Lending a hand to stop maternal deaths

Maria Endah Hulupi, The Jakarta Post, Jakarta

Cicih was in the late stages of pregnancy and her past experiences told her that it was time for her to deliver her baby.

So one morning, the mother of four and her husband walked to a maternity clinic where she was to have a routine check on her pregnancy. It was a five-kilometer trip but they got there on time.

Anxious and in pain, Cicih had to wait her turn. While waiting, she started bleeding.

Even after her turn came, she still had to wait, this time for the midwife to finish breakfast and her own husband to go out and buy a pair of gloves, several blood bags and other medications. All the while, she continued bleeding profusely. And by the time her husband got all "the requirements", Cicih was dead.

The rural woman's tragic experience as disclosed by non governmental organization Maternal Neonatal Health (MNH) was a real picture of what many Indonesian women have to face.

The saddest part is, the facts show that 80 percent of maternal death can be prevented but still, death rates remain high and usually take place during critical periods, between the late stage of pregnancy and a week after delivery.

Ministry of Health data reveals a staggering maternal death figure at an average of 18,000 cases annually -- or about two deaths every hour. And the country ranks 3rd highest in maternal deaths among the Southeast Asian countries.

Maternal Neonatal Health (MNH) identified three delays as the major causes of maternal and/or newborn death during this critical period -- a delay in recognizing the danger signs of pregnancy on time, delays in immediately taking the pregnant woman to nearest health center and like Cicih's case, a delay at the health center.

The organization also warned that several factors, like frequent pregnancy, too many children and young or old age for child bearing, can also lead to obstetric complications.

MNH communication specialist Luthfi Hasan warned that obstetric complications are common, making all pregnancies at risk, regardless of the stage.

The organization's data estimated 40 percent of pregnant women suffer from obstetric complications. "15 percent of which suffer serious complications that require immediate professional help," Luthfi said.

Pregnancy related deaths can be prevented with active roles of the pregnant woman -- like taking good care of herself and her pregnancy, her spouse and/or other adult family members (to watch over their pregnant relative), neighbors (to provide immediate help when needed) and obstetricians or doctors or trained midwives (to provide proper services).

Prevention initiatives have been highlighted in the group's campaign, dubbed Siaga, literally meaning to be prepared. Siaga is short for Siap-Antar-Jaga, or ready to watch over a pregnant woman and take her to a nearby maternity clinic.

Through the campaign, expecting women, spouses and other family members are encouraged to be aware of possible life threatening symptoms which might take place during pregnancy like bleeding, eclampsia, abortion, infection, delayed delivery or anemia; or during or after delivery, such as bleeding, uterial rupture (often a result of rigorous massaging), eclampsia and infection (due to poor hygiene).

Expecting women are advised to perform routine checks, which ideally would be accompanied by her spouse or other family members, in order to provide information to all of them as their support is needed to ensure her well-being.

"When something unexpectedly goes wrong, they (the patient's spouse or family members) know what to do. This is important because a pregnant woman (ready to deliver her baby) is in pain and unable to make decisions," said Luthfi.

Pregnant women living in villages are also encouraged to seek help from professionals like obstetricians, doctors or trained midwives for the delivery process instead of entrusting the process to unskilled traditional midwives.

Unlike unskilled traditional midwives, Luthfi said, health professionals were trained to, among others, provide counseling prior to giving birth or in emergency, ensure clean and safe delivery and provide immediate treatment for obstetric complications and proper care of newborns.

However, it would not be easy since some areas, especially in small villages, still lack accessible and affordable maternity services.

The organization believed their campaign would help overcome the problem and mobilize community members to provide life-saving assistance, like alerting local doctors or trained midwives or allowing the use of a neighbor's car to transport women who are ready to give birth.

Luthfi urged the public to shift their old perceptions that pregnant women are the ones to make decisions of her own or her baby's health, and though maternal death is widely believed as a syahid death (if she dies during the laboring process she will go to heaven), it should not dampen efforts to immediately save her life.

"We have seen people work shoulder to shoulder to help their neighbor when a family member dies. Such an attitude is also needed to help save the lives of pregnant women in our neighborhood."