Nigeria: Making Childbirth Less Arduous for Pregnant Women

13 January 2021

Rebecca Ejifoma, who visited the Iyana-Era in Ojo area of Lagos State, reports that the goal of healthcare workers, especially those in involved in the process of childbirth in Primary Health Centres, should be to make the journey less arduous for pregnant women, which in the long run reduces maternal mortality.

For pregnant women in Iyana-Era, Ojo area of Lagos State, they clamour for better health care services from the Primary Health Centres (PHC) in their community. Given the choice, these women would gladly grasp PHCs in the community if it would employ educative, entertaining, and more professional services to save mother and child.

According to them, one of the ways to achieve this is during the process antenatal care (ANC) by engaging pregnant women in some dancing, safe exercises, educative information on maternal and child health, interactive sessions with doctors, and professional services from health workers.

Without these activities, a handful of women have said, pregnancy would be boring and stressful. Corroborating, Rose Ogbu who resides in Era, a rural community in Ojo Local Government Area (LGAs) near the Badagry axis of state, said this was one of the several worries that need dire attention.

Ogbu had gone for ANC but left "after pregnant women like me were stranded for hours that Tuesday. There was no activity, information or enlightenment on what to do and not to do".

Interestingly, for this first-time pregnant woman, two things snatched her attention from Era PHC she had long dreamed of visiting after two years of childlessness - it was the lack of education and entertainment associated with pregnancy.

Just like the other pregnant women she met at the PHC, their taste bud called for some dancing, safe exercises, educative information on maternal and child health, interactive sessions with doctors, and professional services from health workers during ANC, but they didn't get that.

According to the World Health Organisation (WHO), ANC is an important aspect of maternal health as it covers a wide range of activities with huge potential benefits for positive pregnancy outcomes. The organisation further recommends that every pregnant woman visits a health centre for ANC at least four times.

It was to relish those benefits she could not find in the PHC that Ogbu went to a private clinic, Ilogbo Central Hospital, still in Ojo. "Although I had my child through C-section, which almost claimed my life, I'm happy my baby and I are fine", she added.

Maternal Death

Sadly, maternal death has remained one lingering issue that Lagos State and the nation at large are yet to defeat. Annually, pregnant women die during childbirth in several rural and urban communities, thus contributing to the maternal death rate of the nation.

Every year, Nigeria loses 512 pregnant women out of every 100,000 of them during childbirth, an estimate by the Nigeria Demographic and Health Survey (NDHS) 2018. This is a significant decrease compared to 917 maternal deaths the previous year.

While Nigeria recorded such an alarming rate in 2017, Chad recorded 1,140 death of mothers during childbirth while Sierra Leone had 1,120 maternal deaths.

Although this statistic by the NDHS shows a decline in maternal deaths in Nigeria, for every 512 pregnant women lost during childbirth, about 512 husbands become widowers and possibly single fathers. This loss could have huge negative impact on the families, the communities, the states, and the economy.

Shoddy Experience at PHC

Indeed, since Ogbu did not want to be among the often-cited statistic, she stressed how she needed such information among others to keep her and her then unborn baby alive.

"When other pregnant women and I discussed earlier at the ANC, they said women used to come in a large number before, but many pulled out because of the attitude of the workers; lateness, dull moments and lack of activities to keep their sanity in check.

"Even my husband grew tired of waiting; he had to leave for work. What if I wanted to have my baby? Is that how I would have waited? When the matron finally came, She just touched my tummy when it was my turn; she told me to pay N2,500 for registration. I even paid N600 for drugs, and N2,500 for test".

According to the first-time expectant mother, after buying the drugs, she said the matron asked an unkempt boy to attend to her. He instructed me to come with my urine on every antenatal on Tuesdays. That discouraged me. The worst of it was when we opened the medicine. It was doused in mucous and powdery substance like it was stale. It was expired medicine," she exclaimed.

By the next Tuesday, Ogbu found herself at the Ilogbo Central Hospital where she began the process of registration from scratch. "I paid N1,000 for card, and N500 for every antenatal on Tuesdays."

At every ANC, the excited Rosy said over 20 pregnant women including her were given medicine and snacks; the nurses engaged them in dance exercise to massaging music, too. "I felt livelier. The doctors checked us well at every visit; they lectured and enlightened us about pregnancy, changes in the body, and danger signs. That lecture was the most important for me because I knew nothing about pregnancy. It helped me know the signs of labour when I was due that night."

Although she found a private centre about 20 minutes drive from home, she wouldn't mind it closer home. "If that PHC in my place will do all these activities, why not? It's five minutes' walk from my home."

While Ogbu sought enlightenment, and safe exercises, Mrs. Luciana C, another expectant mother sought for comfort and guidance. Although she already has three children, her third child is less than four months old.

