Saving African mothers with clean delivery kits

In the West, when women get pregnant, they gosh about how the baby kicks and are eager to find out about the baby’s gender.

African women have much more to worry about.

An average pregnant woman in Africa is worried about giving birth safely. They are scared for their lives and their babies because of the flawed healthcare system. They worry about affording antenatal and postpartum care. They don’t know how to get money to pay for their hospital bills. And if there’s a complication, they are at a loss on what to do.

It is worse for women in rural settlements, and Healthcare centres are usually located in towns and are inaccessible to pregnant women in faraway villages. These women risk giving birth on their way to the hospital and, as such, enlist the services of Traditional Birth Attendants (TBAs) to give birth in their homes.

However, these rural women do not know that they are putting their lives and the lives of their babies at risk. Research has proven that women who give birth at home are more susceptible to complications that could result in death or life-altering disabilities. Some of these complications include haemorrhage, hypertensive disorders and infections.

Data according to United Nations reveals that Sub-Saharan Africa holds two-thirds of the global maternal deaths. At the same time, UNICEF ranks Sub-Saharan Africa as the region with the highest maternity mortality ratio, with 200,000 maternal deaths and 1.42 million newborn deaths per year.

However, most of the complications that result in maternal and infant mortality are preventable.

Post-partum haemorrhage is defined as blood loss of 500 mL or more within 24 hours after delivery or within 42 weeks of delivery. If a healthy mother is left ignored, severe hemorrhage after birth can kill her within hours. Injecting oxytocin immediately after labor minimises the risk of bleeding significantly.

Hypertensive disorders are a collection of conditions that are characterised by high blood pressure during pregnancy, proteinuria, and, in certain circumstances, convulsions. The most significant complications of these disorders for the mother and child are pre-eclampsia and eclampsia. Pre-eclampsia medications, such as magnesium sulfate, can reduce a woman’s risk of developing eclampsia.

Infection is common in Sub-Saharan Africa. Puerperal sepsis is a term used to describe uterine infections caused by bacteria entering the uterus during labour. Endometritis, myometritis, and parametritis are the three primary kinds.

Let’s dwell more on infection as one of the major causes of maternal and infant mortality.

Infections developed after birth cause 10.7% of maternal fatalities and 23% of newborn deaths. Delivery in the home under unsanitary conditions is a key contributor to neonatal and maternal infections, increasing the likelihood of harmful germs entering the mother’s cord stump of the neonate or birth canal. Tetanus toxoid immunisation for pregnant women effectively lowers tetanus-related neonatal and maternal fatalities.

Clean hands, a clean blade to cut the umbilical cord, a clean cord to knot the umbilical cord, and a clean sheet for the mother and baby to lie on after delivery, as well as two clean towels or cloths for drying and swaddling the newborn infant, can considerably lower the risk of infection.

Research by the WHO suggests that pre-assembled clean delivery kits (CDKs) with instructions for use can be a vital component in improving hygiene at delivery, particularly for deliveries conducted by unskilled care providers. Clean delivery kits promote and support clean delivery practices, specifically the ‘six cleans’ defined by the WHO, i.e. clean hands, clean perineum, clean delivery surface, clean cord cutting implement, clean cord tying, and clean cord care.

Clean delivery kits normally contain just six items: a bar of soap, a plastic sheet to deliver on, a razor blade to cut the umbilical cord, a clean string for tying the umbilical cord, gloves and a pictorial instruction sheet that illustrates the sequence of delivery events and proper hand-washing.

Clean delivery kits have incredible potential for improving the health outcomes of mothers and babies; they can be made accessible to remote villages and are affordable for poor rural women.

For more effectiveness, governments and INGOs should integrate community health workers and traditional birth attendants to effectively disseminate the kits to remote communities and villages far from health facilities.

Public and private hospitals should incorporate the delivery kits in antenatal programmes to inform pregnant women of the benefits and encourage them to buy in preparation for their due date. The health workers can adopt a weekly or monthly contribution payment model so that pregnant women contribute in instalments and can afford their delivery kits even before their due date.

Also, government and INGOs should organise programmes at local and community levels to train community health workers and traditional birth attendants on safe, effective and updated birth practices. Their training curriculum should include how to use clean delivery kits.

DO Take Action run a project, Mother Delivery Kit. The Mother’s Delivery Kit Project is a campaign to distribute sterile birthing kits for safe delivery in underprivileged communities. The Maternal Delivery Kits are designed for home use by untrained and trained birth attendants (TBAs) and women delivering alone.

The content of the kit and the use of its items are as follows:

Sterile razor blade: to cut the umbilical cord

Soap and water: this is used by the mother in labour and the health worker or birth attendant to wash their hands clean.

Gloves: are worn by the health worker or birth attendant to protect the hands and prevent bacteria.

Gauze: is used to control bleeding.

Pads: are worn by the woman after delivery to absorb blood.

Antibacterial wipes: are used to clean the vagina.

Baby cord clamp: is used to tie the umbilical cord.

Delivery mats: are used to provide a clean surface for the mother and child during and after delivery.

Infant receivers: are used to wrap the newborn baby and keep them warm.

Misoprostol: is a drug used to control bleeding.

Instructional pictorial: this guides the health worker or birth attendant on the correct use of the items in the kit.

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