Women have complex needs during childbirth. But experts, in this report by SADE OGUNTOLA, say that the quality of health care services in Nigeria continues to fail pregnant women and highlight aspects of childbirth in Nigeria that need to change.
PREGNANCY and childbirth can be the most simple, straightforward process ever. But one of the most overwhelming misfortunes that have endured throughout history is the death of women during pregnancy and labour. And sadly for many Nigerian women, childbirth often results in the death of mother or baby or both, bringing with it a huge burden of grief, pain and heartbreak.
The World Health Organisation (WHO) report on ‘Trends in maternal mortality: 1990 to 2013’ classifies Nigeria as one of the 10 countries of the world that contribute about 60 per cent of the world’s maternal mortality burden.
But many of these deaths are preventable if aspects of how women give birth in Nigeria are changed. The outcome of a qualitative study by the WHO’s Better Outcome for Labour Difficulty (BOLD) project indicated many challenges to improving the quality of maternity care in sub-Saharan Africa. The findings of the study was recently deseminated in Abuja.
Labour wards inadequacy
According to Dr Bukola Fawole, Country Coordinator, BOLD project, “The constraints within the hospitals, particularly the more recently constructed ones, includes space constraints in the labour ward. It is not every woman who comes during labour, particularly those who come in early who are admitted immediately. Some are asked to go back and return later.
“Initially, some of these women come in when the babies are alive. But by the time, they return because they have not been effectively monitored, some of them have lost their babies. If they had been admitted, examined and their labour monitored, possible problems would have been identified and appropriate interventions instituted,”he said.
Bleeding, leading killer of pregnant women
Although bleeding and disorders arising from hypertension in pregnancy remain the leading causes of death in pregnant women, “once we identify it and we implement appropriate interventions early, we are able to prevent such maternal deaths,” he said.
Dr Fawole, who identified finances, women empowerment and social issues as constraints to women’s access to health care in labour, declared as alarming, the high rate of death in babies in the womb and newborns, the study also found.
Some of the stillbirths actually happen at the time of admission for delivery. And a lot of factors contribute to it, including health system factor, the provider factor and so on.
Women’s expectations in labour The BOLD project found that many women who had given birth in a Nigerian hospital had one or two horror stories to tell about the poor state of facilities in labour ward, rude health workers, or mothers having to share beds. These were also not supportive of ensuring safe mothers, safe babies, a medical officer at the Department of Reproductive Health and Research, WHO, Professor Femi Oladapo, said.
He declared: “They expressed the need for a supportive and respectful care, including empathy and emotional support from providers.
“The women said many doctors and midwives did not communicate in a language that they understood how their labour was progressing and why interventions were given, making them passive participants in the labour process.”
Although health providers could do more to make labour more comfortable for women, Professor Oladapo stated, health workers’ expectation from the women were many.
Many women, health providers’ claim, do not follow the instructions they are given to ensure safe mothers and babies.
Professor Oladapo added that the use of pathogram, a tool developed to monitor labour in remote locations over 40 years ago, was difficult to use since doctors or midwives might be seeing many patients at once despite its many flaws.
Innovation is key
However, Professor Joao Paulo Souza, also a medical officer at the Department of Reproductive Health and Research, WHO, stated that care around the time of birth is most critical to mothers and newborn babies’ survival and, as such, the BOLD project had developed an electronic tool that could serve as an alternative to pathogram.
The tool, called Simplified Effective Labour Monitoring -Action (SELMA) tool, was developed based on data collected from 10,000 women during labour and childbirth from nine hospitals in Nigeria and Uganda.
This digital labour assistant was designed to simplify labour monitoring and support clinical decision of healthcare providers, including non specialists, during labour to ensure safer births.
Although SELMA still needed to be further tested, he declared, “we anticipate that with this tool, we will totally transform the way labour is currently being managed in our facilities.”
According to him, “the tool provides suggestions for the management of labour, something that the pathogram does not do. And more importantly, it was developed with data from Nigeria, so it is much more applicable to women in this part of the world.”
Making healthcare a priority
However, Director, Division of Reproductive Health, Federal Ministry of Health, Dr Kayode Afolabi, noting that pregnant women and children constitute a vulnerable group, said some progress was being achieved in reducing deaths in women.
“Our current maternal mortality rate is commendable, it is also a challenge that we need to work a lot harder; we need to be smarter and collaborate more with every stakeholder. We need to deploy evidence to boost our practice and that is the major reason Nigeria is partnering in the project.”
Dr Afolabi declared that Nigeria was also considering increased private sector involvement in family planning services, saying that it would ensure women have a choice on when they have children and the number of children that will not adversely affect their health.
He added that the Federal Ministry of Health would take advantage of IT and its advancements, adding: “Certainly, the BOLD project will be one of such studies that could positively impact policy in Nigeria, particularly with reference to management of childbirth.”