Childbirth is supposed to be a blessing as every pregnant woman is expected to bring forth a child into the world. However, a combination of certain factors has led to many of them, including their babies, losing their lives; PAUL OKAH reports.

Mrs. Joseph was rushed into the accident and emergency unit of a federal hospital on the morning of a fateful day, but was pronounced dead shortly after by the doctors on duty, alongside her 38-week-old baby in her womb.

Cause of her death? Complications from her pregnancy as she did not register for antenatal care following the safe delivery of her previous children, regardless of the fact that each pregnancy is not the same and traditional birth attendants are not equipped to handle emergency cases.

Sadly, Mrs. Joseph is not alone in the negative precedence of pregnant women avoiding hospitals to register for antenatal care.

According to the United Nations, Nigeria has a high maternal mortality rate, ranking among the highest globally. The maternal mortality ratio is estimated at around 1,047 deaths per 100,000 live births. This means that a woman in Nigeria faces a 1 in 19 lifetime risk of dying due to pregnancy or childbirth, compared to a 1 in 4,900 risk in developed countries.

Nigeria contributes to a significant portion of global maternal deaths, with nearly 28.5 per cent of all estimated global maternal deaths occurring there. Obstetric haemorrhage, eclampsia, sepsis, obstructed labour and complications from unsafe abortion are among the leading causes of maternal death in Nigeria.

UN, however, noted that while there have been some improvements, Nigeria’s maternal mortality rate remains significantly high and is still far from achieving the Sustainable Development Goal target of less than 70 deaths per 100,000 live births by 2030. Infant mortality is also a concern, with a rate of 69 per 1,000 live births and a higher rate of 128 per 1,000 live births for children under five.

Ugly experiences

Speaking of her experience, a businesswoman in Abuja, Cynthia George, said she almost became a victim of maternal and infant mortality if not for the quick intervention of her husband. She advised men to be proactive to save their pregnant wives and children.

She said, “I remember that I was registered to give birth in a particular hospital and I had my antenatal care there. I had experienced rupture of the membrane at home, so we rushed to the hospital, but didn’t meet any obstetrician. The people available were just nurses and general doctors. It was clear I’d have to give birth immediately, otherwise I could get infected. Unfortunately, the hospital officials walked about nonchalantly as if we didn’t deserve any attention.

“I was weak and couldn’t speak, but my husband was alert. He called a family doctor in the UK and explained the situation. Later on, he took me to a different hospital where I gave birth and made sure all his questions were answered. Actions like these are things expected of anybody that accompanies a pregnant or sick person to the hospital. You don’t just wait for doctors or nurses to enter your wife’s ward before you act.

“The rate of maternal mortality in Nigeria is high and it’s mostly caused by hospital staff’s incompetence and negligence. There are many avoidable situations; we can do better. You are the life your wife has while at the theatre during CS. You are the eyes your wife has while in the labour room. We need to follow up, check on these workers and be duly updated with every procedure. God would do His, but it’s also on us to work it out as well.”

Also, speaking with this reporter, a nurse, Florence Alu, said childbirth becomes riskier as women advance in age, saying maternal and infant mortality persist because many pregnant women run to quacks and prayer houses for delivery, instead of standard hospitals.

She said, “I had my first two kids in my 20s and then the last one after a long break at 32. I went to hell and back. In fact, I landed right back at the hospital due to intense bleeding after eight days of delivery. Due to the countless emergency hospital visits/admissions with the pregnancy, I have decided to not have more kids.

“Childbirth becomes riskier as one advances in age. During antenatal, pregnant women are classified into different categories using one’s age, number of children, nature of previous delivery (if any), medical history, family history. This will determine if they’ll tag the pregnancy a risky one or not. Most of the people who have children out of wedlock are very young, between the ages of 18-25. At that age, pregnancy and child delivery is less risky. They will tell you in the hospital that the risk starts at age 35 and above.”

