Vivian Ihechu, News Agency of Nigeria (NAN)

Every woman looks forward to a safe birth experience and going home with her planned baby after delivery.

However, in Nigeria, the journey to birthing is usually dicey, so much that it has become a concern for the country and the international community.

In 2016, Mrs Mummy Nkoronye was full on joy and expectations as she shopped for baby items and made plans on how to travel to the village in December to present her “new’’ baby, as it is customary, to her mother in-law.

But when she went into labour at a health facility in the Ikorodu area of Lagos, no one expected that it would be a tough one.

That was her fourth journey to the labour room; the labour was prolonged and she wasn’t advised to take another alternative or intervention. Unfortunately, her husband was not immediately available at the hospital to decide on what measure could have been taken.

Her sister in-law, who narrated the account to the News Agency of Nigeria (NAN), said that the health workers lack of sense of urgency aggravated the matter.

Nkoronye eventually underwent a Ceasarian delivery but the baby was already distressed and had died; unfortunately also, Nkoronye lost her life, adding to the number of maternal mortality.

Maternal mortality as defined by the World Health Organisation is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accident or incidental issues.

Mrs Vivian Oha says she was attending antenatal classes at one of the General Hospitals in Lagos and the experience was actually fantastic to her.

However, things started going sour toward her Expected Delivery Date (EDD).

“I was expected to deliver on the first day of June that year; so by the last week of May, I went for an Xray/Scan and they gave me an incorrect reading; it was sealed and I was told to give it to my doctor.

“When I came out, I personally checked the result and saw that I was given a date in August, an extra two months.

“I went back to the radiographer and the response was like, Madam what is it? We have given you your result.

“I said I suspected an error and rather than hear me out, they were all nasty and shouting at me, asking if I was a doctor; a shouting match ensued.

“Amid the exchanges, a doctor came in and intervened. I explained and it was discovered that I had been given a wrong reading.”

The doctor was furious with the other health workers and apologised because the baby had actually been struggling to come out; almost suffocating.

Oha was promptly put on bed and two days later, she was delivered of a baby through Cesarean delivery or C-Section.

At the FCT in June 2018, Mrs Priceless Uka had gone into labour on a Sunday evening when her baby was just at six months gestation.

She and her husband went to a couple of public hospitals looking for a facility that had an incubator; they didn’t attend to her because she wasn’t registered at their institution, some told her to pay an exorbitant amount; she was rejected.

It took the intervention of a “Samaritan doctor’’ to transport them to a facility in a suburb of Abuja which agreed to take care of her; baby J came out on his own. Unfortunately, Baby J died at his seventh month, after a month in the incubator.

Mrs Adebimpe Oba told NAN that in November 2018, at the General Hospital Igando, Lagos, those of them that were at the emergency ward were made to sleep in the open air one night.

While she could not exactly say why the patients were left to sleep outside overnight and in the cold with mosquitoes, her grievance was that the patients, even pregnant women and those on drip slept outside without explanations or apologies.

“What if I had gone into labour that night? What if I had malaria as a result of the mosquitoe bites? What if I had contracted cold?’’ she asked NAN

NAN investigations show that many factors are responsible for the very high maternal and newborn deaths and they will require different kinds and levels of interventions to ameliorate the situation.

These factors include obstetric and non-obstetric factors which are not limited to haemorrhage, infection, unsafe abortion, obstructed labour, prolonged labour, eclampsia, anaemia, poor attitude of health workers (nurses, midwives, doctors etc), poor healthcare services and delays.

Also, cultural biases, inability to make prompt decisions, unavailability of transportation to access health facility, lack of life-saving equipment, unskilled attendants, negligence and strikes are contributory factors to maternal mortality.

However, the attitudes of health workers have been found to play very critical roles during pregnancy, during child birth and after child delivery.

One of the biggest lapses is the inability of health workers and medical professionals to detect these signs of complications early before they degenerate.

It is also sad that these complications could have been tackled or prevented with the right and essential interventions if the workers had put the right attitude, dedication and empathy to it.

It has been recorded that over 90 per cent of deaths in Nigerian hospitals are due to poor attitude of health workers.

Thomas Agan, the Chief Medical Director (CMD), University of Calabar Teaching Hospital (UCTH), had disclosed the information on Sept. 19, 2017.

Agan, who doubles as the Chairman, Committee of Chief Medical Directors of Federal Tertiary Hospitals in Nigeria, had said that some health workers were not taking the lives of patients seriously in spite of their professional training and work ethics.

