Old birth rites, new ways

When bringing a new life into the world there are risks involved hence even old traditions have to adopt new ways to ensure the safety of the mother and the unborn baby.

It was 5am when Oluwakemi Junaid’s waters broke.
She was rushed to a bungalow building, known as a ‘face-me-I-face-you’ in local slang, similar to the many overcrowded, multi-tenanted houses surrounding it in the bustling town of Epe in Lagos state.
The man waiting to deliver the baby had no medical qualification, and the ‘clinic’ he has fashioned from jumbled rooms was not registered with any health authority.
But Oluwakemi, like many Nigerian women, chose not to go to a hospital or health centre.
She wanted her child to be born with the help of a traditional birth attendant.
Oluwakemi, who was pregnant with her fifth child, dislikes and mistrusts government health centres after her first four children were born in them.
“Most times when you go to hospitals, they don’t honour people’s life.
They won’t allow family or friends to take care of you,” she said.
When she hears cries from within the clinic, Oluwakemi rushes inside and returns with a warm bundle wrapped in a pink-and-whitestriped blanket.
She had given birth a few hours earlier.
“It is the warmth and love of the place that draws me here, especially the traditional attendant Alhaji Sulaimon’s easy-going manner with his patients.
“Giving birth with traditional birth attendants is far better than going to a health centre.
“It’s true that they don’t have medical background, but they are good with delivery,” she says, unlatching her baby from her breast.
As a child, Sulaimon watched as pregnant women from all over the port town of Epe, as well as from nearby Ijebu-Ode and other parts of South-west Nigeria, came to his father to give birth.
Sulaimon’s father was a renowned attendant.
The boy was an avid apprentice and learned everything he knew from his father.
As Sulaimon poses for a picture in the chair at his desk in a dimly lit room at his clinic, he just laughs when he is asked how many babies he has delivered.
Sulaimon himself is no stranger to acclaim, a wall in his office is covered with award certificates and recognition from local chiefs for his work with pregnant women.
For nearly three decades Sulaimon has followed his father’s ways, practically, using his bare hands to deliver babies.
But this is an unhygienic practice that can easily spread infection from an attendant to a mother or her newborn baby, and along with accusations that many traditional birth attendants use unsterilised tools and are often illiterate and innumerate, has added to the controversy surrounding Nigeria’s thousands of birth attendants.
Infections including sepsis, pneumonia, tetanus and meningitis account for at least 26 per cent of neonatal deaths in Nigeria, according to WHO data cited in the federal ministry of health’s 2016 plan to end newborn deaths.
Nigeria is one of the most dangerous places in the world to give birth; the country’s maternal mortality rate was 576 deaths per 100, 000 live births, its 2013 Demographic and Health Survey shows.
Maternal deaths, the WHO said, happen when women die while they’re pregnant, during childbirth or within 42 days of giving birth from any pregnancy-related cause.
Across Nigeria, only 43 per cent of births are attended by skilled birth attendants, a 2016/17 WHO and UNICEF survey shows.
In the country’s northern regions, where the vast majority of states do not have doctors at primary healthcare centres and midwives are scarce, up to nine in 10 women deliver at home, UNICEFs maternal and newborn health specialist Garba Safiyanu said.
Postpartum haemorrhage or excessive blood loss during birth is one of the major causes of maternal mortality in the country, though women in the north are at much higher risk.
“More than 50 per cent of women dying as a result of childbirth are actually women who have bled, or have had postpartum haemorrhage.
The fertility rate in northern Nigeria is very high.
Women give birth to six, seven, even 11 children before they are 40.
Obviously the tendency for haemorrhaging is very high,” Safiyanu said.
As a woman who has had multiple pregnancies, Oluwakemi was also at risk of excessive bleeding, but Sulaimon was prepared.
And this time, as he had for the past two years, he did not use his bare hands.
“Now we are using gloves, a sterilising machine, scissors and a surgical blade.
So many changes and techniques have come into play,” Sulaimon said.
When Adepeju Jaiyeoba lost her friend to child birth complications in 2011, she realised that, behind the numbers of Nigeria’s maternal mortality, there are faces, families thrown into grief and “children whose lives may never, ever be stable until they die.” Jaiyeoba, a lawyer, wanted birth attendants to be trained, so she started the Brown Button Foundation, a Non Governmental Organisation.
In the North, Jaiyeoba said that the Foundation has opted to move away from the main cities and has trained birth attendants in hard-to-reach, far-flung places where access to healthcare is limited and healthcare workers don’t want to go, places where women have seen so many mothers die in childbirth that they seek spiritual protection when they are due to deliver.
“Going to the hospital alone is not enough.
It requires some form of spiritual protection, in addition to anything that medics can offer you.
Women believe that traditional birth attendants are able to offer them this spiritual protection that is highly necessary and needed at childbirth to prevent deaths,” Jaiyeoba said.
The Brown Button Foundation has trained more than 15, 000 birth attendants across the country, its records show, and Sulaimon is one of them.
When he delivered Oluwakemi’s baby, he also prompted her to buy a cheap white package.
The kit contains the usual necessary supplies; medication, antiseptics, surgical blades, mucus extractors and sterile gloves, that birthing kits in the rest of the developing world do.
But the Brown Button Foundation’s packs also provide four tablets that other supply kits, including those made available by government, do not.
The pills are life-saving essential medicines to prevent and treat excessive bleeding during birth.
But they have also caused a backlash from men in the deeply conservative and religious North.
It was two years ago, after Jaiyeoba listened to birth attendants in northern Nigeria explain their methods of stopping postpartum haemorrhages, that she introduced the drug, misoprostol, into the kits.
One woman said that she prayed to God when her patient began bleeding after giving birth, another “asked women to sit on a high chair and close their legs in the hope that their bleeding would stop”, Jaiyeoba said.
The WHO recommends the use of misoprostol for the prevention of postpartum haemorrhage, where the drug oxytocin is not available.
It is ideal for use in low-resource settings as it is cheap, widely available and does not need to be refrigerated.
Misoprostol is approved for communitywide distribution across Nigeria for the treatment and prevention of postpartum haemorrhage, but it has also been added to the WHO’s essential medicines list for use as part of medical abortions.
“In many communities they don’t want it.
They believe it is an abortion drug,” Jaiyeoba said.
Even though Jaiyeoba has to pilot the training and use of kits every time the foundation goes to a new state, it has distributed 400 000 birthing kits to women in 30 of Nigeria’s 36 states.(Culled from bhekisisa.org)

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