Reducing maternal deaths in the country-Role of midwives

IT was around midnight when Afia Boatemaa (not her real name) began to feel labour pangs. When she informed her mother with whom she was living, what she was going through, Afia was told to hold on since it would take some time for the baby to actually come. On three separate occasions during the night, Afia had to struggle to get to her mother’s bed to wake her up, and at every time, her mother told her to wait.
Being her first pregnancy and with no experience in child delivery, Afia took her mother’s advice and continued to go through terrible pain throughout the night. The next morning, it was after Afia had been chanced upon by the wife of the local catchiest that she was rushed to the health post, but unfortunately, there was no midwife to attend to her. For hours, Afia was left unattended to and when she was finally sent to the nearest hospital some 30 kilometres away, she was immediately operated upon but unfortunately, she could not survive another case of maternal mortality.
Maternal mortality, according to the United Nations Population Fund (UNFPA), represents the greatest health inequity in the world. Aside it, no other health indicator starkly illustrates global disparities in human development.
In addition, the United Nations (UN) body indicates that apart from the human tragedy associated with the death of any woman through preventable maternal causes, a family tend to lose a principal breadwinner and also a reduction in the survival of the existing children in the family.
Most maternal deaths, according to health workers, occur during labour, delivery or the first 24 hours after delivery. Skilled care during pregnancy, childbirth and the immediate postpartum period, by healthcare professionals such as midwives with appropriate skills has been recognised as one of the key interventions to reduce maternal mortality. But it must, however, be noted that these skilled birth attendants required the necessary emergency obstetric care facilities and equipment in order to prevent these deaths. Skilled birth attendants include midwives and other health professionals with midwifery skills.
Information provided by the Country Midwifery Advisor of UNFPA in Ghana, Mrs Fredrica Enyonam Hanson indicated a midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed course of studies and has acquired the requisite qualification to be registered and/or legally licensed to practice midwifery.
To perform effectively, she pointed out that a midwife must be able to give the necessary supervision care and advice to women during pregnancy, labour, and the postpartum period. She is also to conduct deliveries on her own responsibility; and to care for the new-born and the infant.
This care, according to Mrs Hanson, included preventive measures, the detection of abnormal conditions in the mother and child, the procurement of medical assistance and the execution of emergency measures in the absence of medical help. A midwife is said to have an important task in health counselling and education, not only for the patient, but also within the family and the community. The work should involve antenatal education and preparation for parenthood and extends to certain areas of gynaecology, family planning (FP) and child care.
Midwives may practice in hospitals, clinics, health units, domiciliary conditions or any other service.
It is also important to point out that when women are unable to access the necessary services provided by midwives, they cannot benefit from these life-saving services. To save the lives, Ghana has over the years taken innovative steps to increase women's access to healthcare; however, maternal mortality in Ghana still remains high. Mrs Hanson observed that gaps in women's access to comprehensive reproductive healthcare were due in part to barriers and challenges midwives faced, and these challenges included overcrowding and high client midwife ratio, outdated facilities and equipment; few support networks; limited opportunities for continuing education; and traditional beliefs and practices-all of which affected maternal and neo-natal health outcomes.
She pointed out that midwives often found themselves practising within a context of rooted cultural practices and beliefs, rules governing social behaviour and clients' limited exposure to modern medicine.
“As a result, a supportive and informative environment needs to be developed so that midwives are better able to explain the relevance and value of their services to clients and their communities. We must recognise the unique skills, roles and responsibilities midwives bring to delivery care, and to the central role that midwives play in making motherhood safer”, she stressed.
To ensure that they are well trained and skilfully empowered to deliver the women of Ghana who have always delivered for Ghana, Mrs Hanson maintained that the training of this calibre of health workers must be critically looked. It is by so doing that the slogan adopted at the launch of the Ghana Campaign for Accelerated Reduction of Maternal Mortality in Africa - CARMMA which is “Ghana cares, no woman should die whilst giving life” could make any meaningful impact.
It is also after we have had enough well-equipped midwives that the unacceptably high maternal mortality ratio of 451 deaths per 100,000 live births (Ghana Maternal Health Survey, 2007) could be reduced.