By Dr Karen Cummings
(Minister within the Ministry of Public Health, Dr Karen Cummings)
MATERNAL and Child Health should always be at the top of the list of priorities of any health sector. In our public health system in Guyana, it is no different. In an effort to improve the health of women and children of our nation, the Ministry of Public Health (MoPH) must ensure that motherhood is safe. Safe Motherhood basically means “safe pregnancy.”
This process of preparation starts from childhood. It includes health care from preconception, following through to conception; then care throughout the pregnancy until the safe delivery of the baby.To ensure that every woman gets this privilege, each health facility should provide adequate “safe motherhood” services. Maximum results can be achieved if several key factors are considered. Firstly, patient-safety includes a safe living environment for the patient as well as confidential medical service.
Secondly, cultural competency and community policies are also essential and facilitate the engagement of traditional medicine as well as modern evidence-based practices. These factors would help patients feel more comfortable and cause them to be willing to participate, resulting in better women’s health care services. The “Safe Motherhood” strategy includes five pillars.
1. Preconception Care
2. Access to quality Antenatal care
3. Identification and management of high-risk pregnancies
4.Clean and safe delivery
5. Access to Postnatal care
Preconception Care
Under this banner, family-planning services and counselling for all patients – male, female, single or married – are provided. In this period, persons are prepared mentally for parenthood and are educated about what to expect when they become parents.Sexually Transmitted Infections are discussed and tests for the same offered.
The importance of waiting for specific timing for child-bearing is explained, along with the value of appropriate spacing between pregnancies. Exclusive breast-feeding is also discussed with both males and females.All the basic sexual and reproductive rights are explained to individuals during this time. It is important to have one-on-one sessions with patients to prevent unwanted pregnancies and promote responsible use of contraceptive methods.During these visits, patients are screened for breast and cervical cancers. Preparation means having a completed immunisation card for both parties.
It also means that regular exercise is pursued and balanced diets are consumed. If the correct food groups are not consumed in the right amounts, then a woman’s body would not be ready for pregnancy. Balanced diets are encouraged to prevent simple oversights such as Anaemia, which is a serious but correctable condition. If Anaemia is not treated in a timely manner, both the patient and the baby can experience complications during the pregnancy.
During this period, in addition to balanced meals, pregnant mothers are encouraged to start using Iron and Folic Acid tablets, which incidentally help to protect the baby against Neural Tube Defects (problems with the spinal cord).Healthy lifestyles also mean no alcohol or illegal drugs during this time.
Access to quality Antenatal care
The Ministry of Public Health is currently working to ensure that every mother has access to a health facility during her pregnancy.
According to the recommendations made by the World Health Organisation (WHO), a pregnant mother must have at least four (4) antenatal visits. 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.
All pregnant women should be treated for intestinal parasites and given iron tablets and folic acid.During antenatal visits, the fathers are encouraged to be present and to actively participate so that all the counselling on hygiene, breast-feeding and birth complications could be discussed as a team.Patients should be aware that from their first visit, they should have a complete physical examination done by the medical personnel. On completion of the examination, the clinic information would be duplicated and one copy would be given to the patient, while the other is kept in the health facility.
The patient’s family history is recorded and any health condition should be revealed to the doctor, as this might affect the treatment needed for the safe and healthy delivery of the baby.At each visit, the patient’s weight, height, blood pressure, heart rate, urine test and sugar test are done. This data also includes measurement of the mother’s abdomen and palpation to define the position of the baby. A device is used to check the baby’s heart sound.
Identification and management of high-risk pregnancies
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 or > 35 years old), lifestyle (use of drugs and alcohol, smoking, obesity), existing health conditions (High blood pressure, diabetes, sickle cell, anaemia) 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 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
All our health care facilities throughout Guyana where deliveries are done should have a skilled birth attendant present. The presence of this person helps to ensure the safety of the mother and the neonate. The health care facility should have systems in place in the event of an emergency.All health care workers should be able to recognise obstetric emergencies and call for immediate help.
Everyone, including Community Health Workers (CHWs), needs to be re-evaluated every two years to ensure their skills are evaluated and upgraded. 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
Before discharge from the health facility, the mother must be aware of alarm signs which include fever, smelly vaginal discharge, heavy bleeding, and pain to 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 breast-feeding is highly recommended for all new mothers at all health facilities, except if medical conditions prevent this activity. Exclusive breast-feeding is promoted for all infants.
At this first postnatal visit to the health facility, the health care personnel should check to see that breast-feeding is being done, unless it is medically unindicated.At this visit also, we would also initiate the conversation about family planning, so that the mother would be able to make an informed decision about spacing of her children.
In an ideal world, zero maternal death is the benchmark, but this goal can be an almost impossible task. However, the cooperation and education of our population help to promote and ensure “safe motherhood” for all our womenfolk. The Ministry of Public Health asks all citizens to work collaboratively to reduce the maternal mortality rate across Guyana.
