Maternal mortality: Let’s look back to the 1980s

I WAS really touched by the story entitled “Labour of life … and death” (Lesotho Times, February 27).
As a medical doctor, I thought it important to also make my own contribution in response to the well-researched article.

Firstly, antenatal care is an assessment and follow-up of expectant mothers from early pregnancy till the onset of labour.

It is done by the village worker –– who encourages the mother to attend clinic early, the health centre nurse midwife –– who does the requisite tests and follow-up at the antenatal clinic and the medical officer –– who analyses and interprets the test results while also looking for congenital malformations of the fetus using ultrasound technology where possible at twenty weeks to determine the method and place of delivery.

If all these steps are followed well, very few mothers would need to be referred to the obstetrician.

However, the breakdown of the above essential steps has contributed immensely to the alarming maternal mortality figures in Lesotho, as what your story rightfully indicated.
This is because mothers start antenatal care very late in pregnancy if not already in labour.

They are often not seen by a doctor and even in most hospitals the doctor will only be called when trouble has occurred during or after labour.

This is when drastic measures are called for and, sadly, under limited resource levels or totally non-existent.
It is important to understand that proper antenatal care is a preventive phase in the care of expectant mothers which, if done properly, is far less expensive and more relevant and appropriate for an under-resourced country like Lesotho.

The commonest cause of maternal mortality in Lesotho is post-delivery bleeding and other related complications.
First-time delivery mothers are the commonest victims.

Pregnant women, who are otherwise healthy, can tolerate quite severe blood loss. Blood loss of up to one litre may cause no significant upset.

However, women with underlying medical problems have a much lower tolerance of blood loss.
In that case, blood loss in excess of a litre requires prompt replacement of fluid or blood transfusion in addition to obstetric or surgical measures to control the loss.

Medical conditions that develop gradually during the course of pregnancy are rare and can often be picked up during the antenatal care and referred in time.
In the 1980s, Lesotho had a vibrant primary health care programme which was the envy of most African countries.

During this period, vaccination coverage for under-fives was 70 to 90 percent and it was made possible by the district public health nurses and health inspectors. Unlike now, during that time most health centres catered for deliveries.

Village health workers were quite effective and worked hard to encourage mothers to attend antenatal clinics and deliver at health centres.

Medical officers supervised health centres monthly on a regular basis. Health centres had a reliable radio communication with each other for ease of consultation and referral.

With the advent of HIV and AIDS and other factors affecting our health delivery system, the health-care situation of this nation has deteriorated to catastrophic levels.
Indeed, we are a dying nation and we need to look back and relive the 1980s.

Dr Charles Makhube,
Mohale’s Hoek

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