Monday, May 4, 2009
Maternal Health Protection
Maternal Care In Emergencies
By James Achanyi-Fontem
Pregnancy-related problems that women face are many, and, in most cases, unpredictable. Some of them lead to death or permanent injury. Social, political or economic factors should not be allowed to deny a woman her fundamental right for a healthy pregnancy and childbirth. Reducing maternal deaths is therefore a matter of rights and an urgent priority. That is why every family needs to be encouraged to make savings in advance preparation for emergencies. Fortunately, modern medicine has the capacity to handle most of the problems in health facilities.
Both mother and baby stand to benefit from treatment at a health facility. Some treatments at the prenatal stage have the benefit of preventing children from being born with complications and defects. In the home delivery story presented here, the placenta retention could have resulted in death.
Zinkeng got married and soon became pregnant, but did not go for pre-natal consultations in a health facility as one would expect and at the ninth month labour started at home. She was delivered by a traditional birth attendant successfully to a baby boy but the placenta did not come out thereby causing bleeding profusely. The Traditional Birth Attendant (TBA), accuses Zinkeng of infidelity, believing that this is the reason the clan gods and ancestors are bringing punishment on her by causing the placenta to be retained. This belief is common in most Cameroon rural traditional communities. Fears of infidelity are usually confirmed by divination. When the placenta is retained, there is no other verdict but guilt.
During a routine visit, a community health nurse comes across Zinkeng and her intervention saves her life. Subsequently, the nurse advises the traditional birth attendant and Zinkeng’s mother on the importance of antenatal and postnatal care, insisting that even though they risked denying Zinkeng the essential prenatal care, she must receive postnatal care.
During labour, Zinkeng cried out her sufferings and asked that she should be taken to the hospital, but the mother-in-law told her that it was no hospital matter. She asked her to confess her unfaithfulness to her son, and the placenta will come out. In her words, “You certainly know that our gods hate infidelity on the part of a woman.”
Sounding angry, feeble, and sobbing, Zinkeng replied that “I have not been unfaithful to your son. Which man in this community have you ever seen me with? I’m not a rotten woman. Please, stop ruining my good name and take me to hospital before I bleed to death.” By the tradition of some of these less educated parents, there is not justification but the fact that retaining the placenta clearly confirms her unfaithfulness.
The nurse had asked the expectant mother, Zinkeng, be taken to the hospital immediately there are any signs of labour, but the mother-in-law, who is a TBA would not heed to the advice, because according to her, she is a qualified TBA. But the nurse asked her to say, what was needed now that the baby is born, but the placenta was retained.
The TBA did not know what to say. And the nurse added that this is where there is a difference. The problem has nothing to do with infidelity. The nurse decides to help Zinkeng suckle her baby but the TBA refused, protesting vehemently, “No, no, no! We can’t suckle the baby boy on the first milk (colostrums). It’s bitter milk and the colour is not good.”
The TBA added that it had to be expressed and thrown away to allow fresh, clean milk to form, which is the good for sucking milk. Apart from that, both mother and baby should be bathe first, she went on.
The nurse realising how ignorant the TBA was, started explaining that the first milk that mothers in the village term bitter milk is the best for the baby. It is God’s own immunization against diseases. She invited the TBA and other relative present to just watch her!
As the TBA continued her vehement protest, the nurse told her of the Chinese proverb, that “One who says that a thing cannot be done should not interrupt the one doing it. You see how vigorously the baby is sucking? Now, hold the placenta and pull it gently and let’s see what happens.”
As the placenta came out, the TBA was surprised and a reluctantly said, Hmmm … With a sigh of relief, Zinkeng said, “Thanks, nurse!” Where diviners were ruining my life, reputation and marriage, you came to mend my soul and preserve my chastity.
The nurse on her part said, “Let all thanks go to God.” Zinkeng reported later that she was feeling dizzy and the nurse told her that with so much loss of blood, it was natural to feel dizzy. She was told to drink a lot of fluids and that a meat-based broth would be good, because she also needed iron.
Zinkeng was immediately taken to a health facility and was told not to get out bed until she felt better. Those who went visiting move away to talk about other matters and to give the new mother time to rest, as they arranged for transportation to the health facility.
What really happened?
When the nipple is stimulated through the sucking, it produces a substance in the body, a hormone called oxytocin. This hormone causes the muscles of the woman's uterus – the bag where the baby was growing – to tighten and contract. When the uterus tightens like this, it helps the placenta to separate from the uterus so that it can come out as it should.
The mother of the Zinkeng did not take the daughter to the hospital as advised because the labour took them by surprise. If she had been attending a health facility regularly, healthcare providers would have been able to figure out her due date, an estimate of the day her baby would be born. Most babies are born within two weeks before or after their due date. The labour wouldn’t have taken them by surprise.
The partner needed to put aside some fund for pre-natal, post-natal and emergencies. He did not secure any funds for the above. The role of TBAs is very important within the communities, but some of the complications of pregnancy and childbirth cannot be handled by Traditional Birth Attendants! Only health facilities have the necessary tools to handle most complicated situations.
Here’s what happens with prenatal visits. At a woman’s first prenatal care visit, healthcare providers counsel her on the importance of proper nutrition, diet, and exercise. They ask the woman about her health and her partner’s health; they identify any medical problems; they weigh her and check her blood pressure, and they check a urine sample for infection. The Traditional Birth Attendant cannot take these precautions.
Postnatal care is equally important in ensuring good health for mother and child. In the first few days after delivery, when her breasts begin to produce milk, she can have engorged or swollen breasts if care is not taken. She’ll also need to know how to prevent cracked nipples. There is a lot to know about. Simply let the mother access the nearest health facility.
Later Prenatal Visits
In later prenatal visits, the health providers measure the woman’s belly to see how the baby is growing; they check her hands, feet and face for swelling; they listen to the baby’s heartbeat; later on, they feel her abdomen to assess the baby’s position. They also ask the woman if she has any other personal concerns bothering her.
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