Lending a hand to stop maternal deaths

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."