On the 7th of May 2013, Save the Children in Nigeria joined colleagues across the world to launch State of the World’s Mother’s Report. The Report is an annual publication that follows the diverse interventions and initiatives that support maternal and newborn health. It also shows which countries are succeeding – and those that are failing – to save the lives of mothers and their newborn babies.
The State of the World’s Mother’s Report was launched in Nigeria at a high profile event that was hosted by the Lagos State Commissioner for health. The launch served as an opportunity for leveraging National attention on some key interventions in Nigeria such as Kangaroo mother care for pre term babies, Helping new babies breathe for birth asphyxia, use of Chlorhexidine for cord infections and antibiotics for neonatal sepsis.
Every day, about 800 women across the world die during pregnancy or childbirth and up to 8,000 babies die within their first month of life.
To emphasize how a few critical investments in health care can make a big difference for mothers and newborns, we showcased the important role that frontline health workers and highlighted how investing in their training, equipping and equitable distribution could save millions of lives.
I travelled to Gombe, North East Nigeria, where the rate of maternal newborn and child mortality is among the worst in the world. The purpose of my trip was to capture the reality of child survival in a short DVD. I wanted to not only put a face and a voice to the alarming statistics of newborn deaths, but to also capture the continuous actions of frontline health workers working hard to avoid this.
I met Aisha, a trained midwife in charge of a community health centre in Hain Wuso. I followed Aisha to work the next day, where she successfully conducted the delivery of Baby Mustapha.
Helping babies to survive the first day, as well as the first week of their lives, remain the last great challenge for reducing child mortality and achieving Millennium Development Goal 4.
This is a story about his first day of life
I arrived at the community health centre at about 8am and met with Aisha, the midwife in charge of the health facility. She introduced me to the other staff and explained to them why i was there. I briefed them about the State of the world’s mother’s index and how Save the Children is working towards scaling up key interventions which can make a huge difference in maternal and newborn survival.
Adam arrived with his wife shortly after our debriefing. He was a young man in his late twenties, a commercial biker who migrated from Yobe State because of the excessive religious riots. Adam now lives in Gombe with his wife, Hafsa who is a house wife.
Hafsa started having Labour pains very early in the morning. They came to the health centre using a (public) commercial bus. The midwife (Aisha) did some routine checks on Hafsa and found out that her blood pressure was alarmingly high. She asked her for her past medical history and was told that Hafsa had never attended ante-natal session throughout her pregnancy. Aisha felt it was not a good time to counsel Hafsat on this because she was in Labour, so she made a note to do so after the delivery.
I asked the Aisha if it was common for women not to attend antenatal sessions and why this was so. She told me that their non-attendance was not limited to antenatal sessions alone but also to facility delivery itself. She said that here in the North, majority of births occur at home and women only go to the hospital when there is complication. The reasons for this, ranges from poverty and inability to afford medical services, lack of access to healthcare facilities and sometimes socio cultural factors like the belief that giving birth at home is a sign of bravery.
I was curious as to why Hafsat decided to break this norm, and know why she chose to come to the hospital and give birth. What she told me was that she had given birth at home in the past and the baby died 5 days after he was born. She said that coming to the hospital for delivery was a decision she took with her husband. They did not want to go through that again, so this time, they were not taking chances.
I watched Aisha constantly monitoring Hafsa’s blood pressure. It had reached 160/100, way beyond the normal limits. She explained to me how this can result in excessive bleeding for the mother or breathing constraints for the child if it is not properly addressed. She continued with her routine checks to confirm that the baby was doing fine. Chances of survival for every mother and child, is to an extent dependant on the condition under which she gives birth.
I was standing outside the clinic talking to a 14 year old girl who was selling mangoes. The girl told me that she will be getting married very soon. I asked her if she would give birth in the hospital when she is having her baby and she said she cannot say.
Aisha called me in just then, saying that Hafsa was about to give birth. This was the first time I was witnessing a delivery. It was quite overwhelming. I would never forget the moment when I saw baby Mustafa’s face for the 1st time, he was still coming out bute the cord was pulling him back in. Aisha noticed this and quickly set him free. She explained to me that the umbilical cord was wrapped around the baby’s neck and that this was very dangerous for the child as it could result in restricted breathing. I watched her as she used two forceps to clamp the cord on both sides of his neck, left and right, then she cut the cord in the middle. This freed Mustafa’s head and he came out smoothly.
