Making Child birth safer

Making Child Birth Safer in Nigeria
By
DR Abdullahi Dahiru
Kano
maikanodahiru@yahoo.com
The desire to procreate and reproduce offspring is common to all human societies. In an attempt to fulfill this noble desire, many women lose their lives during childbirth especially in developing countries where medical care is still inadequate.
Maternal mortality ratio is highest in the African region, estimated at an average of 1,000 deaths per 100,000 live births. In Nigeria it is estimated at 1000 per 100,000 live births with wide regional disparities. With our current maternal mortality ratio, these women are subjected to a life time risk of dying from pregnancy related complications of 1in 8 compared to 1in 10,000 in developed countries.
For every woman who dies, other women suffer injury, infection or disease. Pregnancy related complications are among the leading causes of death and disability among women in Nigeria.
When a mother dies, children lose their primary care giver, communities are denied her paid and unpaid labour, and countries forego her contributions to economic and social development. A woman’s death is more than a personal tragedy-it represents an enormous cost to her nation, her community and her family. Any social and economic investment that has been made in her life is lost. Her family loses her love, her nurturing and her productivity inside and outside the home.
One of the common causes is Obstetric haemorrhage [or bleeding]. Bleeding can occur before the birth of the baby due to placental abruption or abnormally situated placenta on the lower uterine segment. Massive bleeding can also occur from the genital tract after the birth of the child from uterine atony or abnormally adherent placenta.
Hypertensive disease of pregnancy and eclampsia is another leading cause of maternal death. Pregnancy induced hypertension is more common during first pregnancy. It is also associated with multiple pregnancy and molar gestation. If pregnancy induced hypertension is not detected early and managed appropriately the woman can develop eclampsia. Eclampsia is one of the most serious complications of pregnancy and can occur before, during or shortly after delivery. It is characterized by the occurrence of major epileptiform convulsions. The mortality varies with the number of fits, the quality of treatment and the speed with which treatment is made available.
Another leading cause of maternal mortality is obstructed labour. It is a dangerous condition if left untreated and can be fatal to both mother and fetus. It can be caused by several factors which include contraction or deformity of the maternal pelvis, large baby, abnormal positions or presentation of the baby during labour like breech presentation, locked twins; congenital abnormalities of the fetus like conjoined twins and hydrocephalus.
Unsafe abortion is another cause of maternal mortality. An abortion is said to be unsafe when it arises from the deliberate termination of the pregnancy resulting in complications like sepsis and severe bleeding. Unskilled persons, in circumstances where the pregnancy is not wanted, often carry out the procedure usually in an unhygienic environment.
Malaria in pregnancy is associated with 10% of all maternal deaths and is a leading cause of morbidity in pregnant women. After delivery, genital tract infection can occur especially if the delivery is not conducted in hygienic environment as in the case of home delivery. Genital tract infection can cause sepsis and even death if left untreated.
Other causes of maternal death include ruptured ectopic gestation, pulmonary and amniotic fluid embolism
Research has shown that small and affordable measures can significantly reduce the health risks that women face when they become pregnant. Most maternal death can be prevented if women have access to appropriate health care during pregnancy, childbirth and immediately afterwards.
We should all realise that every pregnancy faces risk and the family of the pregnant woman and the health care providers must prepare against this risk. The family must save some money during pregnancy so that when complications arise, appropriate interventions like caesarean section can be done immediately without being delayed due to lack of funds.
The community should be educated about obstetric complications and when and where to seek for medical attention.
There should de stronger political commitment from governments at all levels towards reduction of maternal mortality. More health care facilities should be provided especially in the rural areas. The health care facilities should be able to have facilities of conducting deliveries and refer complicated cases to superior health facilities for prompt management. Blood banks should be provided in all maternity units so that blood will always be available for transfusion if the need arises. Relations of pregnant women must be willing to donate blood in case the need arises.
All health care facilities should ensure skilled attendant i.e. doctors and midwives at every birth. Doctors attending to pregnant women should be trained to be proficient in life saving procedures like caesarean section and manual vacuum aspiration. Continuous health education workshops should be organized routinely for doctors and midwives, so as to update both their knowledge and skills in management of pregnancy and labour related cases.
We should promote antenatal care attendance which aims to maintain woman in health of body and mind, to anticipate difficulties and complications of labour, to ensure the birth of a healthy child and to help the mother rear the child. Increasing access to family planning services and post abortal care should be provided in all maternity units.
Government, health care workers, non governmental and corporate organizations, community leaders and well meaning Nigerians must show more commitment towards reducing this high maternal mortality and hence we can make the process of child birth safer in Nigeria.