Why traditional birth attendants need training


It was Priscilla’s fifth pregnancy, she was not new to the journey and so was not expecting any surprise being that she did not experience any hitches in her previous pregnancies.
But like they say, every journey has its own risks; her assumptions soon faded into fears, the pregnancy appeared different. Unlike the former pregnancies, trouble started from the first trimester, unprecedented pains preceded the 2nd trimester.

To be on the safe side, Priscilla paid several visits to the local birth attendant she had registered with, who fortunately was also responsible for her other deliveries. On each of her visits, she was given some herbs and assured of mother and child’s safety.
But rather than relieve, the pains continued and they kept managing it till the time of delivery. But unfortunately, more complications surfaced at the time of labour and rather than timely referral, she was left to labour for more than two days. Eventually, the baby was forced out, but died after some time.

Ada’s case was a bit different. She had had two girls through Caesarean Section (CS) and was expecting her third child. Ultra Scan result showed it was a boy and the couple could not hold their joy as her doctor had advised they quit after the third pregnancy.The scan also showed the baby was in a breach position,  Ada and her husband were, however, not moved knowing that both mother and child would be safe by a caesarean procedure.
Confusion, however, set in when her mother-in-law got the hint that it was going to be a third CS. She accused Ada of being responsible for her son’s recent financial problems. It got so serious that both in-laws got involved.

At the end, it was resolved that Ada abandoned her doctor whom they claimed was extorting the family and registered with an Ijaw local birth attendant whom they claimed had the technique of turning breach babies aright and have the woman give birth the natural way. She was given different concoctions and herbs, there were also times when physical exercises intended to turn the baby were performed on her protruding stomach. The process usually left her with severe pains but she endured, hoping that it would soon be over.

Finally, the delivery date came. Ada, the only daughter among three siblings, was accompanied to the Ijaw woman by her mother. The labour lasted two and half days, the Ijaw woman tried all her techniques but to no avail. The mother and child became weak but no referral was done. The rest is now history. The baby was forced out but could not cry, they beat him severally but no sound. The mother was also losing her breathe. Both mother and child died before an ambulance arrived.

The stories of Priscilla and Ada and their babies are just a tip of the iceberg when it comes to how many women and children lose their lives on daily basis to preventable causes especially in developing countries.

According to reports, neonatal mortality has been a significant public health problem and accounts for 60 per cent of newborn deaths before their first birthday. Estimates show that of the world’s 7.7million deaths in those younger than 5 years, 3.1million occur after birth through to one month of life and nearly 99 per cent of these deaths occur in low and middle-income countries, mostly, in sub-Saharan Africa.

Most pathetic is that majority of these death have been reported to have been caused by preventable or treatable causes, such as asphyxia and infections. Studies on neonatal mortality in Nigeria indicate that low birth weight, lack of antenatal care, maternal illness, premature and birth asphyxia are linked with neonatal mortality.

Asphyxia simply means lack of oxygen while Birth Asphyxia occurs when a baby’s brain and other organs do not get enough oxygen before, during or right after birth. Some causes of birth asphyxia may include too little oxygen in the mother’s blood before or during birth, problem with placenta separating from uterus too soon, very long or difficult delivery, serious infection in the mother or baby or problem with the umbilical cord during delivery.

Statistics show that Nigeria has the third highest infant mortality rate in the world; some school of thought believe that this may not be unconnected with more than 60 per cent of women giving birth outside a hospital. The best way to reduce this menace would have been to ensure that every birth is taken by a doctor or skilled attendant but how possible would this be in a developing country like Nigeria where many rural communities lack a functioning clinic or where most women prefer the services of the traditional birth attendants (TBAs).

One could argue that low cost of delivery with local birth attendant pushes most women out of hospitals, however, researches show that most women prefer these attendants because of  alleged mistreatment they get from hospitals, especially government hospitals. Going by these finding, one could deduce that it might be pretty difficult to separate the bond between these groups.

To bridge this gap, 4breath4life, a US- based charity humanitarian venture, with initial focus on the unbelievably high infant mortality rate in Nigeria, recently stormed Lagos on a health mission with a team of doctors from Canada and United Kingdom to train health workers on safe delivery and basic neonatal resuscitation skills.

Executive Director of the organisation, Dr. Richard Olumide Oyefeso, a United States(US)- based paediatrician in a chat with our Health and Wellbeing decried the alarming rate of neonatal deaths due to preventable causes, stressing that improving the skills of birth attendants would  have a direct impact on infant mortality in the country.

According to him, “statistics show that more than 700 babies die in Nigeria every day, of which many of these deaths can be prevented with a large percentage happening because of birth asphyxia. Unfortunately, this is the third highest infant mortality rate in the world and the only countries ahead are India and china but we understand that these countries have excess population of over a billion people while Nigerian population is an average of 180million people. So there is no reason why we should have such a high infant mortality rate.

“It is clear that the level of skill of our birth attendants needs to be improved, more than 60 per cent of Nigerian women deliver outside the hospital, and there is no health insurance available. Many of the health care providers that care for them meet a basic need but clearly, their capacity and skill level have to be improved.
“So, one goal of our organisation is focused on human capacity development, we know that certainly, by improving the skill level of the providers, there will be a direct impact and infant mortality will reduce.

On why the focus was on care givers, Oyefeso said, “we have embraced a programme called “Helping babies breathe.” It is a programme developed by a collaboration between the American Academy of Paediatrics, WHO, and a host of other bodies. They came together and developed this programme that trains health care providers in basic neonatal resuscitation skills.

The US-based paediatrician said, “through this programme, we teach them on steps to take if a baby is not breathing, safe practices on new born care, appropriate strategies for referral as well as identifying red flags for timely health intervention.”
He noted that, they have seen a significant value in this programme. “It is simple, measurable and achievable and the uptake among the providers has been quite encouraging.” Though frustrated by the attitude of the government, inspite of that, Oyefeso said, “we feel it is our responsibility and the responsibility of other Nigerians to do their part.”
4breath4life, though the initiator relied on other local partnership to carry out the mission and partnering with them this time was Sheba Centre which provided the venue and other logistics.

Mrs. Lara Adelusi, MD/CEO, Sheba Centre, a former course mate of. Oyefeso said she has always been into humanitarian works and when she had the opportunity to be a part of this health mission, she grabbed it, stressing that her life is all about impacting.
Oyefeso on his part said the training programme has been on-going for years and so far, his organisation has trained over 600 providers and is hoping to train more as they get more resources, access, cooperation and collaboration.



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