Negligence by hospital staff

On her part, a seamstress in Abuja, Ruth Emenyi, said she almost lost her life and baby as a result of the actions of unprofessional nurses in the hospital she visited for delivery.

“On Tuesday, last week, I was in labour; so I rushed to a hospital. It was along their corridor that my water broke and I could feel my baby’s head coming out. I had to use my hand to support my baby’s head from dropping out. Do you know that even when someone rushed and called the nurses, they were less concerned? I still pushed myself with the little strength I had and entered the labour ward.

“I was screaming, telling them that the baby’s head was out, but the nurses ignored me. One was even laughing at me. When I couldn’t take it anymore, I just sat down on the floor to combat the pain and then the baby came out. That was when they knew I was serious. It was when one of the nurses inside the delivery room came out and saw my baby on the floor that she shouted at them and asked what their work was as nurses. Even when they saw my baby on the floor, they couldn’t even help. She apologised to me, took my baby and quickly cleaned her up. She then took me inside the delivery room and helped bring out the placenta and also cleaned me up.

“Most of these people don’t know their work. If you notice that they’re not doing what they are meant to do, please leave immediately to another hospital because this life is just one. I’m so happy that nothing happened to me and my baby that Tuesday. Going to the hospital alone or with someone that can’t stand up to the medical workers is very risky. Our health workers have to take their work seriously,” she said.

Similarly, a civil servant, Ijeoma Ethel, said she lost her child as a result of medical negligence.

“It’s been three years since I lost my second son due to negligence by medical professionals in a hospital. The doctor blamed the nurses on duty, while the nurses insisted they did what the doctor said. My baby was to undergo a surgery that day. The doctor told the nurse to give him anaesthesia to prepare for the surgery. The nurse gave my baby an overdose.

“A few minutes later, my little baby died in the surgery room. It was so heart-breaking. Some hospitals in Nigeria are death traps, the doctors and nurses lack empathy. Their aggressiveness and rudeness can’t be described. The nurses seem so nonchalant. Even the way they move sluggishly is so irritating,” she said.

On her part, a teacher, Rita Ezra, said it was the intervention of her husband that saved her life and their baby as she almost bled to death while giving birth.

“When it comes to giving birth, there’s no gentleman! When I was in the labour room, the nurses were all clamouring for me to push even when it was obvious that I was very weak, almost at the point of losing my life. My husband had to yell at them to use any other means, which was emergency CS!

“Nigerian doctors and nurses have no value for human life. Thank God that my husband was with me during delivery. He literally had to drag the doctor to come and attend to me as I was bleeding seriously. You don’t play gentleman in a matter of life or death. A pregnant lady should always register with at least two hospitals. That way, you can easily take a walk when one starts acting funny. If things get worse, they can give you a paper to sign against medical advice, but you will go on with your life in one piece,” she said.

Experts’ admonitions

In an interview with Blueprint Weekend, a UK-based Education and Financial Consultant, Anthony Oko, said a combination of religion, cultural beliefs, illiteracy, poverty, societal biases and peer influence could cause maternal and infant mortality, advising that Caesarean Section (CS) should be considered with proper medical care to mitigate cases.

He said, “As a researcher with substantial knowledge and experience in child care, birth, pre – and post-natal care and management, I have had experiences and issues where expectant mothers refused to go to the hospital for pre – and post-natal as well as antenatal sessions on the premise of religion, cultural beliefs, illiteracy, poverty, societal biases and peer influence.

“Maternal and infant mortality are environmentally impacted by diverse factors. In Nigerian rural communities, they have cultural values and beliefs that women who give birth through natural means are the real women and are celebrated, while those who gave birth through Caesarean Sections are stigmatised into self-shame. In an attempt to identify with this societal prejudice and belief, many women die due to refusal to undergo a Caesarean Section. Others refuse to go to the hospital to prove a point that they are women enough; until it becomes late and they lose their life and babies.

