THE worshipping community of St. Lawrence Catholic Church along LASU Expressway, a suburb of Lagos State, was thrown into mourning recently when Bukola, a pregnant member of the church, suddenly passed away. She had gone to church and taken active part in the celebration a day before she passed away. Her pregnancy was said to be seven-month when she died.
The members of the church were dazed by the incident and kept wondering what could have led to her death. They kept asking one question after the other but got no response. Their expectation of seeing Bukola with her baby after putting to bed and dancing to the altar with her family to appreciate God for adding to their number was dashed. She died.
Loveth, a woman who had married for 10 years without any child, suffered a similar fate when she eventually got pregnant. When she became pregnant after several years of childlessness, the husband was highly elated and wasted no time in getting all the necessary things the hospital asked them to buy in preparation for the baby’s arrival. Towards the period of her delivery, their house wore a new look as they did not want the baby to come into the house the way it was. Because her stomach was extremely protruded, people in her neighbourhood had started calling her mother of twins.
Unlike Bukola, who did not get to the point of going into labour before she died, Loveth went into labour but did not come out alive, neither did her baby. The joy that came after 10 years of painstaking waiting ended up bringing calamity and trauma to the husband, who could not comprehend what went wrong. He asked the doctors series of questions but their answers were incapable of bringing the wife and baby back to life. The incident brought an end to the life of another woman in the course of giving birth.
Clement Ade saw the wife put to bed last month but shortly after the news of the birth reached him, the cold hands of death snatched the wife away. The baby survived but the mother ceased to exist from that moment.
Such worrisome stories are endless in the country. They are instances of maternal mortality cases which Dr. Rotimi Adesanya, a child and public health physician, described as alarming in the country. According to him, “We contribute 13 percent of the world’s maternal mortality rate. It is not just acceptable because we are just after India and Bangladesh. It is still very alarming and we are not yet there.”
Apparently scared by the incidents, checks showed that the number of pregnant women trooping to spiritual homes and traditional birth attendants has been on the rise.
Dr Bunmi Omosehindemi, Chairman, Lagos State Traditional Medicine Board explained the reason for this. He said: “Many people are opting for traditional birth attendants because it has to do with the culture of the people and also inadequate medical facilities we have in the nation. We have a poor human resource for health. In Nigeria, we have only 30 doctors to 100, 000 patients. We have about 100 nurses to about 100, 000 patients and about two lab scientists to 100, 000 patients. Based on these facts, people have to look for various ways of taking care of themselves.
“If you look at the records, only about 30 percent of women who attend ante natal go to hospital to give birth. It also has to do with the attitude of the health workers towards the patients. The factors responsible for this are so many. In some cases, it could be financial reasons, attitude problems and the belief systems of the people that are patronising the traditional birth attendants.
“A human being is a product of his experience, belief system and his religion. Based on these, the women believe that they get better attention from traditional birth attendants and one thing you should know is that traditional birth attendants are part of the people’s culture.”
A traditional birth attendant, who gave her name as Alhaja, opines that the reason is beyond that. She said: “Many pregnant women are now coming to us because they are convinced that doing things the natural way is better. During the days of our fathers, did we have these frightening stories of women dying when pregnant or giving birth? All these are happening because civilisation and foreign religions have rubbished the powers we inherited from our fathers.
“The moment a child is not coming out with his head, doctors will book you for operations immediately. This is what our fathers would only use herbs to reverse within a space of time. We do all these and save women from going through the knives. Some pregnancy challenges are better handled traditionally because there are words that we speak that alter some nasty problems. Doctors don’t believe in this. The moment the drugs cannot handle a situation, the next thing is operation. Many women are scared of this, so they prefer to come to us.
“We also don’t charge much. Our fees are inconsequential compared to what hospitals charge. We render humanitarian services.”
Abiola Alice, Executive Director of God’s Love Natural Health Clinic and Maternity Home, a faith-based centre, attributed the increasing patronage to the quality of attention they give to pregnant women, adding: “Many pregnant women that have come to me have always complained about the harsh treatment they get in public hospitals. Nurses in public hospitals don’t pamper them the way we do. Besides, there are some that have spiritual problems which could make it difficult for them to be delivered. We do organise prayers for them every Monday and in the course of doing that, some of them will begin to confess different things. Some will say that they will die if they are delivered of the baby in their womb. After praying, they always overcome the problem and end up giving birth successfully.”
Aside from prayers, she hinted that she has undergone series of training organised by Lagos State Traditional Medicine Board to enhance her skills in child delivery.
She said: “The training has really built my capacity in caring for pregnant women. Before now, when a baby is sitting down in the womb or coming with leg or hand, we would pray and God will take control. Now, we have a medicine called Adjust sold to us at the centre. When we use it for such women, the baby will turn and come the right way.
