Maternal Health; should be a concern for all

Maternal death is becoming alarming in recent times that one would wonder if getting pregnant is important because of some complications during child birth.

Some circles have attributed maternal death to witch craft whilst others attribute it to the negligence of some health practitioners during delivery.

Child birth is important in our African society; it brings joy, love, bond between child and mother, adds to the number of people in a family among others.

Maternal death is defined by World Health Organization (WHO) as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”.

According to WHO globally, from 1990 – 2015, there has been a reduction in maternal deaths worldwide of about 45%. Still, the death rate stands at 800/ day, which is equivalent to 33/hour.

Also, 99% of these deaths occur in developing countries;

Africa – 1:40 and in Europe – 1:3300

Causes of maternal mortality are:

  • Hemorrhage
  • Unsafe abortions
  • Hypertensive disorders of pregnancy
  • Obstructed labour
  • Sepsis

Indirect causes include;

  • Anaemia,
  • Malaria,
  • Hepatitis
  • HIV/AIDS
  • Tuberculosis

Mrs. Dorcas Sackey, Western Regional Public Health Nurse in an interview with the B&FT explained that there are so many factors that contribute to maternal mortality, these are;

Delay in seeking care;

  • Poor understanding of risk factors and complications and when to seek medical help.
  • Previous poor experience of health care.
  • Financial constraints

Delay in reaching the health facility;

  • Long distance to health facilities.
  • Unavailability and cost of transportation
  • Poor road network.
  • Geographical location, such as crossing of rivers before leaving a vicinity to access health care.

Delay in providing care;

  • Poorly equipped facilities.
  • Inadequate referral system.
  • Bureaucracy at the health facility.
  • Poorly motivated medical staff.

Advice to pregnant women

According to Mrs. Sackey it is important for pregnant women to make it a point to attend pregnancy school since most education about pregnancy is given there.

They must eat a well-nourished diet daily, take in more fruits and vegetables and minimize salt intake, exercise, rest and sleep.

In addition, they must sleep under an Insecticide Treated Net every night and take the (sulfadoxine pyrimethamine) SP given by the midwife to prevent malaria in pregnancy and discuss her birth preparedness and complication readiness plan with the midwife.

  • Take all Tetanus Diptheria (TD) immunizations as per schedule to get protection from tetanus for herself and the baby
  • Prevent Sexually Transmitted Infections (STIs) in pregnancy, especially gonorrhea and syphilis, since these can cause eye problems, birth abnormalities and even death in children.
  • Most women go through pregnancy and delivery normally. However, during delivery, around 15% of all pregnant women develop a potentially life-threatening complication that calls for skilled care.
  • Since one may not know the outcome of pregnancy, it is important to deliver in a health facility because;
  • There’s a wider range of options as compared to delivery outside the facility such as vacuum extraction or cesarean section (CS) if Spontaneous Vaginal Delivery (SVD) is not possible.
  • All medical problems in pregnancy which may complicate delivery such as gestational diabetes, pregnancy-induced hypertension and others, can be properly managed.
  • The first postnatal visit after discharge from the hospital should be between 24-72 hours, and the second and third, 6-7 days and at 6 weeks respectively.
  • Babies should not be bathed immediately. Bathing should be delayed till after 6 hours of delivery. Adequate warmth should be provided for the newborns.
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Postnatal

  • Exclusive breastfeeding, attaching importance to the colostrum.
  • Cord care with appropriate medication (methylated spirit or chlorhexidine).
  • Mother should wash her hands always before handling of baby.

Book Launch

Recently at a book launch on why do some women persistently prefer traditional birth attendants and domiciliary delivery”( domicilary delivery, is the delivery of a range of personal care and support services to the individual in their own homes) a qualitative study on delivery care services in Chirano and Bekwai sub-districts in the Bibiani Anhwiaso Bekwai district of the western region explains that a lot of women in the rural areas prefer the Traditional Birth Attendants (TBA) throughout their childbirth.

