THE HIGHEST RISK TO SAFE DELIVERY IS DELIVERY BY UNSKILLED BIRTH ATTENDANTS

·       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.