Pregnant and resident in Nigeria? Read this.

Pregnancy in Nigeria like most other health issues carry significant risk; and unlike many other health issues, has  almost countless myths and old wives tales associated with it.
Being pregnant in Nigeria means you will get a lot of unsolicited advice; both good and bad but here are some things you need to know and practice.

Photo credit: americanpregnancy.org

(1). Being pregnant and giving birth in Nigeria is a miracle; you need to do same in a developed country to realize that. And like all miraculous occurrences, you need to appreciate it and handle it with utmost care. Take your prenatal vitamins as much as you can and try your best to eat well and stay healthy.

(2). Get yourself registered for antenatal checkups at a good health facility. As it relates to pregnancy, a good health facility is one with at least one midwife on duty at each point in time. There are so many private health facilities in Nigeria made up of one or two doctors and no licensed nurse. Such places could be tolerable for medical checkups where you will have little or no contact with the so called nurses they parade there but when it comes to pregnancy, especially as it would likely be the nurses who would handle delivery, please go to a facility that has a licensed midwife. Licensed midwives know their limits, they do not take most unnecessary risks as they have in-depth knowledge of the likely consequence of whatever action they take. They also know which complications are within their power to handle and how fast you need to get to a doctor when they need arises. Most times, they have a doctor on call who can handle emergencies. So when choosing a facility for your antenatal and child delivery services, look beyond  the doctor's qualification to that of the nurses. If need be politely ask the nurses which nursing school she attended. They are usually the ones that handle birth and afterbirth care. Many maternal or infant deaths have been linked to the nurses and you certainly do not want to be part of the statistics.

(3). If possible register for birth in more than one health facility. It is always good to have options. For example register at one place near your place of work and another near your home; or at one government-owned facility and another good private hospital. With pregnancy you never can predict when or where you will need the best of hands to handle a complication. Hospitals tend to act faster when you are a registered patient of theirs. Besides you would not want the doctors to wait for test results before attending to you.

(4).  Take medical advise only from doctors or licensed nurses/midwives. Experienced mums are not in the best position to do so, neither are religious leaders. Forget all the old wives tales and myths associated with pregnancy, or at least get your doctor or nurse's opinion concerning them. And please stick to medical advice; get second, third or even more medical opinions if your instincts demand so, but let the final decision be based on a medical advice.

(5). Ensure your doctor/nurse is someone you are very comfortable with, also let him/her know your birth plan. Do you intend trying a vaginal birth after a Cesarean Section? Discuss it with them let them be the ones to guide you through it and if they deem it too risky, get another opinion if need be but stick to medical advice. A healthy mother and baby is the most important outcome of a pregnancy, not the method of birth.

(6). If your practitioner ever mentions the need for you and your pregnancy to be monitored, PLEASE PLEASE and PLEASE let them do so. That is why you need a skilled and licensed practitioner who identifies risks when he/she sees them, you also need one you trust to always take decisions in your best interest. Complications often do arise in pregnancy and child birth,  and almost all times can be handled effectively by skilled medical practitioners.

(7).  After delivery, if your practitioner suggests the need for further monitoring in the health facility, please wait. Beyond pregnancy is the puerperium which can also pose a risk to new mums. Understandably, few hospitals in Nigeria are comfortable enough for a new mum to relax in after birth, but when there is need, remain under the professional eyes of your practitioner till you are declared fit to go home.

(8). If you do not have one already, get yourself and your family health insurance. Out-of-pocket payments for medical bills can be very expensive and inconvenient. Click here for more details


Always bear in mind that the cost of loosing one's life during childbirth is very high. While taking whatever decision during pregnancy look beyond the now; beyond the food you need to cook and the chores undone. Your family needs you beyond now. Several mums have lost their lives as a result of their  preferrence for one more domestic chore over their being monitored in a health facility when it was needed.

We look forward to a time when maternal health indications in Nigeria will shift from what is currently obtained to something better; when pregnancy in Nigeria will be no more risky. We all need to join hands to achieve that. We need to play our parts while we hope health practitioners play theirs.

Methods of child delivery and what we as Nigerians need to know about them.

 

We would for the purpose of clarity,  and the different kinds of persons this write-up will reach divide methods of childbirth into 3.

The first and most common is the natural child birth method. It involves vaginal delivery of the baby without intervention; as per no pain medications and no use of whatever tools to 'bring out' the baby. It is the most preferable and recommended mode as the new mother heals very fast. In cases where medical treatment is done out-of-pocket, this method is the least costly. Midwives alone can handle this delivery method.

Next is the Cesarean Section . This mode of childbirth involves a surgical incision into a pregnant woman's abdomen and uterus to bring out the baby. Although can be an elective procedure, it is usually done when one of either the mother or the baby's life is in danger. It is much more costly than the vaginal mode of delivery and is handled by much more medical personel than the natural childbirth method. In the delivery room would be a doctor, a midwife, an anesthesiologist etc. Healing is usually longer and more painful than the natural method and the new mother is usually expected to stay longer in the hospital as she will be monitored till she is deemed fit to go home.