Every four seconds, one child survives. Thanks to the effort of health workers all over the world. Thanks to midwives like Hadiza
Mustapha was born at about 1:00 pm. He weighed 2.6 kg. The birth was successful and he was healthy. I realised that today, the life of Mustafa and his mother was saved simply because the family made a decision to access proper and timely medical care.
I asked Aisha about an unforgettable experience and she told me about the case of a woman who came in with obstructed labour. Aisha was the only person on duty and she was scared because that was the first time she was seeing such a case. She knew that she couldn’t just refer the mother to another hospital with the baby’s head already coming out and the woman’s case looked very critical, but she knew also that she was not well trained or well equipped to deal with such birth complications. She decided not to experiment and referred the mother to a general hospital but then, the mother died while they were helping her back into the car.
Aisha said she remembers this case all the time because she went for a skilling up training very shortly after that episode where she was taught how to deal with cases of obstructed deliveries.
She feels that if only she had had the training a few months earlier, then the life of that woman could have been saved. Aisha has successfully conducted hundreds of obstructed deliveries ever since that time, but she says she still remembers that one case and how the right skills could have saved her life.
After the birth, I watched Aisha as she did some routine checks on both mother and baby. She continued checking the mother’s blood pressure to make sure it was within normal limits. She massaged her womb and monitored her blood flow, watching out for signs of excessive bleeding. Aisha taught Hafsa the correct way of breastfeeding her baby and advised her to practice exclusive breastfeeding. This means that the baby would not take any food or water for the next 6 months.
At this point, Mother and baby were ok and resting from the stress of labour and birth. Aisha told me that that it was procedural to monitor them for certain reasons. First of which was to deal with any post natal complications that may arise. Another reason she decided to keep them was because mothers don’t usually get enough rest when they go back home. Friends and family members will be visiting all week to see how they were doing.
In Hafsa’s case, another reason why she was detained was because her breast milk was not flowing well and her nipples were inverted. This made it difficult for the baby to feed well. Aisha wanted to make sure this was sorted before discharging them from the health centre.
It took a lot of massaging and pumping to get the breast milk to start flowing, but as soon as it came up, the baby was put to feed. The midwife counselled the mother on the importance of ante natal and now post natal checks. She taught her how to hold her baby when she is breastfeeding and how often she should breastfeed the baby. She advised her on proper feeding and proper hygiene practices.
Adam brought a taxi to pick up Hafsa and the Baby around 5pm. He was very excited about the safe delivery. By now the two had rested well so Aisha did some last minute checks on them before releasing them to go home. This was mostly repetition of things she had already done before.
The day a child is born is the most dangerous day of a child’s life.
Every year in Nigeria, ninety thousand babies die the very day they are born. This makes Nigeria one of the riskiest places in the world to be born
The neighbor’s wife received Hafsa and Mustafa at home and helped them to wash up and dress. She had also prepared food for Hafsa to eat. Other neighbors started coming in to say hello and wish the baby well. They came with gifts ranging from food to clothes for both mother and child.
The birth of a baby is considered a huge blessing that is worth celebrating, especially the birth of a male child, but the naming ceremonies are always delayed until one week after birth. This culture is a reflection of the fact that a substantial number of babies do not make it past the first day or even the first week of life. I was told that there isn’t much point naming a child when the possibility of its survival is still low.
I left Adam and Hafsa shortly before 8pm. Baby Mustapha was asleep at the time. His room was heated up with the logs that were used for cooking. A damp cloth was also heated on the charcoal and used to wipe his cord. It s believed that the heat from the charcoal and ash dust would help to heal the cord and make sure it falls off quickly.
I received a call from Adam later that night saying that the baby was restless and was crying all night. He sounded very worried. He told me that they will be going back to the clinic first thing the next morning. I wished them well and promised to check up on them at the health centre.
At the health centre, The midwife confirmed that the baby was fine and that his discomfort was probably as a result of mosquito bites. She advised Adam and Hafsa to always sleep under mosquito treated bed nets. She also noticed the charcoal and ash dust that was used to clean the cord. She pointed out to them that proper cord care was about warding off infection and not how fast she can get it to dry off. I asked the midwife if they use Clorexidine and she said they do but not for cord care. Its use was limited to prevention of mother to child transmission of HIV/AIDS. She was not aware that Government had launched the gel for cord care.
Despite the fact that a quarter of all under 5 deaths happen within the first 28 days of life, there is no specific budget line for newborn health both at Federal and at State level.
Resources must be made available to help reduce the deaths of mothers and babies on the day babies are born.