“Thus, in rural areas, proximity, illiteracy, cultural beliefs and shared values account for a greater percentage of maternal and infant mortality. Also, in urban and suburban areas, negligence, busy times, stress, carelessness and increasing religious perceptions, especially among Christians and Muslims, who want to prove a point of giving birth like Hebrew women, have characterised the major reasons for maternal and infant mortality.

“Negligence, carelessness among medical practitioners, midwives and birth attendants at hospitals also abound as the mental health of the practitioners is not managed and ascertained over time. Fault is often redirected to the woman and her child as medical complexities, even when the causes are engineered by poor medical practices, carelessness of the birth attendant.”

Continuing, he said, “Therefore, where several issues could cause maternal and infant mortality, CS should be considered with proper medical care and condition as the uterus of the woman could get weak over time. Medically, it is advised that a woman shouldn’t undergo CS beyond three times or four in extreme cases. It does not mean that a woman who gives birth through CS is less of a woman.

“Proper education for mothers should be improved as the benefits of antenatal care have not been well-emphasised and sensitised among rural dwellers. Family planning should be considered to help families and women to live properly. Women who have tendencies of postpartum haemorrhage should consider advanced medical consultation and proper care to mitigate the high mortality rate.”

In his view, a medical doctor and chairman, States and Nations Development (STAND) Consults, Dr. Otubo Victor O., advised pregnant women to go for antenatal care in the right place (hospital), saying hospitals give priority to saving lives.

He said safe pregnancy and motherhood are part of Sustainable Development Goal (SDG3), and that the federal government is making significant efforts to ensure pregnancy is a safe and supported journey for women and their families, adding that antenatal care and deliveries are actually affordable in public hospitals.

“I have witnessed several cases of pregnant women avoiding visiting the hospital for antenatal care until it is too late. In fact, I dedicated an entire chapter in my book, My Family Companion, to issues surrounding antenatal care. One of the stories I shared in the book was about a patient who was brought to our emergency department with complaints of severe abdominal pain and fainting. Long story short, she had a ruptured ectopic pregnancy.

“The rupture occurred in her left fallopian tube, and it was so severe that we had to remove the entire tube. What was even more disturbing was that while operating on her, we discovered her right fallopian tube had already been removed years earlier due to a previous rupture. That first rupture happened when she was just 17. She had been raped, but due to stigma and fear, she didn’t tell anyone – not even her parents,” he said.

He added, “She didn’t even know she was pregnant until she collapsed and was rushed to the hospital. Her parents initially thought it was appendicitis, but after some quick examinations and tests, the doctors discovered she had a ruptured ectopic pregnancy and had to operate. Years later, she got married and became pregnant again, but, unfortunately, she didn’t begin antenatal care early. This led to this second rupture. If she had started antenatal care early in the pregnancy, a simple scan could have detected the ectopic pregnancy in time and possibly saved the tube. Now, her options for conception are limited to IVF or other advanced procedures.

“The number one cause of maternal and infant mortality in Nigeria is poor health-seeking behaviour, often driven by cultural and religious misinformation. This leads to situations where people only seek medical help when it’s already too late. In one of the cases I shared in my book, a woman was brought to our hospital after being in labour for three days at a maternity home. By the time she got to us, she was already in a critical condition.

“A lot of things can lead to maternal mortality and multiple childbirths in itself is not a cause. First, nature controls that a woman cannot give birth forever. We all know about menopause. What is a concern in the number of childbirth, or what we call parity, is spacing. The ideal inter-pregnancy interval is between 18 to 24 months. Getting pregnant too soon after a previous birth can place immense stress on a woman’s body, increasing the risk of complications and even maternal death.

“Religion is a strong influence on the day-to-day lives of people around the world, especially in our own societies here in Nigeria. You must have heard the statement, “deliver like a Hebrew woman.” It’s a common expression used in some religious circles to suggest that giving birth naturally – without medical intervention, like a CS – is either a sign of divine favour or strong faith.” (Blueprint)