Between 2008-2013 TBAs had 76% of deliveries in Chirano sub-district,     in the Western Region,  at Humjibre (a small community located in the Bibiani Ahwiaso Bekwai), 23% deliveries took place at the Humjibre clinic, 36% at other health facilities (outside Humjibre) and then 41% happening under the supervision of TBAs.

The study explored factors existing in the communities that promote TBA or domiciliary delivery and factors existing at the health facilities that hinder increased supervised delivery as well as evaluate the attractive roles of the TBAs that make some pregnant persistently use them.

Findings from the study indicates that;

  • 92 representing 53% of them used only TBAs throughout their childbirth (out of which 75 (82%) were multigravidas (a woman who has been pregnant for more than once) and 17 (18%) being primigravidas (a woman pregnant for the first time).
  • Another 47 (27%) participants who were multigravidas used both skilled and TBAs while the remaining 34 (20%) participants used
    skilled delivery throughout childbirths.

Obed Bangdome Ofori, author of the book and also a staff at the Western Regional Public Health Division of the Ghana Health Service said findings from the studies indicates that;

  • Delivery costs with a midwife at health care facility or clinic were perceived unaffordable.
  • This was motivated by the low economic status of the community members. “Brother, everybody in this world likes good things but we don’t have money. Those whose husbands take fat salaries from the mining company perhaps could afford the cost of delivery by a trained midwife. The midwife wants as many as six Geisha soaps among other which we cannot afford; we don’t bath Geisha soaps so we prefer the TBA who won’t ask for expensive soaps” Madam Theresa Hukpatsi said.
  • Sometimes, labour normally occurred at night and getting a vehicle to the health center or clinic becomes a challenge.

Wayforward

  • The District Health Facilities must urgently review the items requested from expectant mothers during labour and standardize it for all health facilities in the district.
  • An in-service training on inter-personal relations for the midwives could help get more skilled deliveries.
  • Health education strategies are required to increase community awareness about the importance of skilled delivery and the education programmes must also lure attention on relatives and friends of pregnant women since they play central role in the decision of place of delivery.

For good health care delivery to be efficient in the health system in the country, midwives and the nurses must be friendly to their clients so that they can be free to report any challenge they may be going through at all times.

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Maternal death is becoming alarming in recent times that one would wonder if getting pregnant is important because of some complications during child birth.

Some circles have attributed maternal death to witch craft whilst others attribute it to the negligence of some health practitioners during delivery.

Child birth is important in our African society; it brings joy, love, bond between child and mother, adds to the number of people in a family among others.

Maternal death is defined by World Health Organization (WHO) as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”.

According to WHO globally, from 1990 – 2015, there has been a reduction in maternal deaths worldwide of about 45%. Still, the death rate stands at 800/ day, which is equivalent to 33/hour.

Also, 99% of these deaths occur in developing countries;

Africa – 1:40 and in Europe – 1:3300

Causes of maternal mortality are:

  • Hemorrhage
  • Unsafe abortions
  • Hypertensive disorders of pregnancy
  • Obstructed labour
  • Sepsis

Indirect causes include;

  • Anaemia,
  • Malaria,
  • Hepatitis
  • HIV/AIDS
  • Tuberculosis

Mrs. Dorcas Sackey, Western Regional Public Health Nurse in an interview with the B&FT explained that there are so many factors that contribute to maternal mortality, these are;

Delay in seeking care;

  • Poor understanding of risk factors and complications and when to seek medical help.
  • Previous poor experience of health care.
  • Financial constraints

Delay in reaching the health facility;

  • Long distance to health facilities.
  • Unavailability and cost of transportation
  • Poor road network.
  • Geographical location, such as crossing of rivers before leaving a vicinity to access health care.

Delay in providing care;

  • Poorly equipped facilities.
  • Inadequate referral system.
  • Bureaucracy at the health facility.
  • Poorly motivated medical staff.

Advice to pregnant women

According to Mrs. Sackey it is important for pregnant women to make it a point to attend pregnancy school since most education about pregnancy is given there.

They must eat a well-nourished diet daily, take in more fruits and vegetables and minimize salt intake, exercise, rest and sleep.

