a first-timer. My asthma returned during labour, but the doctor kept shouting that I wasn’t cooperating. At a point, she abandoned me for hours. My elder sister and husband were with me but couldn’t reach the CMD on phone. They were helpless. It was providence that brought a male consultant whose wife fell into labour that day. He was not on duty but had brought his wife to the same labour room. When he saw me, he practically abandoned his wife and attended to me. He tried, but my baby boy was delivered dead. My son had died of asphyxia, lack of oxygen, from the womb.”
The spiritual angle
Some women, who spoke on condition of anonymity, told Daily Sun that it would be foolish to seek care in the hospital when conception miraculously happened at a herbal home.
One woman told the reporter: “I had a friend who had been married for 22 years without a child. Her IVF failed twice. I recommended a herbal home to her and God answered her prayers. But, unfortunately, my friend refused to go back for other necessary directives. She started going to the hospital. The baby died because of mismanagement by the medical personnel. She has not been able to conceive again. All my five children were delivered in herbal homes. Most of the herbal homes have modernised their facilities with up-to-date equipment and infrastructure.”
Madam Aina Okeremi, a church midwife, said certain women have a pact with the occult and their children cannot be born in the hospital, and “only spiritually-deep churches can handle such cases.”
Olatunji weighed in to state that a wicked doctor could only be found in 100.
“The best handlers are health providers and government should do more awareness campaign on safe motherhood,” he said.
An Ifa priest, Oluwo Elijah Dianu, opined that the oracle was usually the best help in ascertaining situations before the actual birth.
“Most times, some women find it difficult to conceive but, with the help of our fathers and herbs, they would conceive. Sometimes, there could be a divination that forbids hospital delivery, but, no matter the situation, we always advise them to go for a scan and bring the reports to us, except in rare cases where the baby is blocked spiritually from gaining access to the birth canal or tied with unseen ropes, which medical practitioners may not see. Doctors could recommend caesarean section that may cause the death of the woman or the baby and sometimes both of them, but there are some herbs, roots, sacrifices and incantations that would correct certain things. Basically, no woman wants to have babies through CS. That is why they run to us,” he said.
For Mrs. Ngozi Onu, the herbal home is better. She recalled an incident where she was refused admission at the hospital where she had been attending regular ante-natal sessions because she could not deposit the money the doctors demanded.
“I writhed in pain for several hours at the reception of a private hospital before a young female doctor took pity on me, and I was led into the labour room. But the baby boy came out dead.
“Since then, I’ve been using the birth attendants. My babies come out strong and better,” she said.
Idowu declated that some women could have spiritual problems during childbirth, and hospitals might not be able to handle such cases: “I don’t believe that more maternal deaths are recorded in church clinics. Deaths do occur even in hospitals, too, due to carelessness, but doctors usually hide such details, hiding them under the word ‘complications.’
“The job of a midwife is about wisdom. It is a huge job. When a woman falls into labour, she should be monitored strictly, both physically and spiritually. Only the careless minister or midwife would end up with a corpse. The foetal heartbeat and movement must be checked regularly. The mother’s BP must be checked. The passage or pelvis must have been checked to know if the baby would glide through, if not, we hand over to a medical practitioner for a CS.
“If a woman with a small pelvis is allowed to push, chances are that the womb would be torn, the baby would suffocate to death while trying to pass through the carnal and even the woman might die because of lack of strength and loss of blood.”
The bishop alleged that some doctors were into occultism and spiritism to avert strange things during deliveries.
“But you cannot use darkness to combat darkness,” he submitted, “When anyone runs into the strongtower of God, that is, the church, those demons would have been subdued and the babies would be born without complications, to the glory of God.”
‘What govt must do’
Olatunji said government has a lot to do in addressing the situation. He explained that, “Government can tackle this menace through intensified health education, community awareness campaigns and improvement in the health sector.
“Government needs to expand primary health care to further bring health closer to the people at the grassroots. A good way of improving access to health care services is to reduce the out-of-pocket expenditure on health. There is a strong and urgent need to expand and scale up the coverage for the health insurance scheme in both the formal and the informal sectors.
“This would definitely reduce the burden of cost of accessing care and thereby improve access to care. There should be a legislation to make child deliveries compulsory only at registered facilities or at home under the supervision of registered providers.”
For Bello, “In order to avoid unnecessary CS, patients should endeavour to receive care in standard hospitals with a track record of adherence to safety and internationally acceptable norms of practice.”