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Teaching Birthing Skills to Save Lives in Katsina State

 Demonstration at the training with the Commissioner of Health — in Katsina, Nigeria.

Tackling High Mortality Rate During Pregnancy and Childbirth

Nigeria’s maternal and infant mortality rates are the highest in Africa and second highest in the world.

As UN statistics reveal, more than two million Nigerian women live in rural areas and 70 per cent of deliveries in Nigeria are performed by Traditional Birth Attendants (TBAs). In such a scenario, keeping birth attendants abreast of the best practices is crucial to reduce the alarmingly high mortality rates.

To meet this challenge, Brown Button Foundation (BBF) and Women Farmers Advancement Network (WOFAN) came together to organise three-day long refresher training on safe delivery methods for TBAs and Community Health Attendants (CHAs). 

The training, conducted during April 8–11 2013 in Funtua, Daura, and Katsina senatorial zones of Katsina State, was co-funded by Service to Humanity Foundation (SHF), and Ministry of Women Affairs, Katsina State.

Learning New Lessons and Clearing Some Air

TBAs-in-DauraTraditional Birth Attendats in Daura The air was charged and the atmosphere electric, as the auditorium reverberated with the cheering and clapping of excited TBAs and CHUs gathered to undergo the much-awaited training. About 150 TBAs and CHUs participated in the training, 50 from each senatorial zone.

The training covered various important topics on safe delivery methods, including the female reproductive system and menstruation, early signs and symptoms of pregnancy, antenatal care, nutrition during pregnancy, danger signs during pregnancy, maintaining a clean birth area, personal hygiene of birth attendants, importance of using sterilized equipments during childbirth, labor, placenta care, early referral, and recordkeeping of births.

The ill-effects of the TBAs’ various harmful practices, such as using hands to check the fetal position in the womb and applying toothpaste or herbs on the baby’s abdomen after cutting the umbilical cord, were discussed. The explanations provided helped the TBAs understand why these practices are unacceptable in the health sector.

The birth assistants were also told to stop the habit of giving more priority to the placenta than to the baby.

Setting up the Guidelines for Maternal Health

The TBAs and CHUs were also told not to assist the first birth of any woman.

Every woman with her first pregnancy must be referred to a clinic for the birth. If no complications arise, the TBAs can assist the woman with her subsequent childbirths; however, if the first delivery faces complications, then each subsequent delivery needs to be performed in a clinic and not by TBAs.

This will help reduce the death rate of mothers with records of complicated childbirth. The TBAs were also told to ensure early referrals during complications.

It is widely believed that pregnant women trust their TBAs more than any other regulatory body, and hence the TBAs were enjoined to speak to pregnant women about the importance of breast feeding and the need for emergency savings right from the day their pregnancy is confirmed.

The TBAs were also encouraged to introduce the concepts of family planning and maintaining a gap of at least two years between childbirths to ensure the mothers’ safety.

Interacting with the Community

Brown Button Foundation advised husbands to allow their wives access to antenatal care and hospital delivery system.

Pregnant women were advised to save at least ten naira a day so that they can have enough money to fulfill their pregnancy needs and also purchase low-cost sterilized birth kits. Pregnant women were also informed about the importance of nutrition during pregnancy. They were shown some samples of locally made food that contained essential nutrients needed during pregnancy.

The training facilitators also demonstrated the use of clean birth kits.

A Successful Q&A Session

A Q&A (questions and answers) session allowed further facilitation of knowledge for the TBAs and CHUs. Here are some examples:

  • A TBA asked if hot water could be used to sterilize the blade/scalpel. The trainers explained that some bacteria can survive even at 100 °C, and hence fire should be used for sterilization. At the same time, it was emphasized that one blade should be used with only one patient in order to avoid infection.
  • Another TBA queried about effectiveness of applying toothpaste on the newborn’s abdomen after cutting the umbilical cord. The trainers clarified that toothpaste served no purpose and may, in fact, lead to infection. The birth assistants were told to use methylated spirit after a day or two.

Presentations by the Birth Assistants

A short drama was presented by the TBAs on the importance of early referral.

The TBAs and CHUs later gave oral evaluation and appreciated the organizers for acknowledging the importance for their work. They all discussed what they learnt and how to put their learning into practice.

The training ended with the TBAs and CHUs singing songs in their native dialect, which were woven around importance information related to breastfeeding, immunization, antenatal care, delivery and postnatal care.

The End of the Session with Hope for More

First-Lady-with-BBFKatsina State First Lady with Brown Button Foundation Team HeadThe wife of the Executive Governor of Katsina State, Hajiya (Dr.) Fatima Ibrahim Shema, distributed birth kits, mosquito nets, baby Trwrappers, and a sum of twenty-five naira to each participant, on behalf of Brown Button Foundation.

The session concluded with votes of thanks given by the trained TBAs and CHUs, who thanked the First Lady, BBF, WOFAN, and SHF and hoped for more such fruitful training sessions.

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