Neonatal disorders remain the leading trigger of infant mortality. Findings have shown that most neonatal disorders are products of childbirth trauma, but the Nigerian health system may not be doing enough. In this report, MICHAEL BABATUNDE writes on why childbirth trauma keeps contributing to infant mortality.
Despite the declining rate of infant mortality in Nigeria, adequate healthcare for mother and her infant remains a major concern as year in and year out, neonatal disorders have been responsible for a larger percentage of the annual child deaths recorded among infants annually.
Data provided by the United Nations Children Education Fund (UNICEF) puts the infant mortality rate in 2021 at 70.589 per 1,000 births while declaring the total number of infant deaths to be around 852,298.
Relatedly, Statista, a global data and business intelligence platform, disclosed that there are at least 55 deaths in every 1,000 children in 2023 in Nigeria. As of 2023, the mortality rate of infants under one-year-old in Nigeria was measured at 55.17. The data also ranks Nigeria third among the countries with the highest infant mortality rate in the world, while infant mortality remains predominant in Africa.
This is just as the United Nations noted that during the first 28 days of life (neonatal), “the child is at highest risk of dying. The vast majority of newborn deaths take place in developing countries where access to health care is low.” It added that neonatal disorders come up when mothers suffering from child birth trauma can’t give the necessary attention to the child.
To improve chances of survival and to lay the foundations for a healthy life, the UN recommended essential care for newborns including immediate and prolonged skin-to-skin contact and early and exclusive breastfeeding.
But, neonatal disorders set in when mothers, due to childbirth trauma, leave their newborns without the motherly care required in their early stage of life.
Another worrisome development is the fact that mothers who experience childbirth trauma fail to approach health workers for help even during postnatal visits thereby threatening maternal and child health.
While some show lack of confidence in the health care attendants, others said they had no avenue to discuss what they go through and thus resort to self help.
Afraid of stigmatisation, Linda, who held onto her seven-month-old baby, didn’t want to share the experience she had prior to child delivery.
She regularly visited the health centre without issue but became worried when she was past her due date. When she visited the health centre on her due date, she was given paracetamol and told to go home because her “cervix is still closed.” The delay lasted for three weeks.
Not satisfied by the response, she forced her husband to take her to a private hospital in the middle of the night where the doctor on duty declared an emergency due to fetal distress. She agreed to take a Cesarean Section because she was writhing in pain and at the same time wanted to save her baby.
The revelation at the private hospital made her almost lose faith in the attendants at the primary health center where she later went for postnatal visits after delivery of her baby girl.
She struggled for months with child birth trauma that made her stay far away from the child during the weeks of pains and depression.
Despite her regular visits to the health centre, she couldn’t open up to them because “they’re not reserved; they don’t give us listening ears. They talk to us anyhow they like and make us feel like we’re asking irrelevant questions.”
Everything irritated her. Her husband dared not come close to her during the period, but her family’s –immediate and extended– presence provided some sort of comfort.
When she felt pushed hard by the trauma, she went online in search of ways to help herself, adding that “the doctor I met online gave me listening ears and even did a follow up.”
Clara Ebube had a similar experience with Linda during the birth of her second baby. Having had the first through a regular delivery, doctors said her cervix wouldn’t open up for the second delivery and the baby was in distress.
She disclosed that recovery was much more stressful and harder than the first one, that she couldn’t help her baby because she also needed to heal.
Like any new mom, the experiences had a mental toll on her, but having her family members around took her mind off the stress and assisted her a lot.
Whenever she goes for checkup it was only so they could check the healing process of the surgical site and give pain reliefs when necessary. She didn’t speak to a doctor about mental stress. According to her, no doctor asked her how she was coping or even counseled her.
“What concerns Nigerian doctors with your mental health,” she joked in Pidgin English.
Two months after delivery, she’s still trying to cope and struggle through the trauma despite paying heavily to use one of the supposed best private hospitals in the South-South.
For Iyabo Akintunde, a mother of two, who had one virginal birth and one induced birth. She delivered one of her babies without complications. But to have the second, she was induced and even had a tear during delivery. She said aside the pain of the tear and the point when they told ‘her there’s a need to sew that part again’, she had no trouble. She feels there is enough help within the medical system.
Akintunde delivered her babies at the Federal Medical Centre, Abeokuta and she was assured that there were enough hands to cater for her needs pre- and post-delivery because she had enough counseling before child birth.
“I had no need for counseling after childbirth except checking on my babies and how best to take care of them, but the way I was attended to, I was sure they can provide physical and emotional support for nursing mothers,” she said.
Recalling the drama she put on in the labour room, another mother who gave her name as Nofisat, noted that she had regular delivery for her two children.
“I was a mad woman for the period of birth. The nurses on duty reminded me of how I cursed everyone, I had to beg them because I remembered some of it and those moments were nothing to be compared with my personality.
“The first month after childbirth is obviously tough, although there’s this lightness you’ll feel, having to offload what you carried for nine months but the toll of taking care of that baby is draining. Some people have quick recovery of their ‘madness’ after childbirth but for some, it takes weeks.
