· Traditional birth attendants (TBA) do
not have the skills nor the medical materials to prevent women from dying.
· One factor that delay women outside
skilled setting is the wrong assumption or hope that a TBA is all they need, so
they do not seek out any other pre-delivery assistance and then do not go to a
properly resourced medical facility. When complications arise, such women can
die as they are likely to be delayed in such unskilled facilities since the TBA
may be unable to diagnose the complication let alone response to it
appropriately.
· Women can die from any of the
following complications of pregnancy and delivery
Ø Excessive bleeding
Ø Infection
Ø Severe pregnancy induced hypertension leading
to eclampsia or fits
Ø Obstructed labour
Ø Severe anaemia (lack of blood)
Ø Complications of miscarriages
Ø Complications of unskilled
termination of pregnancy
Unskilled
birth attendants can hardly diagnose any of those complications that can kill
women. Even if they recognize excessive bleeding, they have no capacity to help
such women, they usually have no training or the medical resources to help such
women.
· TBA can delay a client with
complications because of fear of forgoing income they would have made
· TBAs are obstacles preventing women
from getting proper care
· Many TBAs and other untrained and
unskilled birth attendants have a vaginal delivery-only mindset. They never
talk about any other form of delivery in case vaginal delivery attempts fail.
They discourage their clients from having a caesarean birth. When it becomes
obvious the woman needs it, they send them away to a doctor without even
telling them they will have a C/S. They engage in some dangerous practices to
enforce vaginal birth. Some give high doses of uterine stimulant to facilitate
vaginal birth. Some of such women end up with uterine rupture and/or the death
of their babies. Most times, spouses or relations of such women rescue them by
taking them to the hospital, most times against the will of the unskilled birth
attendants. However, some arrive the hospital late and so die.
· Some untrained birth attendants also
run prayer ministries and give their clients the impression of providing
spiritual care for them. Since such spiritual exercises are hardly seen in
hospitals, they use it to draw pregnant women to themselves. Since they lack
the training and medical resources to help these women, some of them and their
babies die. When they have complications they quickly tell the rest of their
clients the need for more prayers as those unfortunate women died from ‘spiritual’
attack.
· They also deliver some negative prophesies
to the pregnant women and their spouses to discourage them from going to the
hospital. Such prophesies include but not limited to the following;
Ø “You will die if you go to the
hospital”
Ø “If you do operation, you will die”
Ø “You shall deliver like the Hebrew
women”
Ø “The Lord has told me that you will
not do operation”
Ø “Somebody has tied your womb. So your
delay in delivery is a spiritual problem which cannot be solved in the
hospital”
Ø “Somebody is after your life, you
must come for prayers. As we pray for you there will be no attack”
Ø “If you go to hospital, they will
operate you”
Some
negative words are also spoken to these women to discourage them from skilled
care like the following;
Ø “Occultic doctors and Nurses abound
in the hospital and can use you or your baby for sacrifice”
Ø “Doctors are only interested in doing
operations so as to get big money. They have no skill for vaginal birth and so
do not give women chance to labour and deliver vaginally”
Ø “You will spend a lot of money when
you go to the hospital”
Ø “Nurses will not give you good
attention when you go to the hospital”
These unskilled
birth attendants instill fear in their clients about skilled care or hospital.
These
negative prophesies and statements are not true and have contributed to maternal/new
born mortality more than most cases recognized by medical personnel. They
divert pregnant women from skilled care and prevent those with complications
from accessing skilled care on time. Anybody who lacks the training and medical
resources to deliver pregnant women should have no business doing that.
A major
reason for death of women and/or their babies from the activities of TBAs is
provoking complications that can kill.
o
Engaging
in external cephalic version (Trying to turn a baby) not presenting by the
head. Sometimes this can result in uterine rupture in a woman who delivered
previously by caesarean section or had a scar in the uterus from a previous
fibroid operation. This can result in injury to the uterus leading to bleeding
into the abdominal cavity.
o
Provoking
torrential bleeding by trying to remove a low-lying placenta blocking the
decent of the baby’s head.
o
Introducing
life-threatening infection by examining laboring women with bare hands or with
unsterile hand gloves and without masks covering their nostrils and mouths.
Such infections can kill the babies and/or their mothers if appropriate antibiotics
are not given.
Safe
motherhood Empowerment and Enlightenment Initiative (SMEEI) is engage in the
following activities to encourage women to access skilled child birth care.
§ Public education of pregnant women,
their spouses, relations, friends, social and spiritual mentors on the need for
skilled Antenatal care. Antenatal care connects women to the idea of delivering
in a skilled health facility. This is done through Television Enlightenment
programs, Pregnant women’s health Seminars and Safe Men’s Forum (where husbands
and other men are educated on the childbirth process and the need for skilled
care)
We also train women to recognize danger signs so they will know at what
point they should be sure to seek out emergency care in a hospital.
Our antenatal clinic team identify women likely to need emergency care
§ Previous C/S
§ Bad obstetric history (women with
previous pregnancy wastages)
§ Fetal macrosomia (big baby)
§ Fetal mal-presentation (baby not
staying well)
§ Short women
§ Pre-eclampsia (pregnancy-induced
hypertension)
§ Several previous births
§ Diabetic women
§ Previous difficult birth
§ Low-lying placenta
We provide
training for TBAs and other untrained birth attendants for them to recognize
potential complications and how to respond appropriately to such complications.
We encourage them to forge a working relationship with obstetricians
(specialist in child delivery matters) who should handle any of their clients
who will develop complications
We organize
health worker’s seminars for them.
We provide
spiritual cover for pregnant women through the intercessory prayer activities
of the Power House of the Safe
Motherhood Empowerment and Enlightenment initiative.
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