"I don't use Era Health Centre to give birth. I use a nurse at house. I'm comfortable there. I only go to health centre to immunise my baby," says the nursing mum.

Indeed, for the two women, knowledge on their health and that of her unborn babit's, nutrition, and exercises are more crucial than buying baby items. While Ogbu went to another hospital, Luciana noted that she will simply keep patronising a nurse in her living room for comfort.

Role of Awareness

To curb the alarming rate of maternal deaths, this is where awareness comes to play during ANC. The standard should be educative talks and practicals for expectant mothers at each ANC, thereby making them better informed about their maternal choices.

According to a Reproductive Health Coordinator, who wouldn't authorise her name to be used, those ANC activities like exercises and talks are essential.

She listed the benefits to THISDAY. "It helps women know the danger signs in pregnancy; birth preparedness/complication readiness; exclusive breastfeeding; 10 steps to safe delivery and healthy baby and feeding; nutrition in pregnancy; and importance of family planning after delivery."

In her perspective, PHCs do general health talks, which is apt. "There are different topics every week they come. They are taught to eat right, sleep, rest, avoid alcohol and smoking, feed for your baby, the number of times to come for antenatal sessions, drugs they are supposed to take, and do's and don'ts."

Reacting to Ogbu's case of a PHC void of such activities, the expert described it as unheard of. "The only change we may have right now is because of COVID-19. We have altered our practices a bit. We don't want too many people in the health centres. As soon as you come in, you see the doctor; you leave."

Consequences of Inadequate Information at ANCs

It is gainsaying that there are consequences of zero information at ANCs. According to the Reproductive Health Coordinator, If expectant mothers do not get such educative teachings, it could affect them.

"You see danger signs - when they complain of dizziness, seeing blood, and headache, those are warning signs for eclampsia and pre-eclampsia, one of the major causes of maternal mortality", she said, stressing that expectant mothers should be made aware of such signs and more at ANCs.

Sadly, there are eight main factors contributing steadily to maternal deaths. Eclampsia, as the health coordinator said, is one of them. Therefore, to avoid such complications that could endanger mother and child, she recommended, "That is why you teach them these things to avoid complicated cases. Eat right, limit salt intake and watch your weight to avoid complications during delivery. We also check blood pressure".

UNICEF's Take

When THISDAY contacted the Health Specialist, United Nations Children's Fund (UNICEF) Lagos, Dr. Charles Nwosisi, he echoed the words of the female expert.

"I mean education of pregnant women or health education for any person that visits the health system including a pregnant woman is like the key part of the package of services provided.

"If we go back to primary health care where a lot of our PHCs are supposed to be practising health education of everybody that comes in to access any service, it is like a major part of what they should be doing."

Nwosisi also harped on the importance of health education for pregnant women and parents who go for other services like immunisation in the PHCs.

"The health education is usually focused on for instance in pregnant women; they could talk on things like nutrition; importance of having a balanced diet; what to eat."

For the health specialist, the PHCs should also be talking about exercising. "There are exercises pregnant women can do that are safe, and that will contribute to ensuring that the woman stays healthy during the course of her pregnancy."

According to Nwosisi, there is another bit of health education that also focuses on the important to-do things during pregnancy and even prior to delivery.

Such to-do things, he outlined, are: talks on, for instance, tetanus vaccination. "The only thing is some women don't get it before pregnancies; they only get it during or when they are pregnant". For Nwosisi, it is very important to protect the woman and the child from tetanus infection, too.

While noting that there is education on how to prepare for the delivery - in terms of things you could buy to ensure you are prepared to receive a baby - the expert mentioned that guidance and talk among others go a long way to contribute to a good outcome for both mother and baby.

Another suggestion the UNICEF specialist listed is accessing quality health services, which goes a long way.

"Quality of service in terms of the way the patient is managed based on the proven scientific way that such a pregnant woman should be cared for, so for instance WHO recommends eight visits for a pregnant woman and each visit certain things should be done."

Giving the consequences of zero information and safe physical exercises, Nwosisi cited that knowledge is power. The specialist noted that when individuals have the right knowledge they are equipped to make the right decision.

"So for instance for a first time pregnant woman if she hasn't been properly educated on contractions, and she continues to have contractions and she stays at home, you know it is a poor decision she has made and also based on poor knowledge that she has," Nwosisi emphasised.

He, however, reemphasised that quality services are important for a woman to have an enjoyable experience accessing ANC and delivery.

From the reactions of the medical experts, it is obvious that educative activities and safe exercises are apt for improved health of mother and child to aid safe delivery.

Therefore, if the government will ensure that PHCs across Lagos State uphold these activities for pregnant women and equip them with the right information, then pregnant women like Ogbu and Luciana will return to these centres and in the long run reduce avoidable maternal and child death to achieve Sustainable Development Goal 3.

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