In addition, they must sleep under an Insecticide Treated Net every night and take the (sulfadoxine pyrimethamine) SP given by the midwife to prevent malaria in pregnancy and discuss her birth preparedness and complication readiness plan with the midwife.

  • Take all Tetanus Diptheria (TD) immunizations as per schedule to get protection from tetanus for herself and the baby
  • Prevent Sexually Transmitted Infections (STIs) in pregnancy, especially gonorrhea and syphilis, since these can cause eye problems, birth abnormalities and even death in children.
  • Most women go through pregnancy and delivery normally. However, during delivery, around 15% of all pregnant women develop a potentially life-threatening complication that calls for skilled care.
  • Since one may not know the outcome of pregnancy, it is important to deliver in a health facility because;
  • There’s a wider range of options as compared to delivery outside the facility such as vacuum extraction or cesarean section (CS) if Spontaneous Vaginal Delivery (SVD) is not possible.
  • All medical problems in pregnancy which may complicate delivery such as gestational diabetes, pregnancy-induced hypertension and others, can be properly managed.
  • The first postnatal visit after discharge from the hospital should be between 24-72 hours, and the second and third, 6-7 days and at 6 weeks respectively.
  • Babies should not be bathed immediately. Bathing should be delayed till after 6 hours of delivery. Adequate warmth should be provided for the newborns.
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Postnatal

  • Exclusive breastfeeding, attaching importance to the colostrum.
  • Cord care with appropriate medication (methylated spirit or chlorhexidine).
  • Mother should wash her hands always before handling of baby.

Book Launch

Recently at a book launch on why do some women persistently prefer traditional birth attendants and domiciliary delivery”( domicilary delivery, is the delivery of a range of personal care and support services to the individual in their own homes) a qualitative study on delivery care services in Chirano and Bekwai sub-districts in the Bibiani Anhwiaso Bekwai district of the western region explains that a lot of women in the rural areas prefer the Traditional Birth Attendants (TBA) throughout their childbirth.

Between 2008-2013 TBAs had 76% of deliveries in Chirano sub-district,     in the Western Region,  at Humjibre (a small community located in the Bibiani Ahwiaso Bekwai), 23% deliveries took place at the Humjibre clinic, 36% at other health facilities (outside Humjibre) and then 41% happening under the supervision of TBAs.

The study explored factors existing in the communities that promote TBA or domiciliary delivery and factors existing at the health facilities that hinder increased supervised delivery as well as evaluate the attractive roles of the TBAs that make some pregnant persistently use them.

Findings from the study indicates that;

  • 92 representing 53% of them used only TBAs throughout their childbirth (out of which 75 (82%) were multigravidas (a woman who has been pregnant for more than once) and 17 (18%) being primigravidas (a woman pregnant for the first time).
  • Another 47 (27%) participants who were multigravidas used both skilled and TBAs while the remaining 34 (20%) participants used
    skilled delivery throughout childbirths.

Obed Bangdome Ofori, author of the book and also a staff at the Western Regional Public Health Division of the Ghana Health Service said findings from the studies indicates that;

  • Delivery costs with a midwife at health care facility or clinic were perceived unaffordable.
  • This was motivated by the low economic status of the community members. “Brother, everybody in this world likes good things but we don’t have money. Those whose husbands take fat salaries from the mining company perhaps could afford the cost of delivery by a trained midwife. The midwife wants as many as six Geisha soaps among other which we cannot afford; we don’t bath Geisha soaps so we prefer the TBA who won’t ask for expensive soaps” Madam Theresa Hukpatsi said.
  • Sometimes, labour normally occurred at night and getting a vehicle to the health center or clinic becomes a challenge.

Wayforward

  • The District Health Facilities must urgently review the items requested from expectant mothers during labour and standardize it for all health facilities in the district.
  • An in-service training on inter-personal relations for the midwives could help get more skilled deliveries.
  • Health education strategies are required to increase community awareness about the importance of skilled delivery and the education programmes must also lure attention on relatives and friends of pregnant women since they play central role in the decision of place of delivery.

For good health care delivery to be efficient in the health system in the country, midwives and the nurses must be friendly to their clients so that they can be free to report any challenge they may be going through at all times.

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