RESEARCH PROJECT ON THE ASSESSMENT OF MIDWIVES RESPONSES TO OBSTETRICS EMERGENCIES

CHAPTER ONE

  • INTRODUCTION

This chapter will introduce the sub-heading of the research work as follows: background of the study, statement of problem, objective of the study, significance of the study, research questions, scope of the study, areas of study and delimitation and operational definition of terms.

1.1 BACKGROUND OF THE STUDY

Emergency obstetric management are a set of life saving services that must be available in health facilities to respond to emergencies that arise during pregnancy, delivery or postpartum (Louis, et.al, 2005). Emergency services are needed to handle potentially life-threatening, direct obstetric complications that affect an estimated 15% of women during pregnancy, at delivery, or in the postpartum period even in developed countries (Paxton, et.al, 2006). The obstetric emergency response consists of medical & maternity staff trained to deal with obstetric emergencies and consist of Obstetric registrar/ consultant, Paediatric registrar/ consultant Anaesthetic registrar, Senior midwife (for departments other than maternity) and Patient Flow Co-ordinator.

About fifteen per cent of all pregnancies will result in complications. Most complications occur randomly across all pregnancies, both high- and low-risk. They cannot be accurately predicted and most often cannot be prevented, but they can be treated (UNFPA, 2003).

The United Nations Population Fund has identified Emergency Obstetric Care, to ensure timely access to care for women experiencing complications as one of the three strategies to reducing maternal mortality (UNFPA, 2003). The other two strategies are family planning to ensure that every birth is wanted and skilled care by a health professional with midwifery skills, for every pregnant woman during pregnancy and childbirth.

Globally, obstetric haemorrhage constitutes 31% of maternal death, of which 99% of these deaths occurs as primary postpartum haemorrhage (WHO, 2005). In Nigeria, 1 in 20 women die of pregnancy/delivery related causes, compared to 1 in 61 for all developing countries and 1 in 29,800 for developed country.

In 1987, the Safe Motherhood Initiative was launched; it sought to reduce the burden of maternal mortality especially in developing countries. In the application and implementation of these strategies, undue emphasis was placed on predicting and preventing obstetric complications, rather than effective and efficient management of these complications when they arise. While today, strategies are more appropriately focused. It is essential that pregnant women in whom complications develop have access to the medical interventions of emergency obstetric care to ensure favourable maternal and foetal outcomes (Ebuehi, et.al, 2013).

Research has shown that for every maternal death, there is a potential death of a child, increase in child labour, illness, malnutrition, social isolation and poor hygiene (Ebuehi, et.al, 2013). There is also, dissolution and reconstitution of the family unit, reduced productivity and loss of output. An estimated figure of over five hundred thousand (500,000) women die yearly from pregnancy related complications, about ninety nine percent (99%) of these deaths take place in  developing countries; where a woman’s lifetime risk of dying from pregnancy and related complications is almost 40 times greater than that of her counterparts in developed countries (Reed, 2000). It has also been noted that “for every woman who dies, an estimated 15 to 30 women suffer from chronic illnesses or injuries as a result of their pregnancies” all of these are preventable. Nearly all these lives could be saved if affordable, good-quality obstetric care were available 24 hours a day, 7 days a week (UNFPA, 2003).

The 2008 Nigeria Demographic and Health Survey estimated maternal mortality ratio to be 545 deaths per 100,000 live births (National Population Commission and ICF macro; 2009). These deaths are due to direct and indirect obstetric complications with the direct complications accounting for about seventy five percent (75%) of maternal deaths in the developing countries (Nadia, 2002).

Eighty six percent (86%) of these direct obstetric deaths are caused by five major medical complications: haemorrhage (28%); complications of unsafe abortion (19%); pregnancy-induced hypertension (17%); obstructed labour (11%); and infection (11%). A complication can be defined in practical terms as an event of sufficient severity that staff must respond with a life-saving procedure or referral to another facility. The response required for these direct obstetric complications have been identified as the “signal functions of emergency obstetric care” (Ebuehi, et.al, 2013)

The fact that midwives effectively manage obstetric emergencies is questionable because the incidence of maternal mortality high in Developing country. It is against this background that the study is designed to assess midwives’ knowledge in management of obstetric emergencies in ABU, Zaria, Nigeria.

1.2     STATEMENT OF THE PROBLEM

Over the last decade, midwives in Nigeria have been exposed to training on life saving skills yet, maternal mortality and neonatal mortality due to obstetric emergency is still very high. Nigeria provided 6% of the global neonatal deaths in 2005 while the country moved from the third to the second position in terms of the highest number of neonatal deaths in the world between 2000 and 2010. The Nigeria Demographic and Health Survey (NDHS) 2013 estimated its Neonatal Mortality Rate (NMR) as 37 per 1000 live births which constituted about 54% of infant mortality (Joshua O, 2015). Nigeria has one of the highest maternal mortality rates in the world, second only to India whose population is eight times larger than that of Nigeria. The WHO 2015 put the maternal mortality rate of Nigeria at 814 per 100 000 live births. This figure shows that much need to be done in combating obstetric emergency.