“Until healthcare givers in our hospitals begin to realise that the health of the patient he/she is handling could be his own, his wife or siblings, things will not go well.

“Until we realise that we will be held accountable for every challenge we create, things will not go down well.

“Our oath, for instance, says we should preserve life from conception to death; this means that the life that is entrusted into your hands must be preserved,’’ he had said.

His statement substantiated some accounts of women who told NAN the ordeal they had gone through in the hands of health workers, including midwives and nurses while pregnant or giving birth in hospitals, especially public hospitals.

Mrs Ij George, a mother of three who uses a public health facility in Lagos, is yet another person who narrated to NAN her near fatal experience.

“I gave birth to a set of twins about five months ago in a private hospital because my last experience with the workers in a public facility left a bad impression.

“I almost had a miscarriage at 11 weeks; I was bleeding and went to a public hospital.

“I was crying, pleading and wailing to be attended to with immediacy but they insisted that we do the registration and paper work before any form of first aid or help could be given to me.

“I told them my husband can pay for all of those while they attend to me, but they refused saying that was the procedure.

“We left to a private hospital where I was attended to while my husband sorted out the registration and other issues.

“They actually looked at me first because it was an emergency; they rushed me into a room, checked me, scanned to see how the foetus was doing and eventually stabilised me,’’ she told NAN.

Mrs Folake Iyanu said her baby came out as still birth having gone through long and hard labour without the doctor or midwife showing sense of urgency or even being empathetic.

“The doctor was not accessible and when he showed up, he was detached; the baby eventually came as still birth,’’ she wept as she recounted the incident to NAN.

These situations are some of the practical examples that could have contributed to Nigeria’s high maternal mortality indices.

According to the United Nations International Children’s Emergency Fund (UNICEF), maternal and newborn mortality and morbidity in Nigeria is one of the highest in the world with an estimated 574 maternal deaths for every 100,000 live births according to Nigeria Demographic and Health Survey (NDHS 2013).

Nigeria contributes about 10 per cent of global burden of maternal deaths and the health indices are particularly very poor in the northern part of the country.

Also, a joint report, “Trends in Maternal Mortality: 1990 to 2015’’ by WHO, UNICEF, World Bank and United Nations Population Fund, estimates that Nigeria has approximately 58,000 maternal deaths, accounting for 19 per cent globally.

A joint report by UNICEF, WHO, United Nation Population, UNFPA and World Bank revealed an increase in maternal deaths in Nigeria between 2011 (55,000) and 2015 (58,000).

To make the scenario worse, Mr Bill Gates, Co-Chair of the Bill and Melinda Gates Foundation, in early 2018 said that “Nigeria is one of the most dangerous places in the world to give birth.

“It is also the 4th country with the worst maternal mortality rate after Sierra Leone, Central African Republic and Chad.’’

It is also known that Lagos State alone accounts for 24 per cent Maternal Mortality Rate in Nigeria.

In a 2013 statistics by the NDHS, the maternal mortality rate in Lagos State was put at 555 per 100,000 live births with a contraceptive prevalence rate of 48.3 per cent.

These indices are so worrisome that the Minister of Health, Prof. Isaac Adewole, says: “We must reduce maternal mortality. Our women are not disposable — when a woman dies, the baby is likely to die and the communities suffer.’’

To address the high maternal mortality rates, Adewole in July 2017 inaugurated a 34-member Taskforce to accelerate reduction of maternal mortality in Nigeria, yet the complaints still remain.

Mrs Elegance Alegba, who also gave birth at a public facility in Lagos, said the care she got was not personalised.

When she went into labour, she was almost hounded with “Madam, you no fit push? A beg push, you wan kill your baby?, Stop shouting,’’ ; these were a few of the words that keep replaying in her memory.

What could be the factors responsible for health workers poor attitude?

NAN learnt through questionnaires and direct interviews that the causes below may be contributory.

However, these are not excusable and should not be allowed to continue as health workers’ attitudes and behaviors pose an impediment to the actualisation of patients’ rights and health outcomes.

NAN also met with some stakeholders to proffer solutions to this malady.

Prof. Oladapo Ladipo, Obstetrician and Gynecologist, attributes the poor attitude of some health workers to environmental change.

“I can trace it back to the 1980’s when the senior staff were retiring or emigrating to greener pastures, especially to the Gulf states of Saudi-Arabia and Oman.

“So, we lost a crew of role models who were trained locally and abroad, now the younger ones don’t have somebody to mentor them.

“There are certain behavioral patterns of each professional personnel in the health sector that you don’t read in books, rather you acquire them by association.