The third is the vaginal but assisted childbirth. Assistance here could be in the form of epidurals, forceps, vacuum extractor etc. The mother is aided in delivering her child either by numbing the labor pains or using devices to 'extract' her baby vaginally. This method of childbirth is not common in Nigeria and needs specific monitoring and child delivery devices not seen in a majority of the hospitals in Nigeria.

Whatsoever the mode of childbirth, the most important issue is the life and well-being of the new mother and her baby. No method diminishes the challenges of a pregnancy, none invalidates a mother, none makes one a better mother than another. They all make the new mothers face varying types of challenges during delivery and the healing process. They all make one a new mother at the end.


In as much as the natural childbirth method is preferred, there are cases when it is not possible or medically advised. A pregnancy can come with certain challenges that could make a medical practitioner rule out natural childbirth; all in a bid to save the life of mother or child or even both. If that happens to be an expectant mother's case, she can seek a second, third of even more medical opinions from medical doctors and midwives but  NEVER religious leaders or other mums. Refusal of interventions during childbirth has been known to cost lives of either mother or child and sometimes both. No one has ever won an award for natural childbirth, at least not in Nigeria. So if interventions ever get recommended, get another medical opinion (if there is time left for that) and stick to medical advise. Except the slower healing pace and the deep hole it can dig in one's pocket, there is absolutely nothing wrong with assisted childbirth when it is needed to save lives. What is wrong is loosing one's life or that of the newborn as a result of one's refusal of assistance during delivery, and contributing to the already unacceptable maternal and child mortality rates in Nigeria.

NIGERIA'S TREND IN MATERNAL MORTALITY

The World Health Organisation recently released a document titled "Trends in maternal mortality: 1990 to 2015". That document left my heart bleeding. Despite recording a 44% reduction in global maternal mortality rates from 1990 to 2015, Sub-Saharan Africa accounted for 66% of the maternal deaths, with Nigeria accounting for 16%. The average annual change in maternal mortality rate in Nigeria since 1990 to date was placed at 2%.

Forget the statistics and the figures, we are talking about human beings; women like me (and maybe you), our mothers, sisters, friends, colleagues and neighbours.   We are taking about 867 maternal deaths per 100,000 live births in this age and time. If you are a Nigerian reading this, you'd know this figure could probably be less than the true figure as countless deaths go unreported. Hardly are the deaths in rural areas recorded. We need to really do something about this ridiculously high figure. We need to help save mothers from avoidable deaths. How? Get informed. Get enlightened. Throw away those behaviours, cultural and religious beliefs that put our lives at risk. Some of which are addressed as follows.

Get medical attention once pregnancy is confirmed. You don't necessarily have to wait for the traditional 16 weeks post-conception to seek medical attention. Given the very high maternal mortality rate, we in our part of the globe should seek medical attention ASAP. This ensures that whatever that could go wrong is noticed early and if possible nipped in the bud. No matter how experienced you are, as per how many kids you've had, get early attention. Maternal death knows no experience.

Eat healthy.We have countless myths surrounding what to eat and what not to eat in pregnancy. It seems the very foods which are necessary are forbidden in pregnancy. Foods like plantain, snails, meat, eggs, etc carry laughable myths that make the uninformed mum keep away from them. If in doubt, ask the TRAINED midwife or doctor nearest to you. 

Take your prenatal  vitamins. With the nausea that often accompanies pregnancy this aspect is often difficult, but try in whatever possible way to achieve it as your well-being and that of your unborn baby depends considerably on it.

Rush to hospital once you aren't sure what is happening to you.  I was well known in the two places I registered for birth as I kept appearing off and on schedule for even the slightest disturbance. I had a myriad of questions to ask and when one doctor or midwife didn't have a convincing answer, I asked another. I knew almost everything that could go wrong at whatever stage and their signs. I believe one should rather be paranoid and safe than careless and dead.

Pray. We are a religious people so I wouldn't forget to emphasise the need for prayers. At whatever stage, seek the grace of God to accompany you. But do not replace medical attention with prayers, each has its own role to play. 

Push myths aside. We have so many myths surrounding pregnancy with some bothering on the diabolical. Stick pins to your cloth, never cross your legs, never scratch your tummy, never spit on the wall, bla Bla bla. Some of which are from the pit of hell. Please put them aside. Don't even give heed to all the visions and dreams people tell you about.

As much as possible, give birth at a registered health facility with at least a midwife in attendance . 

Heed your doctor's or midwife's advice. Many maternal deaths have occurred as a result of the mum's refusal of assisted birth. If your doctor suggests a cesarean section, if you aren't convinced, seek a second or maybe third opinion from a medical practitioner and not your pastor or man of God.

The issues to address are countless. When in doubt, ask your midwife or doctor. Even though we have a medical system which leaves so much to be desired, the ridiculous death rate can be drastically reduced when we do what is up to us. We should do those up to us while those in charge of policies and laws guiding right and wrong in maternal care do theirs. 

May we lose neither our lives nor that of our loved ones in the process of bringing forth.