“If the baby does not adjust after using it, we would refer the patient. I have used it for four people and have never had any disappointment. We also have never recorded any death since we began operations. It is a call from God and we answered it.”
A pregnant woman, who patronises traditional birth homes, said: “I have had all my children in this place. I prefer traditional birth attendants because they use natural treatment. Here, you don’t have fears of undergoing operations because they have what it takes to correct situations that medical doctors would be quick to use operations to tackle. I don’t think anybody will go through operations and remain the same.
“We have heard cases of people that they forgot one instrument or the other in their stomach after operations and those that died after they were sedated before operations. I believe that herbs are better. I have the ones that I drink and have a liquid that I rub on my body. It works perfectly for me.”
Findings also revealed that many churches, especially the pentecostal ones, now organise special prayer sessions for pregnant women. The sessions observed were often attended by a large number of pregnant women with the ministers dishing out thunderous prayer points aimed at destroying all the forces that may be working against the safe delivery of the women.
One of the attendees told The Nation that she opted for spiritual help when her doctor repeatedly told her that she didn’t have enough fluid in her sack. She said: “Every time I went to the hospital, the doctor will ask me to do a scan. After doing the scan, he would check it and say that the fluid wasn’t enough. It was becoming very scary for me, especially when they asked me to go and register for operation.
“When I told my mother about it, she brought me here for prayers. I agreed because when doctors told my cousin she would not be able to give birth by herself, my mother brought her here and she was delivered safely. I refuse to be sacrificed on the altar of medical experiment.”
A cleric, who identified himself as Elijah, said such prayer sessions were important for the pregnant because “There are many evil forces that are out to terminate the life of either the woman or the child and at times, both of them. These are beyond what sciences or medicine can handle. The bible made us to understand that we wrestle not against flesh and blood but against principalities in high places. Medical practitioners cannot fight these forces using thermometer. They are battles that can only be fought spiritually.”
Causes of maternal mortality Medical doctors
Explaining the factors responsible for rising cases of maternal mortality, however, Dr Eze Godwin, a medical practitioner said: “When a pregnant woman dies much earlier than the time she is supposed to go into labour, like the case of Bukola, it is possible that such woman had an underlining ailment that led to her death after all, she was not in labour.
“In the advanced society, people will surely ask for a postmortem to know what actually happened. The death may be as a result of the pregnancy and it might not. There might be about 70 to 80 percent chances that the pregnancy might be the cause but the remaining 20 percent may not be. Some women become sick right from the time they become pregnant. That sickness does not leave them until they put to bed. Those kinds of people are supposed to be monitored. If they don’t follow that routine, they may die.
“Some people’s placenta will not come out after delivery. At times, when the placenta comes out, the uterus will fail to contract. If it doesn’t come out, the woman would bleed and once somebody is losing blood continuously and it gets to a point where she doesn’t have any again, the person may die.”
On his part, Dr Rotimi Adesanya, began by explaining what maternal mortality is. He said it is the number of female death per a thousand live birth in a country that arises from pregnancy-related condition in a year. That, he said, includes somebody that dies six weeks after putting to bed.
The Maternal Mortality Ratio (MMR) in the country, according to him, is presently 600 per 100, 000. “This means that out of every 100, 000 women that go into pregnancy, 600 will die. If you want to break it down, out of 1,000 pregnant women, six will die from child birth and it is that bad. In developed countries like UK and US, they have less than one person out of 1,000. Out of 100, 000 that we have 600 cases, they have just 10.”
He classified the causes into medical and non-medical, saying: “One of the non-medical causes (maternal mortality) is ignorance. A lot of our people are not educated. When you tell them that these are precautions you need to take, they will ignore you because a good number of them believe more in their culture and tradition that have been handed over to them. Some people believe till date that there are some health issues you don’t take to hospitals.
“The other thing is poverty. At times in public hospital, you will find a man and his wife coming to the hospital with just N100. In Nigeria of today, what can N100 do? When most of them have complications and are asked to do surgery, they cannot afford it. The least you can pay for surgery even in public hospital is N50, 000. An average man on the road, especially in the rural areas, don’t have N50, 000 to cough out for such.
“The cultural aspect, as I earlier stated, is also a serious factor. Some cultures don’t believe in going to hospital to seek medical help. I have a client, who told me that a mallam who works for him, took delivery of his six children because he forbids his wife going to hospital. He said the wife never went to the hospital each time she was pregnant. It is all borne out of the religious and cultural practices that forbid their wives to be seen by another man.”
He noted that people in rural areas are more involved in the problem of maternal mortality because they don’t have good roads, ambulance services and the required expertise there. “When they even get to these hospitals, the attitude of the health workers will discourage some of them and cause them to go elsewhere,” he stated.
The medical factors, according to him, what is called Pregnancy Induced Hypertension (PIH).
