Home Births Contributing To Maternal Mortality

Lazarus Sauti

In Zimbabwe, just like any other country, a new born child is looked upon as a gift to the family and society at large.

Because of this, pregnant women expect the successful delivery of a healthy, bouncing baby.

Nevertheless, maternal mortality remains insidious, especially in rural areas as pregnancies end in losses, killing the mother, baby or both.

“The causes are numerous, the occurrences diverse and the circumstances complex,” said researchers, Munyaradzi Kenneth Dodzo and Marvellous Mhloyi.

In the study titled “Home is the best: Why women in rural Zimbabwe deliver in the community”, published in the PLoS ONE journal in August last year, Dodzo and Mhloyi assert that the main causes of high maternal mortality in rural areas are deliveries without skilled staff, equipment and drugs, as well as deliveries in conditions that are not conducive for safe delivery.

Moreso, the study confirms that women prefer home deliveries due to perceived low socio-economic and opportunity costs involved plus diminishing quality and appeal of institutional maternity services.

According to the Zimbabwe Demographic Health Survey (ZDHS, 2015), about 20 percent of Zimbabwean births over the past years occurred at home whilst 77 percent of live births in the five years took place in a health facility.

The survey also showed that the country recorded 651 maternal mortality cases per 100 000 live births every year.

In addition, the Ministry of Health and Child Care reported that a total of 582 maternal mortality cases were reported in 2017.

Gender equality supporter, Norman Muvavarirwa says the 20 percent of home deliveries reported by the ZDHS is a high number given the country’s high maternal mortality rate.

“The figure shows that women, especially in rural areas are still at risk of maternal deaths in the country,” he said.

A nationwide cohort study of 146 752 women in the Netherlands with low-risk pregnancies has also shown that there can be undesirable effects to both mother and child if a delivery occurs at home.

“Two out of every 1 000 women died while giving birth at home and 55 percent of the home birth women experienced a hemorrhage, or dangerous amount of lost blood,” noted the study.

Furthermore, the study declared that there is a 26 percent risk reduction if a woman gives birth in a hospital.

“This is likely because if emergency treatment is necessary, like a caesarian section or the need to put a child on neonatal assistance, as well as routine procedures, like removal of the placenta or ensuring the woman is not losing too much blood, the hospital can immediately provide that care,” stated the study.

Published in the BMJ Journal, the study further stated that if things go wrong during a home birth, emergency assistance must be sought at a hospital, not by the one or two midwives that may assist a woman at home.

“Time spent getting to a hospital could be the difference of life and death for either the newborn or new mother,” affirmed the study.

While 288 women in the study died during a home birth, only 141 women died during a hospital birth.

This shows that the availability of rapid care is highly important, especially given that there are two lives involved, a fact supported by Muvavarirwa.

“Home birth can be a beautiful experience, but unforeseen things can go wrong,” he said. “Women can hemorrhage and lose lots of blood.”

Muvavarirwa, who is also a journalist, believes there is need to raise awareness, as well as come up with policies that will ensure that women choose health institutions as the safest and convenient places of delivery.

For development practitioner, Cynthia Chanengeta, delivering at home is correlated with higher risk of maternal deaths, and for that reason, reducing the number of home deliveries is imperative to improve maternal health.

“One of the reasons why mothers still deliver at home is the long distance from the nearest maternal clinic,” she said, adding that to reduce maternal mortality, access to health facility by pregnant mothers need to be improved.

Sharing the same sentiments, women rights defender, Anoziva Marindire, advocates for “the establishment of basic obstetric care facilities, especially in rural areas and more efficient emergency referral systems.”

Blogger and project coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health, Sarah Hodin, believes the use of maternity waiting homes (MWHs) is a workable solution for rural women, but “communities should be involved in the design, implementation and monitoring of these homes.”

As for the United Nations Children’s Fund (UNICEF), one critical strategy is ensuring that every baby is delivered with the assistance of a skilled birth attendant which generally includes a medical doctor, nurse or midwife.

“Experts agree that the risk of stillbirth or death due to intrapartum-related complication can be reduced by about 20 percent with the presence of a skilled birth attendant,” noted UNICEF.

Reflecting its importance in reducing maternal morbidity and mortality, skilled birth attendance was included as indicator 3.1.2 (Proportion of births attended by skilled health personnel) under goal 3 (Ensure healthy lives and promote well-being for all at all ages) and target 3.1 (By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births) of the Sustainable Development Goals (SDGs).