Maternal, neonatal deaths rise for skilled-hand shortage

Most C-section unnecessary: Experts

SM NAJMUS SAKIB | Thursday, 11 August 2022

Manpower crisis in government healthcare facilities is blamed for higher maternal and neonatal deaths, experts observe.

They also find most C-section done in Bangladesh hospitals and clinics unnecessary.

District hospitals and community clinics trail badly with less than 50-per cent manpower-nurses and midwives to deliver maternal services, officials tell the FE.

Zobaidul Islam (32) took his spouse to Lalmonirhat district hospital last November. Before delivery, both mother and the foetus were medically sound.

"But after hours of a normal delivery, the infant had a serious seizure and turned blue. The baby needed life support…," he tells the FE while narrating the story.

"After four days of no progress, we shifted our baby to a private hospital in Rangpur. Our baby survived after about a week of ordeal. It cost nearly Tk 350,000."

"The doctors told us that an unskilled nurse, instead of a trained midwife, led the delivery and hurt the baby's head during the process," he laments.

A World Bank estimate shows the number of infant deaths in Bangladesh is now 21 per 1,000 live births.

And, according to health ministry, the number of maternal deaths is 165 per 100,000 live births.

Bangladesh needs to reduce the maternal mortality numbers to less than 70 per 100,000 live births to meet the UN-set sustainable development goal (SDG).

Noted gynaecologist Prof Dr Samina Chowdhury says, "Pregnant mothers need sufficient time and skilled midwives to ensure normal deliveries, but we don't have such arrangements at rural healthcare facilities."

"We need to increase the number of midwives to support doctors, maternal care and ensure safe motherhood."

Government data shows some 86,000 nurses and midwives are working in the country which needs 200,000 more to fill the gap in line with a WHO recommendation.

Meanwhile, unnecessary C-section has increased at an alarming rate because of the poor healthcare system.

C-section is a major operation that can cause uncontrolled bleeding and long-term health effects, Prof Samina, also former president of Obstetrical and Gynaecological Society of Bangladesh (OGSB).

Public-health expert Dr Lelin Chowdhury suggests a holistic approach to come out of the crisis of reducing maternal and neonatal deaths.

"We cannot prevent unnecessary c-section until we can ensure quality time for pregnant mothers and raise the number of midwives," he says.

The WHO says Bangladesh needs three nurses and five technicians against a doctor. But it has a nurse against two doctors and a single technician against five doctors.

Dr Lelin points out that the average age of being a mother has crossed 24 years, thus risking her health and rising C-section as elasticity to give birth normally reduces with age.

According to Save the Children, 77 per cent of all C-sections were medically unnecessary in 2018 which is rising at an alarming rate.

"Labour pain is normal for a pregnant mother. We have to accept this," he adds, suggesting formation of a monitoring cell to determine it C-section was needed.

Dr Md Mahamudur Rahman, director of Maternal and Child Healthcare Services, says major causes of mortality are post-partum bleeding, child marriage, late delivery, menstrual regulation and unsafe abortion.

Deaths in unsafe abortion are seen in the country. The abortion rate was 1.0 per cent in 2010 which increased to 7.0 per cent in 2016.

"Such deaths are rising, but we don't have an official record," says Dr Rahman, adding that the major cause of maternal death is unsafe delivery at home.

Fifty-per cent deliveries in rural areas happen at home, mostly blamed for post-partum or uncontrolled bleeding that often lead to maternal death.

Again, 43 per cent of the total deliveries at home happen with the help of unskilled midwives or senior female family members, mentions Dr Rahman.

"We need the readiness of facility at nearby hospitals or community clinics to convince pregnant mothers and their family members for a safe delivery."

"We have readiness like infrastructure and drugs but we don't have sufficient midwives to conduct a safe delivery," he continues.

"We're running with less than 50-per cent manpower like midwives and nurses," he laments, saying: "Most of the country's 3,364 such clinics are running without any trained midwife or nurse."

"We need at least two midwives at a clinic and three at a district hospital. So, at least 8,000 posts of midwife need to be created to ensure safe pregnancy."

Some 5,000 midwives graduate from public and private institutions annually, but the government cannot recruit them as district and community clinics do not have approved posts for them.

Health ministry has asked the nursing and midwifery directorate to prepare a proposal to create necessary posts at government hospitals.

"We are working on it, Dr Rahman tells the FE, hoping to ease the crisis soon.

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