“Some women’s blood pressure used to go up when they are pregnant. This used to kill a lot of women. In short, there is what we call pre-eclampsia. Here, the BP will be high, you will see protein in their urine and the kidney is affected. After pre-eclamsia, you have what you call eclamsia. When this occurs, the woman will start convulsing because the BP is so high and has affected the brain, the liver and so many organs in the body. When such women are convulsing, a lot of them die and lose their baby.
“When a woman has eclamsia, a doctor will quickly bring the baby out even; if the baby is a day old, the doctor would have to bring him out once the mother has convulsed. If you have that in the rural areas, who will help them? Such women would just die like that. Another cause of maternal mortality is post partum haemoharrage. After delivery, some women would just be bleeding for just no reason. The doctor will try all his best and would still not be able to control the blood. Such women may be referred to a gynecologist.
“Some of such women’s womb may be totally or partially removed by a gynecologist. But most times, the whole womb will be removed. If this is not done, she may bleed to death. When this is done, such a woman may not give birth again.”
Infections, he added, also lead to maternal mortality. Malaria during pregnancy is part of this. Some women also break their water before delivery. When this happens, it is better for the woman to quickly go to hospital to be given antibiotics to prevent infections because the sac is what is covering the woman from infection. Once the water breaks, the place is open and anything can come in.
He expatiated: “Some people believe that when you go to hospital, they will tell you that they want to do surgery. We doctors are also part of the problem because if you have to do surgery in western world, a psychologist will have to counsel you for almost an hour to assure you that there is no problem. But here in Nigeria, especially in the public hospital, doctors don’t even have the time because of the number of patients they have. Once the women are rushed there, they will just say madam, you are doing surgery and it is an emergency.
“In that situation, the woman doesn’t even have the time to think. A lot of women run away from hospital because of this belief that if you go to the hospital, they will ‘cut you’ (do surgery). Many of them now resort to going to traditional birth attendants because of this.
“Some will tell you that people die in the hospital and would prefer to go to traditional birth attendants. Traditional birth attendants have a role to play and even some governments have absorbed them, but the truth is that in Nigeria, people go beyond their limit.”
‘Our worries about traditional birth attendants’
Though he appreciates the role of traditional birth attendants in the society, Dr. Adesanya has some reservations about their activities. “They are supposed to be handling people that have been having babies before. We call them low risk. But some of them still dabble into handling people that had CS before and people who want to give birth for the first time and that is always a difficult delivery. They are not supposed to go into all that but they still do.
“Now, thank God for scanning machine. Traditional birth attendants also accept scan but they don’t even have training in scanning. In medicine, if a woman giving birth for the first time has the baby coming out with the leg, she has to go through surgery because it would be very difficult and you may lose the baby or the baby may be deformed. But they still dabble into it. They will say they will turn it round and all that. Such things are not scientifically proven. Some practices like the use of incantation when delivering a woman of a baby is unscientific but they do it and our people still go there. Part of the drugs they give them are concoctions. It is unhygienic. Besides, they don’t do HIV test; they use the same instrument for patients.”
However, Dr Omosehindemi frowned at any attempt to describe activities of traditional birth attendants as unscientific. “That is the belief of any doctor that tells you that. He is talking from an ignorant point of view. If you have no knowledge about how something is done, it is better you keep quiet about it. It is only an ignorant and arrogant person that condemns what he does not know.
“If you as a medical doctor have disagreement with anything in traditional medicine practice, put it into scientific discussion and let us debate it. I am a medical doctor too. I don’t believe they are the cause of maternal mortality,” he said.
“We in Lagos State are training traditional birth attendants. We give them six weeks training at the traditional medicine board. After, they go for another training at the general hospital close to them and give them another round of training at our College of Health Technology so that they can be part of our community. Pregnancy is not a disease. People do deliver without assistance. It is only when people have health challenges that it becomes a problem,” he added.
Possible solution
Proferring solution to the menace, Dr Adesanya said: “Female education is important because they are the ones that are concerned. Studies have shown that female education helps to put the women in the right track. The second is that people need to plan their family so that a woman that was just delivered two months ago will not be going through the stress of pregnancy again. The problem in this part of the world is that many women don’t accept family planning because of cultural beliefs. I am a certified family planning provider by USAID but in spite of all the efforts the body has put into family planning, our women don’t want to do it. They have wrong beliefs that it will cause cancer or that it will change their menstrual cycle. Some women even believe in getting pregnant and aborting it. That has a higher risk than using family planning.
“The government also needs to equip our hospitals and ensure there is at least one gynecologist in every rural area. They also need to fix our roads so that when pregnant women go into labour late in the night, they can have good roads to go to hospital in no time. They should also provide unhindered access to health facility. Nigeria has an alarming rate of maternal mortality.”
