WITH postpartum haemorrhaging (PPH) being one of the leading causes of maternal deaths in Guyana, the Midwife Association of Guyana (GMA) and Guyana Nurses Association (GNA), in collaboration with the Ministry of Public Health, on Monday held a training session on “Postpartum Hemorrhaging”, conducted by Obstetrician-Gynaecologist, Dr. Narine Singh.
Singh, who has over 35 years in the profession, notes that even as more is being done to prepare healthcare providers to deal with PPH, the onus is also on patients to play their part in mitigating risks. “Join clinic early, take the advice from the midwife, use the iron supplement,” Dr. Singh encouraged expectant mothers.

PPH is a condition whereby a woman bleeds heavily after giving birth, and though it usually happens within one day of giving birth, it can happen up to 12 weeks after having a baby. “Some of the risk factors we can deal with, but they [the patients] have a role to play also,” Dr. Singh said. “With the doctor and patients collaborating, we can put a dent on the incidents of maternal deaths in Guyana. Lots of times there are risk factors that we could change; that could prevent PPH from happening. So we encourage women to join the clinic as early as possible,” he added.

Here in Guyana, antenatal care is provided free of charge at all health centres and other public health facilities across the country. Another risk factor associated with PPH, Dr. Singh said, is anaemia, a condition in which there is a deficiency of red blood cells or haemoglobin in the blood.

Anaemia is combatted by iron supplements, which are given to expectant mothers, also free of charge, during the course of attending antenatal clinics. It comes in the form of oral tablets or something called ‘Sprinkles’.

ANTENATAL CLINIC
“Women can attend antenatal clinic early, and we can identify risk factors in them so that they can be monitored and followed up closely so that when they do go into labour, we are prepared for them,” Dr. Singh said, adding: “When the nurses give the ‘Sprinkles’ for iron supplementation, use it. A lot of times they take it home and don’t use it, then when they turn up at the time of delivery, their blood count is low.”

Noting that becoming pregnant too frequently, called multi-parity in medical parlance, can also lead to maternal death, Dr. Singh said, “One of the things we encourage women to do is family planning. A person with 10 children coming in is at a high risk of haemorrhage. The WHO has shown that effective family planning can help to reduce maternal deaths by one-third.”

Like antenatal care and iron supplements, varying forms of contraceptives are also available free of charge at most health centres and public health facilities across the country. “Contraceptives is another thing that we should focus on; it can reduce maternal deaths,” Dr. Singh said, adding: “Access contraceptives; it’s available! Just don’t wait for it to happen; plan your pregnancies.”

Guyana has been placing much emphasis on reducing maternal deaths over the years.
Since 2009, the maternal mortality rate in Guyana rose to 92.2 deaths per 100,000 live births, and has been continuously rising since. In 2018, Guyana recorded a mortality rate at 229 maternal deaths per 100,000 live births. The global maternal death rate is 211 deaths per 100,000 live births, which is still exceedingly high.

“This collaboration between MAG, GNA and MoPH is quite appropriate and timely. If we are going to strengthen our midwifery services then we are going to have to invest in educating our care givers. In order to build their capacity to deliver timely lifesaving interventions designed to ensure safe delivery and prevent infant maternal morbidity and maternal mortality in Guyana,” noted Deputy Chief Nursing Officer Lalinie Dass.

“We have had our fair share of maternal deaths over the years; 2019 is no different. Some were avoidable, and some were not,” she said. “PPH has always stood out as the top cause of maternal deaths in Guyana. Today’s session is focused on addressing the management of PPH. Give your undivided attention in order to take away valued information and techniques and to accelerate your efforts in effective management in PPH.”