When the Lagos State
Government released its 2010 Maternal Mortality Rates Survey penultimate
Friday, experts called on governments to redefine the role of
Traditional Birth Attendants to reduce infant and maternal mortality
rate in the state.
The debate on who is qualified to take
delivery of a pregnant woman in labour has been renewed as the Lagos
State Government released its 2010 maternal mortality health survey
conducted by Ipas, a sexual reproductive health organisation on Friday.
Stakeholders in the medical profession,
including gynaecologists, nurses and obstetricians, who were present at
the presentation called on the state government to reverse its policy
that allows Traditional Birth Attendants trained by the state to take
delivery of pregnant women.
According to them, the move is
practically endorsing unskilled personnel to attend to pregnant women.
This, they warned, could
increase maternal and infant mortality rates in
the country.
Presently, the World Health Organisation
rates Nigeria second only to India in maternal mortality rate. The
nation accounts for over 10 per cent of the world’s total estimate of
maternal deaths.
The experts criticised the state
government’s initiative which had seen over 1,264 TBAs trained in the
past two years in primary health care centres to offer midwifery
services in local government areas in the state.
In his view, the Country Director of
Ipas, Dr. Ejike Oji, said though TBAs are a relevant chain in the
maternal and child care system of the country, they lacked the knowledge
and skills to save a mother and her baby from dying during delivery.
According to him, TBAs can not recognise
and also intervene medically in the five leading causes of maternal
deaths during child birth which include obstructed labour, unsafe
abortions, Enclampsia, haemorrhage (bleeding) and infections.
He said, “When a woman obstructs, and
the baby cannot come out, the woman can only be helped by a caesarean
section. Now this woman is being managed by a TBA, 200 kilometres from a
health centre, how will the TBAs help that woman, is that not death
penalty for the woman?
“If a woman has post abortion
complications, what will a TBA do for her? Can she evacuate her uterus?
If it is an abortion done by quacks and her abdomens have been removed,
would a TBA be able to repair that? When a woman is bleeding during
delivery like a tap that some doctors even run from, would the TBA be
able to remove the placenta and stop the bleeding?
“They would not be able to. Does a TBA know the antibiotics to prescribe for a mother with post-partum bleeding? They do not.”
According to him, previous programmes
that championed the training of TBAs to take deliveries in Africa had
been scrapped after research showed that maternal mortality had
increased as a result of such training.
Oji stated that research had shown that
80 per cent of pregnant women would have normal deliveries with or
without the intervention of TBAs or skilled health workers while all
maternal deaths during deliveries arose from the 20 per cent that were
complicated.
He noted that the misuse of TBAs in
rural areas and even cities had significantly contributed to the
maternal mortality rates that Nigeria records.
“Eighty per cent of pregnant women
would deliver safely without the help of a TBA or skilled attendant.
Those are the success stories we attribute to them. What happens when a
TBA is attending to a complicated case that they cannot handle or did
not predict? That is the 20 per cent that is killing our women.
“We are saying a midwife not even a
nurse, who would be able to provide the minimal care and also refer her
to the appropriate quarters, should be required. What we see in most
cases is that the TBAs will not even know that the woman is in trouble
in the first instance.”
President of the Neonatal Society of
Nigeria, Prof. Angela Okolo, also said the use of TBAs as birth
attendants was a major factor responsible for Nigeria’s high infant
mortality in the world.
Okolo said surveys had revealed that 60
per cent of babies were born at home by unskilled personnel and
according to WHO and the medical profession, only a skilled birth
attendant, a professional trained in an orthodox way, that is a doctor, a
midwife, an obstetrician or gynaecologist should take deliveries.
She warned that trained TBAs lacked
medical orientation to recognise tell-tale signs of complications,
including prematurity, neo-natal jaundice, lack of cry and infections
that could lead to death or mental disabilities in babies if not
detected early.
Okolo said, “We know why mothers and their babies die and TBAs cannot contribute to saving their lives at that point in time.
“We can predict that a woman would have
post- partum haemorrhage (excessive bleeding) how do I teach a
traditional birth attendant to avoid that. Does she know what group of
blood to give the dying mother? How do I teach her to do foetal heart
monitoring or know that a baby would be born prematurely? The life of
the mother is at risk too when the baby does not come out.”
She, however, suggested that state
governments should define the roles of TBAs such that they are used as
community health resource persons who identify the pregnant women in the
communities and bring them to heath centres.
Okolo said, “We are not completely
rejecting TBAs. In our country, most women first disclose to TBAs that
they are pregnant in the first instance because they believe in
witchcrafts that could hurt their babies before it is visible. But they
should bring their clients to the hospital.
“This has worked in reducing maternal
deaths significantly in Sierra Leone where TBAs get a $5 reward for each
pregnant woman they bring to the hospital. TBAs should educate women in
the communities that delivering babies in their backyards or bedrooms
is a dangerous practice.”
Policy makers in the field of
traditional medicine however rose in defense of the TBAs, saying that
their duties go beyond identifying pregnant women to come to health
facilities.
They stated that the presence of skilled
TBAs who are usually grass roots people reduce maternal and infant
deaths in rural areas that do not have health care providers and
facilities.
The Chairman of the Lagos State
Traditional Medicine Board, Dr. Olubunmi Omosehindemi, said the
integration of TBAs into maternal health care services in communities
would increase the number of skilled providers at the grass roots and
reduce the load on health care facilities.
Omosehindemi said, “This is an age-long
argument that even the World Health Organisation is yet to resolve. In
Nigeria, most births take place in the homes and our mothers would
patronise TBAs whether they have the skills or not. So why don’t we
train and equip them with the knowledge they require.
“How many doctors or nurses are
available to the population of our pregnant women in Nigeria? Most of
them cannot access quick care at hospitals when they are in labour
because of patients’ overload. The presence of trained TBAs would save
mothers and their children from dying. “
However, the State Commissioner for
Health, Dr. Jide Idris, said the initiative to integrate TBAs into the
maternal health care services of the state was aimed at increasing
access to care and referral to health care centres in the state.
Idris noted that activities of some
faith-based organisations that discourage women from delivering in
hospitals, in addition to poor attitude of health workers, had increased
the population of women who deliver at home.
He said in order to curb the excesses of
some TBAs or organisations in the state, the state government would not
hesitate to sanction anyone found wanting.
Idris said, “We have realised that
pregnant women are referred at a very late stage to our hospitals when
complications that cannot be helped have occurred. We will sanction any
establishment, organisation or persons that continue to engage in
practices that are killing our women and children.”
To save women and children from dying
from preventable deaths and also increase pregnant women’s access to
quality care, the experts called on the governments at all tiers to
train more midwives and deploy them in rural areas.
Oji said that monitoring and evaluation
of maternal health care services could change poor attitude of health
workers to pregnant women.
“If a woman dies in the hands of a TBA,
they say it is an act of God but if it is in the hands of a midwife,
they call her a witch. So they prefer the TBA who will care but not give
the treatment rather than the midwife that would provide the needed
treatment and not the care. There is need to build confidence of
pregnant women in our health care providers, else they would continue to
patronise TBAs,” he noted.
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