Wednesday 26 April 2017

Pregnant and resident in Nigeria? Read this.

Pregnancy in Nigeria like most other health issues carry significant risk; and unlike many other health issues, has  almost countless myths and old wives tales associated with it.
Being pregnant in Nigeria means you will get a lot of unsolicited advice; both good and bad but here are some things you need to know and practice.
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(1). Being pregnant and giving birth in Nigeria is a miracle; you need to do same in a developed country to realize that. And like all miraculous occurrences, you need to appreciate it and handle it with utmost care. Take your prenatal vitamins as much as you can and try your best to eat well and stay healthy.

(2). Get yourself registered for antenatal checkups at a good health facility. As it relates to pregnancy, a good health facility is one with at least one midwife on duty at each point in time. There are so many private health facilities in Nigeria made up of one or two doctors and no licensed nurse. Such places could be tolerable for medical checkups where you will have little or no contact with the so called nurses they parade there but when it comes to pregnancy, especially as it would likely be the nurses who would handle delivery, please go to a facility that has a licensed midwife. Licensed midwives know their limits, they do not take most unnecessary risks as they have in-depth knowledge of the likely consequence of whatever action they take. They also know which complications are within their power to handle and how fast you need to get to a doctor when they need arises. Most times, they have a doctor on call who can handle emergencies. So when choosing a facility for your antenatal and child delivery services, look beyond  the doctor's qualification to that of the nurses. If need be politely ask the nurses which nursing school she attended. They are usually the ones that handle birth and afterbirth care. Many maternal or infant deaths have been linked to the nurses and you certainly do not want to be part of the statistics.

(3). If possible register for birth in more than one health facility. It is always good to have options. For example register at one place near your place of work and another near your home; or at one government-owned facility and another good private hospital. With pregnancy you never can predict when or where you will need the best of hands to handle a complication. Hospitals tend to act faster when you are a registered patient of theirs. Besides you would not want the doctors to wait for test results before attending to you.

(4).  Take medical advise only from doctors or licensed nurses/midwives. Experienced mums are not in the best position to do so, neither are religious leaders. Forget all the old wives tales and myths associated with pregnancy, or at least get your doctor or nurse's opinion concerning them. And please stick to medical advice; get second, third or even more medical opinions if your instincts demand so, but let the final decision be based on a medical advice.

(5). Ensure your doctor/nurse is someone you are very comfortable with, also let him/her know your birth plan. Do you intend trying a vaginal birth after a Cesarean Section? Discuss it with them let them be the ones to guide you through it and if they deem it too risky, get another opinion if need be but stick to medical advice. A healthy mother and baby is the most important outcome of a pregnancy, not the method of birth.

(6). If your practitioner ever mentions the need for you and your pregnancy to be monitored, PLEASE PLEASE and PLEASE let them do so. That is why you need a skilled and licensed practitioner who identifies risks when he/she sees them, you also need one you trust to always take decisions in your best interest. Complications often do arise in pregnancy and child birth,  and almost all times can be handled effectively by skilled medical practitioners.

(7).  After delivery, if your practitioner suggests the need for further monitoring in the health facility, please wait. Beyond pregnancy is the puerperium which can also pose a risk to new mums. Understandably, few hospitals in Nigeria are comfortable enough for a new mum to relax in after birth, but when there is need, remain under the professional eyes of your practitioner till you are declared fit to go home.

(8). If you do not have one already, get yourself and your family health insurance. Out-of-pocket payments for medical bills can be very expensive and inconvenient. Click here for more details

Always bear in mind that the cost of loosing one's life during childbirth is very high. While taking whatever decision during pregnancy look beyond the now; beyond the food you need to cook and the chores undone. Your family needs you beyond now. Several mums have lost their lives as a result of their  preferrence for one more domestic chore over their being monitored in a health facility when it was needed.

We look forward to a time when maternal health indications in Nigeria will shift from what is currently obtained to something better; when pregnancy in Nigeria will be no more risky. We all need to join hands to achieve that. We need to play our parts while we hope health practitioners play theirs.

Monday 10 April 2017

Memoirs of a Nigerian Mum; maternal mortality in Nigeria

Isn’t it amazing how blind we could be to issues around us till someday, somehow, the scales fall of your eyes and you see clearly what has been so obvious?  Growing up, maternal mortality to me meant the statistics churned out by the World Health Organization and similar bodies; I never agreed with the figures, not even when my god-mother died in related circumstances.  I thought they were overestimates. I was probably busy growing up, studying and doing many other things except noticing the maternal health indicators around me.

Then I got married and extended family obligations demanded my new family’s stay in a semi-rural area in South-Eastern Nigeria. My first shock came with a case of a teenager whose placenta was retained hours after the delivery of her baby which was attended to by a local birth attendant who claimed she told the poor girl’s mother to take the girl to a nearby hospital where there would be capable hands to handle the case; they did so but not before inviting their religious leader who spent hours ‘commanding’ the retained placenta out. Long story cut short, the girl died leaving behind a helpless little baby.

Then I started to notice. I noticed the lady who went for her scheduled antenatal checks and was advised to stay back for monitoring as her blood pressure was abnormally high; she accepted but insisted she must cook for her family and return later. That was the last meal she made for her family.

 I noticed the case of the lady whose religious leader ‘prophesied’ that she will have a normal delivery; and convinced her to reject all pleas by her doctor to have a Cesarean Section when she had complications that demanded so.

 I noticed the case of the lady who died due to complications that arose from a C-Section that went wrong; doctors in all government hospitals were on strike so she went to one of the one-doctor-and-no-licensed- nurse hospitals found at almost every corner of the country.

I also noticed that a week hardly goes by before I learn of another case of maternal mortality on social media. Then I started arguing that the statistics did not give the true picture; that things are much worse than depicted.

More painful is the knowledge that almost all the deaths were preventable. They were largely errors in judgment from either the patient, her relations, her health practitioner, religious leaders, and even failures of the health institutions; errors which I blame the Nigerian health system for, for  failing to introduce innovative measures to minimize and if possible eliminate preventable maternal deaths and in fact all preventable deaths. There should also be punitive measure meted on persons implicated in preventable cases of maternal deaths; from birth attendants to religious leaders and even some patient relations.

Every case of maternal death translates into huge human and economic losses. It leaves behind a trail of heartbreak and despondency. While  we expect the government to make significant and sustainable changes to the health system, mothers and everyone concerned should be well-informed on what their choices and chances are to enable them make informed decisions. Every one should know what  their roles are in the bid to reduce the unacceptable maternal mortality rate in Nigeria

I look forward to a time when preventable maternal deaths in Nigeria will be a thing of the past.