Curbing maternal deaths by discarding misconceptions: The role of antenatal care providers
Of the many health concerns in developing countries, maternal and new born health remains disturbing as pregnant women and sometimes their new born babies can unexpectedly lose their lives within a short time and from causes which can be readily taken care of.
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Maternal deaths occur generally from complications that arise from five identified causes which can be taken care of if the right equipment, drugs and supplies are adequately available and women utilise the services in a timely manner.
African countries, including Ghana, are steadily making services available to women and their new borns but progress in reducing maternal deaths is slow. Part of the underlying reason is that there are misconceptions that people hold, which prevent the right approaches to be taken, particularly by the users of the available facilities.
Misconceptions
There are some cultural beliefs about certain symptoms of pregnancy, and even with regard to complications, which are misconceptions of what is actually the case. For example, a case of obstructed labour during which a woman may labour for more than the normal hours could be interpreted as an indication of unfaithfulness to the spouse and therefore appropriate steps to assist her will be denied or delayed. Cultural and popular opinions can prevent people from appreciating the emergency nature of an onset of a complication and seeking appropriate care.
One other strongly held opinion about maternal death is that using family planning and contraception prevents maternal deaths. The usefulness of contraception is just as it says; it simply prevents conception in the first place. Reproduction, however, remains a normal function of all species so the female, provided she is fertile, can potentially become pregnant at some point in her life time, unless she chooses not to. Using contraceptives will therefore not prevent maternal deaths from occurring when there are complications.
Another misconception is that since pregnancy and childbirth is a normal, natural process which millions of women go through without problems, especially if she takes care of her diet, keeps personal hygiene and maintains good health, there is no need to become agitated.
Thus, even when a woman starts showing signs of distress during a complication, the attitude that prevails is one of let’s wait and see. Yet, despite the fact that pregnancy and childbirth are normal, something can go wrong without notice and a woman can lose her life and or that of the baby within a short time.
In connection to this is the related misconception that the use of antenatal care (ANC) or prenatal care provides adequate cover to prevent the onset of a complication. Across Africa, studies have shown that pregnant women endeavour to attend ANC at least three times during the nine-month period. However, just over a third of births take place in a hospital or a registered institution. thus, when there is a problem, no one is adequately prepared.
ANC assessments cover blood pressure, abdominal palpation to check the development of the foetus, testing of urine and haemoglobin, and some health talks. These measures are to screen and identify those at risk of certain conditions.
Ultrasound scan
There is what has become a routine requirement during pregnancy and that is an ultrasound scan. The popular misconception associated with this is that any abnormality can be detected on time for precautionary measures to be taken. Most of the complications take place at the time of delivery and except for cases such as breech presentation, it is not the case that the scan can be used to predict the onset of a complication, much less prevent it.
Yet many pregnant women anxiously look for the resources to have the scan done and then on assurance that all is well with the progress of the pregnancy, they become lulled into thinking that they are adequately covered.
Hospital cost
One more misconception people have about hospitals is the perceived high cost. Cost has been a deterrent to the use hospitals by many women when they are ready to deliver, especially in situations where they assure themselves that the delivery will be normal. Such assurances come after paying for ANC and carrying out tests with favourable results from the ultrasound scan.
This is a misconception which lulls women into thinking that they will experience a problem-free delivery and therefore there is no need to deliver in a hospital which has Emergency obstetric and newborn care (EmNOC) services to deal with any unforeseen complications.
Discarding misconceptions
To do away with misconceptions, we need to be clear in our understanding about what maternal mortality actually is. All pregnant women face the risk of dying or suffering disabilities during or after delivery from five major complications-hypertension, haemorrhage or bleeding, obstructed labour, complications of abortion and infection. These conditions, when they occur, can be life threatening, especially in the absence of an established appropriate service, which is available on a 24-hour basis.
In fact, it is now known that out of every 100 pregnant women, 15 will develop a complication and therefore emergency preparedness for that eventuality makes sense. Pregnancy then has to be perceived as a state which requires that precautionary measures are put in place for use when a complication arises so that it is treated as an emergency.
Therefore, preparedness must be the watchword. The provision of large billboards or well-sounding slogans and sentiments do not mean preparedness. Rather, it is the provision of well-laid out facilities which are accessible and have skilled and friendly professionals that hold the key to a rapid reduction of maternal deaths.
The UN spelt out the standards to be followed some two decades ago and many countries, including Ghana, are working to ensure that emergency care is available to both mothers and their newborns.
Known as Emergency obstetric and newborn care (EmONC), the recommendation is to be provided at two levels — the basic EmONC at the community level where the facility has the capacity to provide five important functions and which will be available to serve a population of about 125,000; and one comprehensive EmNOC to which complications will be referred to obtain additional services –blood transfusion and caesarean sections. Such health institutions should be well-equipped and have skilled professionals to run them.
GPMM
In Ghana today, organisations such as the Ghana Prevention of Maternal Mortality(GPMM) have the expertise to assist both the public and private sectors in planning such care.
There is urgency for government, private sector and non-governmental organisations to work together to expand the basic and comprehensive EmNOC services across the country to make them accessible.
To this end, all current ANC centres can be upgraded and equipped to provide the basic EmNOC signal functions while their existing staffs are also upskilled. Prior arrangements for the transfer of women with complications to the nearest comprehensive EmNOC centre will ensure that women arrive on time and in more stable condition for the next step to be carried out. In this way, current providers of ANC will play a truly supportive role in the drive to reduce maternal deaths in the country.