Pillars of safe motherhood

Nov 06, 2022 News

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By Rehanna Ramsay

Kaieteur News – Safe motherhood begins before conception with proper nutrition and a healthy lifestyle. Planned pregnancy, appropriate prenatal care, prevention of complications when possible, and early and effective treatment of complications when they occur are all essential elements of maternal care.

There are basically five steps in safe motherhood care: preconception care; prenatal or antenatal care; the identification of high-risk pregnancy; clean and safe delivery; and postnatal or postpartum care.

These five pillars are strategies and interventions aimed at reducing deaths in women of reproductive age and improving family health.  In the past, Guyana has had quite its share of maternal and infant mortality; this started to decline in the past five years. However, the recent reports of maternal deaths and stillbirths at the nation’s premier public hospital have raised concerns about maternal healthcare, once more.

As such, Kaieteur News will attempt to shed some light on safe motherhood practices for aspirant and expectant mothers. To do this, this publication will highlight some points raised by Dr. Karen Cummings, a former Junior Minister within the Ministry of Health.  Here is some important information on what is required to achieve a safe and healthy pregnancy.

Preconception Care

According to Dr. Cummings, under this banner, family-planning services and counselling for all patients – male, female, single or married – are provided.

During this period, she said people are prepared mentally for parenthood and are educated about what to expect when they become parents.

The doctor explained that Sexually Transmitted Infections are discussed and tests for the same offered.

The importance of waiting for specific timing for childbearing is explained, along with the value of appropriate spacing between pregnancies. Exclusive breastfeeding is also discussed with both males and females. All the basic sexual and reproductive rights are explained.

Antenatal care

According to Dr. Cummings, based on recommendations made by the World Health Organisation (WHO), a pregnant mother must have at least four (4) antenatal visits.  This step is crucial to a safe pregnancy and delivery.

In addition, she must be able to join a clinic, at least, before the first 12 weeks. During the patient’s assessment at the health facility, the medical personnel should be able to determine whether she should continue her antenatal visits right there at that facility. Depending on the results of the screening that is done, the patient could be referred further up the chain to regional or national hospitals.

While not every facility has access to all the necessary blood tests, measures are in place to ensure that every mother has basic tests done. These basic tests include blood group, haemoglobin or blood count, blood sugar, HIV, and Hepatitis B.  It is also recommended that an ultrasound be done preferably in the first trimester, or at least before the 20th week of pregnancy.

Identification and management of high-risk pregnancies

The former Junior Minister of Health noted that high risk is used to describe those patients who are expected to have a complicated pregnancy due to a health problem with either the mother or child. Such patients need to be seen by an Obstetrician throughout their antenatal care. Once diagnosed, these patients are referred to a specialist as early as possible. Some of the risk factors that influence high-risk pregnancies are as follows: age 18 –35 years old, lifestyle (use of drugs and alcohol, smoking, obesity), existing health conditions (high blood pressure, diabetes, sickle cell, anemia) and conditions of pregnancy (twins, malformations, placenta previa, etc.).

It should be emphasised that high blood pressure remains one of the most seen conditions in our high-risk clinics and patients are encouraged to continue with their balanced diets, exercise, and medications when needed.

Depending on the medical condition that the patient presents, a delivery plan would be made for her during her antenatal visits. This plan includes the timing of delivery and mode of delivery; that is, whether it would be by normal delivery or caesarean section.

Other important conditions include diabetes, malaria, and some sexually transmitted diseases.

Clean and safe delivery

Dr. Cummings noted that all our health care facilities throughout Guyana where deliveries are done should have a skilled birth attendant present.  She said the presence of this person helps to ensure the safety of the mother and the neonate. The healthcare facility should have systems in place in the event of an emergency. All healthcare workers should be able to recognise obstetric emergencies and call for immediate help.

The doctor explained that everyone, including Community Health Workers (CHWs), needs to be re-evaluated every two years to ensure their skills are evaluated and upgraded.

She said, “For the mother, it is important that the signs of labour be explained to her. These signs include regular contractions, rupture of membranes (water bag bursting) and “show,” which is a bloody discharge on the patient’s underwear.”

Postnatal care

According to Dr. Cummings, before discharge from the health facility, the mother must be aware of alarm signs which include fever, smelly vaginal discharge, heavy bleeding, and pain in the breasts. Even after the mother has had a safe delivery, she is asked to do a follow-up visit a week after the birth to ensure her safety and well-being.

Initiation of breastfeeding is highly recommended for all new mothers at all health facilities, except if medical conditions prevent this activity. Exclusive breastfeeding is promoted for all infants.

 

 

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