Delivery – Women Opt for Home, Not Clinic

REMEMBERING the experience she went through last year when giving birth to her set of triplets at Bugarama Dispensary in Kahama District in Shinyanga Region, Ms Elizabeth Yohana (30) swore she would never return to the clinic, let alone face the wretched attendants.

With tears running down her cheeks, she narrated a harrowing experience: “The delivery was complicated as the babies did not come in the normal way. The doctor was not there at that moment. No one knew where he was, because I heard a nurse calling him on the phone many times.”

This was her fourth delivery. There had been no problem with the previous three. Elizabeth went to the dispensary early one morning after she had gone into labour.

The nurse on duty was around. By the time the doctor came, the babies were already dead. Angelina Paschal (23) has a different story. She, too had been in labour and went to the dispensary only to be assisted by a fellow patient in the ward.

Ms Paschal, a food vendor at Nyangalata mining area, Bugarama earlier lived in Geita. She also said the bad experience at Bugarama Dispensary made her opt to deliver at home.

“I was assisted by my grandmother during the second delivery and my husband was there when I was giving birth to my third baby,” she explained. Narrating her experience at the dispensary she said: “After one hour of labour pain, some of the patients who were in the ward offered a hand.

A good number of them had no experience but tried all the same to assist and handed a health baby to me. When you are in labour but there is no one to assist, it can be very disappointing,” she stressed.

Proper medical attention and hygiene during delivery can reduce the risk of complications and infections that can cause death or serious illness to mother and the newborn.

According to the 2010 Tanzania Demographic Health Survey (TDHS), 51 per cent of pregnant women deliver through a health professional and almost the same proportion are delivered in a health facility, a slight increase compared to 2004/2005, that is, 46 per cent delivered by a health professional and 47 per cent delivered in a health facility.

Interestingly enough, some of the women do not want to go to the hospital for delivery for fear of losing their siblings through theft that is still dogging the health facilities. Ms Pili Emmanuel (30) who also resides from Bugarama village is among women who fears to deliver at the health facility, claiming that she heard rumours that unfaithful attendants steal babies.

“These nurses of ours are thieves, they steal our children and claim that the babies died from some reason or another. I have not witnessed but my neighbour claimed that her baby was stolen in the hospital and it was said that ‘it died after birth,” she said. Ms Emmanuel has four children with the same partner; she attends the clinic sessions without fail but delivers at home.

For all her four children, she had never delivered at the health facility. Again the TDHS of 2010 shows that almost 96 per cent of pregnant women were reported to attend antenatal clinic and they met a health profesEsional at least once.

The Shinyanga Regional Hospital data shows that in 2011 the number of clinic attendance differs from the birth at the health facility. Ms Halima Hamis, the Assistant Nursing Officer in the hospital said that the clinic attendants were 182,994 and the deliveries were 76,376 which is equal to 40 per cent.

She said attending antenatal clinic (ANC) is important for injections like tetanus toxoid that is given during pregnancy or at other times in a woman’s life to prevent neonatal tetanus, also vitamin A supplementation improves maternal vitamin A status and breast milk vitamin A concentrations, which is beneficial to both mother and new born baby.

Ms Emmanuel said for the first birth she was helped by her mother, then, she started doing it herself with little help from her husband. However, in the region there is shortage of more than 70 per cent professional medical attendants.

Mr Fabian Kalabwe, Regional Hospital Nursing Officer said that a single staff should assist six to eight people per day but the situation is different. “We have shortage of medical attendants which has led to poor service including people being attended by non-professionals,” he said.

Trained birth attendants are important for preventing both maternal and newborn deaths. West Java is one of the provinces on Java Island, Indonesia, where many women still deliver at home and without the assistance of trained birth attendants.

A recent review of 2010 reported that around 20 to 30% of neonatal mortality could be reduced by implementing skilled birth care services. The number of medical attendants depends on the level of the health facility and Bugarama dispensary lacks an assistant doctor, a laboratory person and health officer. The dispensary has seven attendants and two security guards while it serves a population of 45,152 people.

The shortage of servants has created another story from Ms Rahel Justine (27), in the village who also has been delivering babies at home. She said that she once found only two attendants which made her to wait for the service the whole day. Nevertheless, in Bugarama area there is a well known traditional midwives who assist pregnant women to deliver at home, her name is Ms Habiba Sitta (80).

She resides at Buyangu village; she has been attending the pregnant women for more than ten years and has managed to help 260 live births. She started to keep records of newborn, premature, deaths of the newborn and mothers. The record shows that from 2005 to October, last year she has attended 282 pregnant women. Among them live infants were 270 and 9 deaths, premature were 10. While out of 282, three mothers died in her hands.

Ms Sitta said that many deaths are of the premature stage and she uses local technique to save their lives. She said: “What I do to save their lives is boiling the cooking oil and apply it on the body of the infant and then cover it with blankets for the whole remaining days till it reaches the nine month.”

Ms Sitta has a small room in which she uses as the maternity ward in case a pregnant woman was brought there, but many deliveries are done at their homes. Over the past decade, traditional birth attendants in many nations have been trained in midwifery and basic hygiene as part of a safe motherhood initiative aimed at reducing maternal mortality.

Because these traditional birth attendants speak the local languages, allow traditional birthing practices and often have the trust and respect of the community. In the process of providing skilled medical attendants for all deliveries in poor communities, the developing countries look at an intermediate solution to identify, support and train birth attendants who are already practising in local communities. Retention of birth attendants is high because they share cultural and health beliefs with the women and have strong ties with the community.

The Ministry of Health and Social Welfare provide awareness to TBA on the effects of attending the pregnant woman informally. The spokesperson of the Ministry, Mr Nsachris Mwamaja said that they no longer encourage people to go for traditional midwives attendants and therefore they have a policy of every village to have a dispensary depending on the number of people in the area.

“We were helping them with training before but recently we no longer do that, we encourage the mothers to give birth at the health facility and not to the traditional midwives,” he said.

However, Dr Moke Magoma, the Evidence for Action Advisor said that poor knowledge of the pregnant women on the importance of delivering at the health facilities has made them to see that delivering at the traditional midwives is much safe. He said that there is a need for the government to look for the second eye, to view the health facilities and add more experts and enough medical facilities to tackle the problem.

Just three years has remained into attaining the Millennium Development Goal (MDG) number 4 and 5 to reduce under-five and maternal mortality rates. In the country maternal deaths are high whereby according to World Health Organisation (WHO) records, one woman dies every day during delivery.

At the same time an estimated of 250,000 newborn die annually in Tanzania, the neonatal mortality rate is 48 per 1000 live births as the aim is to decrease by 15 per 1000 live births and Maternal Mortality from 800 to 250 per 100,000 live births by 2015.

The report says that the success is particularly notable in light of much slower progress in the 1990s, where in some cases, mortality rates rose due to conflict and instability and high HIV prevalence rates.

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