“There may be little matrons can do because of the belief of ‘abisinwin’ in Yoruba, they feel it is bound to happen and the mother will recover in due time. This is the point I feel we should concentrate on. I don’t think the medical line should allow a nursing mother to tarry in her hallucinations. The child is in danger, the mother herself is in danger, even the husband.”
One her own part, Gloria does not want to recall her experience. She claimed to have healed from the thoughts but her emotions betrayed her while speaking with Sunday Tribune.
She told Sunday Tribune wanted to have more kids but for someone who’s had two CS, it is not a good idea.
It was almost hell for her after the period of child delivery, as nothing even mattered. She was literally developing hatred for her own child. Mishap might have happened but families around kept her sanity at bay.
She used two private hospitals for her first and second delivery but, according to her, there was “no opportunity for mental assessment, as long as the baby is okay and the mother has been adhering to the instructions given; their assessment is perfect.”
A nurse, Favour Omoigberale, said some women present different situations during postnatal visit which, usually are stress of childbirth, healing, which often comes naturally, and the stress of having to adjust to life with a newborn. Childbirth trauma, PTSD or mental issues barely come up for discussion.
Omoigberale said from her experience of antenatal and postnatal visits, women are often encouraged to always be vocal about whatever challenges they may face right from pregnancy till even after childbirth.
She said mothers may be hesitant in discussing mental or trauma issues because of fear of stigmatisation.
“Since everyone else around them could be related or someone they are familiar with, mothers seem to go through childbirth without any obvious difficulty. Discussing such things might make them look weak. The fear of being called lazy or being told that their complaints are what every other woman goes through,” she explained.
She recommended societal engagement to change the narrative of stereotyping.
“Many see pregnancy as a normal phenomenon every woman must go through. We must acknowledge that no two women are the same and while some might adapt to motherhood without any difficulty, it is not a crime if other women do not quickly adapt,” she added.
Also speaking on the issue, a Chief Nursing Officer, who resides in Lagos, Matron Awodele, maintained that medical workers are providing the needed support for nursing mothers and it starts from pregnancy. She however pointed out that misconceptions and traditional taboos are reasons why some mothers don’t speak up during encounters with matrons.
“The support starts from pregnancy. We let them know about pains. It is important they cooperate with nurses and adhere to instructions. We usually prepare them ahead of what will happen after birth. We let them know it’s going to be a difficult phase but the joy of their child, but mothers shy away because of various misconceptions that are related to taboos and traditional beliefs.”
From her experience as a nurse and midwife, Beatrice Adegoke-John stated that the expertise of the health care attendants is needed to make the mothers speak up as their feelings and responses are important during information taking.
She added that to enhance maternal and childbirth through prevention of neonatal disorders from child birth trauma, proper counseling must start before child birth.
“We need to prevent what can be prevented and prepare them for what is to come; intervene when necessary, teach all they need to know. The right education is all we can offer. When they are more knowledgeable, it helps them to cope well with their condition.”
A former Provost and Medical Director, Neuropsychiatric Hospital, Aro, Abeokuta, Dr Adegboyega Ogunlesi, agreed that “mothers may experience psychological challenges, especially when there are stresses prior to delivery, during delivery and post delivery.”
He said the psychological challenges are more with the unplanned or emergency Cesarean Section where the mother is not emotionally prepared, but was done to save the life of the baby or mother or both.
He listed challenges after childbirth to include poor sleep, anxiety, guilt, hypervigilance, intrusive thoughts, flashbacks of the trauma, etc. or even post-birth depression from unmet expectations of the mother.
Drawing from decades of psychological practice, he said, “most women going for delivery have an expectation that it will be a natural birth. When surgical interventions come in, their expectations are dashed. Post natal depression can also occur in varying degrees, but sometimes women with natural births also experience this in a mild form called postnatal blues.
He warned that “the quality of life index may be worse in such women who have CS than in women who had normal delivery. A mother with PTSD or severe post natal depression may perform poorly with infant-feeding, and other maternal tasks as well.
“It is important to address these issues in such women, because if unattended to, they may impair child care negatively. Their doctors may invite the psychologist or psychiatrist, as deemed fit, to offer counseling,” he said.
Aligning with the fears of many mothers who seek help at the hospitals, he said, “I doubt whether there is enough help available in the health system. What we have in abundance is palpable ignorance where the charlatans, spiritual and traditional healers have come in to fill the void. Many women and families suffer in silence for the reason of stigma. Our traditional healers have a diagnostic label called ‘abisinwin’ to categorise some of these psychological challenges.”
On his recommendations, Ogunlesi said “there is need for public information, in all facets, about the complications that may follow child birth, whether normal or complicated.”
He called for “improvement in obstetrics care to ensure that fewer women get complicated deliveries, start antenatal care early, institute regular liaison between obstetrics and mental health care providers, identify at risk groups early and offer needed services, public education about the psychological challenges that attend such an expected happy event of child bearing, increase in the number of health providers, reinforce primary care obstetrics services, especially in rural areas with the aim of picking up sufferers early, educate men on what to look for in their wives post delivery, incorporate men into antenatal care services, where they can be educated on some of these matters among others. Let me also add the need to conduct further research on the subject in the country.”
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