A woman dying during childbirth is devastating for her family. Within the scope of the Sustainable Development Goals, it aims to reduce the global maternal mortality rate to below 70 per 100,000 births. And in line with these goals, it is aimed that the maternal mortality rate in any country will be more than twice the global average. In settings where health systems are weak and service delivery is insufficient, more and more women continue to use midwives who are traditional obstetricians during childbirth.
Traditional obstetricians (midwives) are unskilled, unable to prevent or treat complications that lead to maternal deaths during pregnancy or childbirth. Every effort should be made to prevent maternal deaths. It uses the methodology of qualitative research and discusses the challenges of preventing maternal deaths in an environment where women routinely use traditional obstetricians. And people are still studying the reasons for the persistence of traditional birth attendants in some countries. In fact, the solution to the impasse on this issue is essential.
Maternal health refers to the health of women during pregnancy, childbirth and postpartum. While motherhood is often a positive and rewarding experience, for most women it is associated with pain, illness, and even death. Maternal death is the death of a woman during pregnancy and within 42 days after birth, regardless of the gestational age and place of gestation. The maternal mortality rate is the number of maternal deaths per 100,000 live births, while the maternal mortality rate is the number of maternal deaths per 100,000 women of reproductive age. Maternal mortality is a key performance indicator for mothers’ efforts to improve health and safety before, during and after birth in every country around the world. 94% of all maternal deaths occur in developing countries.
With a population of approximately 200 million, Nigeria is the most populous country in Africa. Nigeria is also the country with approximately 20% of all global maternal deaths. It is estimated that more than 600,000 maternal deaths occurred in Nigeria between 2005 and 2015. Reducing maternal mortality in Nigeria must be tackled to achieve maternal mortality reductions worldwide.
Sustainable development goals (SDGs), which aim to transform the world through the 2030 sustainable development agenda, are an intergovernmental goal of 17 aspirations with 169 goals. In 2015, the United Nations committed to accelerate progress in reducing neonatal, infant and maternal mortality by ending all such preventable deaths by 2030. This commitment aims to ensure universal access to sexual and reproductive health services, including family planning, and education.
By 2030, the UN SDG goal is to reduce the global maternal mortality rate to less than 70 per 100,000 live births. This is largely impossible in the face of poor health systems operating in developing countries. In countries with weak health systems, urgent steps must be taken to achieve the goals. A health system, sometimes referred to as a health system, is the organization of people, institutions and resources that provide health services to meet the health needs of target populations.
A good healthcare system provides quality services to all people when and where they need it. The exact configuration of services often varies from country to country, but requires a solid funding mechanism in any case; a well-educated and adequately paid workforce; reliable information on which decisions and policies will be based; Well maintained facilities and logistics to deliver quality medicines and technologies. A well-functioning health system responds to the needs and expectations of a population in a balanced way: improving the health status of individuals, families and communities, and so on. as.
The health workforce is central to achieving health. A well-performing workforce is a skilled workforce that responds to people’s needs and expectations and is fair and efficient to achieve the best possible results given the available resources and conditions. Countries are at different stages of development of the healthcare workforce, but common concerns are improving recruitment, training, education and distribution; To increase productivity and performance and to increase retention rate.
This requires regulations to achieve the right mix (numbers, diversity and competencies) in sufficient numbers, payment systems that generate the right type of incentives, regulatory mechanisms to ensure system-wide distribution and distribution in line with needs, and business-related norms. Regarding childbirth, skilled birth attendant is the focus of human resources to prevent maternal deaths. A qualified obstetrician is a midwife, physician, obstetrician, nurse or other healthcare professional who provides basic and emergency health services to women and their newborns during pregnancy, childbirth and postpartum.
The World Health Organization (WHO) recommends women’s easy access to evidence-based maternal and perinatal care provided by a skilled obstetrician, as an essential intervention for improving maternal and perinatal outcomes in low-income countries. Consultation on improving the quality of maternal, newborn and child care in healthcare facilities. Standards must be established to improve the quality of maternal and newborn care in healthcare facilities.
The best markers of maternal and perinatal health and well-being are seen in countries with the highest skilled maternal health participation rates, even after controlling for other extra developmental parameters. Nigeria currently has the second highest number of maternal and perinatal deaths in the world. Insufficient access to maternal and perinatal health services is the most important factor that puts women at increased risk for adverse maternal and perinatal outcomes.
