Preparations during pregnancy in a rural setting

With barely three years left to achieve the targets of the Millennium Development Goals 4 and 5, world-wide efforts have shifted into high gear. Ghana needs technical capacity to make changes that can result in the reduction of child and maternal mortality.
The quality of clinical care can be improved when pregnant women receive all elements of care from the providers every time they visit them.

In 2009, Project Fives Alive! (PFA) developed a Birth Preparedness Plan (BPP) checklist to minimise variation in care and improve client and provider adherence to antenatal and perinatal practices.

The BPP checklist documents the provider’s (Midwife, Community Health Nurse, etc.) cell phone number in case of complications. It also reminds the provider to discuss several things with pregnant women as part of antenatal care – including plans for facility delivery, transport, family support during delivery, type of delivery (caesarean section, etc.), facility type to deliver, etc. The checklist was first tested in three districts: West Gonja in the Northern Region, Jirapa and Lambussie in the Upper West Region.

Client and provider experiences

We learned a lot listening to the client experiences during the testing of the BPP in these districts. Aisha Yeboah comes from a community where women who deliver in the health facilities are mislabeled as cowards. Aisha Yeboah was 28 years old when she lost her baby in the fourth month of her first pregnancy.

Two years later, Aisha became pregnant, and had the opportunity to discuss family support during pregnancy with her midwife at the community health centre. She told her family about the importance of going to the antenatal clinic with a family member (husband, mother-in-law, father-in-law, etc.). The use of the BPP checklist also reminded the midwife to discuss the need for Aisha to have a caesarean section and to have a transport plan to the district hospital.

This turned out to be helpful when Aisha’s labour began. She called the community volunteer who was the stand-in family member because the husband had gone to the farm. The volunteer found the midwife’s mobile phone number in her antenatal book, and immediately called the midwife to tell her about the labour contractions. The midwife asked the volunteer to read her decision on the type of delivery. “It is caesarean section,” the volunteer replied. The midwife told the volunteer to take the lady immediately to the district hospital and tell the husband to follow up.

After quick review of the checklist, which was stapled to the antenatal booklet, the hospital midwife requested additional blood for the surgery because the woman was anaemic. The volunteer offered to donate the blood for the surgery and the delivery was done immediately. This time, her child survived.

Our discussion with the midwife at the health centre was interesting. She said that during antenatal care, the checklist reminded her to discuss the woman’s plan for caesarean section after her recommendation. She said together they thought of a backup plan when the husband was away. They also agreed that the stand-in family member should be nearby, have a mobile phone, and could donate blood to her like the husband since it was difficult to know if the district hospital would have blood for her surgery when the need arises.

Lessons from Aisha’s story

So many opportunities for better care are missed during clinical care because we are over-relying on clinical assessments. Patient experiences can give clues to the many clinical assessments we make every day in our clinics. Patient experiences can reveal psychological problems at home, fears, financial difficulty, cultural hindrances, etc., which could help us to make more informed clinical decisions embodying these social factors.

Provider experiences are also important to improving clinical care. When patient load is huge, providers forget to follow steps in the process of care. Provider experiences can be used to plan better processes of clinical care.

By Linda Azumah/Daily Graphic/Ghana
The writer is a Monitoring & Evaluation Assistant.