“We lost that aspect; also the fact that some health workers think they know it all, is wrong.’’

For solutions, Ladipo, who is the Lead/Co-founder of the Association for Reproductive and Family Health (ARFH), said: “It is very unfortunate that in recent times we have had a lot of complaints by pregnant mothers about attitude of health workers, both doctors and midwives.

“It needs to be addressed because what we promote now is respectful birthing, you must respect your client, your patient.

“Surveys consistently demonstrate that one of the reasons why people do not go to deliver in government facilities is the way they are treated, both in the north and in the south.

“The last NDHS 2013 observed that only two out of five pregnant women were delivered by skilled birth attendants, even though three out of the five attended ante-natal clinic.

“They will rather go to where they will have somebody care for them, show them empathy rather than shout or scream at them.

“Every client should be respected and when you show compassion, you get more information that will guide your process of making diagnosis and proffering the appropriate treatment,’’ Ladipo said.

He advised health workers, doctors and midwives saying: “You are paid to look after sick people, pregnant women and your rapport with your patient sometimes helps to cure many things.

“It maybe, your good counselling, good manners that can help to resolve most problems of some patients.’’

To the government and health facilities, he said: “We have to go back to the training programme, training institutions to educate the students and those coming into the programme to respect their client at all times.

To patients, Ladipo said: “In terms of disciplinary measures, I think patients who have been offended should report to the chief medical director and if necessary purgative measures should be taken.

“It is not acceptable for anybody to be rude to a pregnant mother and when people are indicted for misbehavior, I think things will begin to change.’’

Also, Dr Rotimi Coker of the Lagos State University Teaching Hospital College of Medicine (LASUCOM), said that qualitative service delivery by health workers is a non-negotiable attribute.

“The right attitude is important; our patients are not stable emotionally and we need not compound their problems; our attitude goes a long way in making lasting impression on people,’’ he said.

Coker said that health workers should imbibe the right attitude to work and possess excellent qualities that would distinguish them in their career as people that save lives.

“As healthcare providers, we must be friendly, respectful, polite, helpful, optimistic, proactive, compassionate and honest; we must enjoy our work and always make ourselves available for work as life savers,’’ he said.

Dr Joan Oluyemi, Service Improvement Officer, Lagos State Ministry of Health, say: “As health workers, we should be diligent in delivering service to our patients.

“We should care about what people will say about us because the impression we create matters a lot as it is our representative.

“We should also have complimentary attitudes; we must greet our patients, assure them of solutions to their problems and be patient with them,’’ she said.

A former Chairman, Lagos State House of Assembly Committee on Health Services, Mr Segun Olulade, urges health workers to be prompt and efficient in healthcare services.

According to him, what is needed is efficiency from health workers and not more hands as “we have many doctors, nurses, record officers and so on who can provide world class services.

“Everybody is expected to do his or her duty without delay,’’ the lawmaker said.

According to Olulade, the state will not make the desired progress if its workers will not change their attitude to work.

In summary, the WHO in its new guidelines says that individualised, supportive care is key to positive childbirth experience, especially as every labour is unique and progresses at different rates.

It is said that about 830 women die from pregnancy or childbirth-related complications around the world every day, the majority could be prevented with high quality care in pregnancy and during childbirth.

WHO identifies that disrespectful and non-dignified care is prevalent in many health facilities, thereby violating human rights and preventing women from accessing care services during childbirth.

So, achieving the best possible gynaecological, physical, emotional, and psychological outcomes for the woman and her baby requires a model of care in which women are empowered to access professional and satisfying care that focuses on safe birthing outcomes for the mother and child.

Moreover, positive attitude of health workers is not a choice, it is a necessity; attitude is important because it is infectious, especially when it comes to patients and outcomes.

A positive attitude reduces mistakes and accidents in a health facility, can increase high performance and guarantee patient satisfaction; in fact, it can earn one good rewards.

A good case is the case of Mrs Adefolakemi Oladimeji and Mrs Olufunmilayo Oyekunle who were rewarded with N200,000 each for outstanding services, following praises by patients at the Isolo General Hospital, Lagos on Feb. 28, 2017.

Two members of the Lagos Assembly Committee on Health Services, Messrs Segun Olulade and Jude Idimogu, who honoured them during the committee’s visit to the hospital, said the gesture was an effort to promote excellence.

So, beyond the workplace and patients, having a good attitude also benefits the health worker because it earns one good reputation, gives way for promotion and advancement and influences all other areas of life.