• Women die during pregnancy and delivery without qualified maternal care. Evidence shows that unskilled delivery dramatically increases the risk of maternal and perinatal death. These are hypertension, obstructed labor, unsafe abortion, and puerperal infection. Known interventions to prevent these direct causes of maternal deaths include the following interventions. These;
Family planning to prevent unwanted and unwanted pregnancies,
Identifying antenatal care and pregnancy complications to encourage early screening
• Managing appropriately to prevent morbidity and mortality,
Preventing eclampsia, uterine rupture, obstructed labor, retained placenta, abruptio placenta, antepartum hemorrhage, postpartum hemorrhage, abnormal bleeding at birth, fetal distress during delivery by using emergency obstetric care effectively.
Application of medications and treatment regimens (to effectively manage potential birth complications) to reduce deaths from obstetric complications, such as the skilled obstetrician (SBA) at birth
Postnatal care (infant feeding practices and newborn baby health to support the mother’s recovery). Despite these known interventions to prevent maternal deaths, it is worrisome that women continue to use traditional birth attendants who cannot provide these interventions. Accordingly, SBA’s basic knowledge of aseptic technique, manual and pharmacological uterotonics, basic antibiotics, and magnesium sulfate, this lack of intrapartum care results in preventable maternal mortality.
Care During Birth
Nigeria currently has the second highest absolute number of maternal and perinatal deaths in the world. Often times, it is women who died during pregnancy or had perinatal deaths, women who did not receive antenatal care, women who gave birth with an unskilled obstetrician during childbirth, or women who gave birth alone at home. Evidence shows that unskilled birth dramatically increases the risk of maternal death. National data from the Population Health Survey show that only about 65% of Nigerian women receive antenatal care during pregnancy, and less than 33% attend skilled birth attendants (SBAs) at birth.
The World Health Organization defines the traditional obstetrician (TBA) as: “ the person who assists a pregnant woman in childbirth (usually a woman), and Predictions who have initially acquired the skills to give birth or work with other TBAs, i.e. shows that 60% to 90% of births in their region are supported by TBAs, and that in countries such as Chad, Niger and Nigeria reach an extremely high proportion of TBA-attended births.
In cases where the number of qualified birth attendants is insufficient to meet the needs of the community, calls have been made to empower PCAs with their health knowledge and skills to enable them to improve their practice and prevent maternal mortality. Prevention of maternal deaths is provided by providing necessary and emergency health services during pregnancy, childbirth and postnatal period.
Qualitative research uses different methodologies and discusses the challenges of preventing maternal deaths in an environment where women routinely use traditional obstetricians. In this way, the reasons for the persistence of traditional birth attendants are examined.
Study Population and Methods
Researchers from the Nigerian Rivers State Branch Medical Women Association conducted a study that screened 20,000 pregnant women for hyperglycemia in pregnancy, as part of efforts to improve outcomes of gestational diabetes mellitus. The study was conducted in 42 communities in five local government districts (LGAs) in Rivers State. Rivers State is one of the 36 states of Nigeria located in the oil-rich region of the country known as the Niger Delta.
The LGAs included in the study were Ahoada East LGA, Khana LGA, Obio-Akpor LGA, Okrika LGA, and Port Harcourt City LGA. Social mobilization officers from various LGAs, Local Government Office (LACA) officers for the control of HIV and AIDs, Women Leaders and Health Care Workers helped acquire TBAs.
In one study, ethical approval was obtained from the University of Port Harcourt University Research Ethics Committee. Informed consent was obtained from the Ministry of Health, Primary health services board, the heads of the selected Local Authority regions, the health counseling consultants of the relevant YGAs and the health officials of the various LGAs and the women before starting the interactions.
In-depth interviews and 10 group discussions were held at five YGAs; one for pregnant women and one for each TBA. Pregnant women range in age from 25 to 42 (median = 31 years), while TBAs range from 34 to 67 years (median = 44 years). While the majority of pregnant women received secondary education, TECs did not have formal training. Pregnant women patronized TBAs because they were close, cheaper and allowed to pay in installments.
About a third of TBAs claimed that the creator showed them that they had to give birth in a dream. One fourth said that they aspired to be a nurse, but could not afford formal training as a nurse, so they chose to be TBA and they already learned TBAs without practicing TBAs. Another quarter said they were trained as assistant nurses, but it was decided to establish a TBA practice. The rest are cleaners in maternity units, retired healthcare workers or family members of developing TBA practices.
Most TBAs gave births in their bedrooms. They did not have separate facilities, some TBAs had a separate room to give birth, and a few had facilities such as two-bedroom apartments. TBAs said they sang and danced, made pepper soup, and were paid in installments in order to maximize the patronage of those who gave birth. The TBA stated that they wanted the government to employ them as healthcare providers.
Author: Ozlem Guvenc Agaoglu