Recently read with amazement the story of a woman who was assisted to deliver at the Electoral Commission premises. Mother and baby survived, thanks to sensitivity of the midwife that was sitting next to this labouring woman in a taxi!
In Uganda we are still struggling with an unacceptably high mortality rate of 505 per 100,000 live births, and one of the major reasons is the lack of skilled attendance at birth. Skilled attendants are people with midwifery skills â€” trained to manage uncomplicated deliveries safely, recognise complications, treat those they can and refer women to health centres or hospitals if more advanced care is needed.
If the midwife was not around, anything could have happened to the labouring woman. This woman in her state, left by the roadside, she would have easily contracted an infection, which could lead to her death. Her baby could have come out, and without knowing what to do next, she could have lost the baby, and worse still, she could have delivered the baby and ended up bleeding to death (bleeding after delivery is the major cause of maternal deaths in Uganda).
Our government should recruit midwives. Midwifery skills are what will lift the burden of mothers and babies. Countries like Sweden, and the USA, whose maternal mortality rate is so low, were at one point having figures higher than the ones we are struggling with in Uganda. Indeed studies suggest that having skilled birth attendants is one of the key interventions for reducing maternal and perinatal mortality.
Just here in Mulago hospital, one visit is enough to prove that once these services are available, mothers and babies would survive. On Ward 6, a mother dying is news whereas in the ward below (Ward 5), maternal and perinatal deaths are a common occurrence. Certainly one will ask, â€˜what do you expect with free services?â€™ But we women should not be condemned to death for our right to reproduce. We should enjoy the right to reproduce with the services being availed to us.
Every pregnancy carries a maternal risk. WHO defines maternal risk as the probability of dying or experiencing serious injury as the result of pregnancy or childbirth. This maternal risk is not exclusive. It can affect the woman in a rural community, just as it can do a minister or a doctor (this country in the recent past lost a cardiologist in Mulago hospital due to a complication that arose after delivery).
Available information suggests that around 40% of all pregnant women have some complication, and about 15% of pregnant women need obstetric care to manage complications, which are potentially life threatening to mother or infant. Such complications are often sudden in onset and unpredictable.
Faced with such facts, we cannot close our eyes to the fact that women are producing. Uganda has one of the highest fertility rates in the world (6.9), and our annual pregnancies are 1.2million. The most appropriate person to care for these pregnant women is someone with midwifery skills who lives close to the community.
People trained in midwifery are qualified to provide preventive care to pregnant women, detect abnormal conditions in mothers and babies, assist women through labour and delivery and prescribe essential drugs. They can also offer social and psychological support to delivering and new mothers. These are the people we need in our health facilities.
Uganda needs more midwives