Training of midwives stressed
KARACHI- Midwives can help reduce maternal mortality rate drastically but the government does not attach enough importance to the education, training and development of midwives.
This was observed by Dr Laila Gulzar, a Pakistani academician who teaches midwifery and nursing at an American university, while delivering a lecture at the PMA House on July 23 evening.
Pointing out that every 20 minutes a Pakistani woman lost her life during childbirth, she urged the government to take worthwhile steps to reduce the rate of maternal mortality.
Dr Gulzar said in the developing countries there was generally a lack of cooperation and coordination between the doctors and midwives, as the former treated the latter as competitors. “But the fact of the matter is, both can work side by side,” she told the audience. The midwives could go to the rural areas, where the doctors generally do not go, and provide services to the pregnant women there.
Dr Gulzar said that the government should realize the importance of midwifery in the health care system and come up with effective programmes to train the midwives properly.
Speaking of the problems affecting the existing programmes, she said the trainees were not given hands-on training. “As a result, many of the qualified midwives cannot supervise deliveries,” she said.
She pointed out that the midwives acted as the backbone of any emergency obstetrics care system. “But unfortunately, this country does not have an emergency obstetrics care system at all.” She called for the establishment of such a system without delay.
Dr Qaiser Sajjad, secretary of PMA’s Karachi chapter, demanded of the government that in every public sector health centre unit there should be 15 nurses or midwives for every doctor.
“This is the ratio approved by the WHO and we demand that it be adopted by the health department as soon as possible,” he added. Dr Shershah Syed of the PMA’s central chapter made a presentation on maternal deaths in Pakistan.
He mentioned that 30,000 mothers died in the natural process of child delivery while 40 cases of relevant morbidity were reported every minute in Pakistan, where the situation appeared to be a little better than Afghanistan and a few African states, adds APP.
He said that the scenario was almost static for the last nearly 56 years despite a considerable increase in the number of highly qualified obstetricians and gynaecologists. He opined that it would be only through presence of competent and committed midwives that the unnoticed deaths of mothers and the plight of children left behind be addressed.
Dr Shershah said that while even in urban areas of the country only 60 per cent of women preferred to avail institution- based services, the large majority in rural areas were largely left without skilled health care personnel.
According to him, it was during the last few years that due consideration was being extended towards the needs of local mothers. Sindh had taken the lead in establishment of midwifery schools, he said. The problem, however, was the dearth of adequately qualified trainers, he added.
Earlier, Dr Laila Gulzar stressed on team approach coupled with meaningful coordination among policy makers, midwives, nurses, gynaecologists to help contain high maternal mortality and morbidity rates.
She said that the high incidence of maternal death as well as related complication could not be curtailed lest a mutual trust was developed among obstetricians, gynaecologists, nurses and midwives and concerted efforts were made on their part to influence the policy makers for adequate budgetary allocations for improved facilities ultimately preventing avoidable loss of life and complications.
Reiterating urgent need for modification in the existent hospital-based structure of delivery services and turning it more mother-friendly with maximum involvement of mothers and relevant families, she acknowledged the limitations of health care professionals in the country.
Dr Gulzar said that midwives on the basis of their experience could provide the policy makers well-documented data and facts turning the latter to adopt a real sympathetic attitude towards the issue.
She regretted that 500,000 mothers died each year across the globe as a result of pregnancy and child birth complications. Observing that no less than one million of children are left motherless as a result of maternal deaths while much higher numbers of families are affected due to the very situation, she maintained that these human issues needed to be taken into account by each and every segment of society.
According to her, since midwives are the first-hand witnesses they can play a multiple role of a health care provider as well as researcher to turn the existent structure human-friendly. The presentation was followed by question-answer session.