It takes a child to change a village, as some birth attendants learn

The AKU works with ‘dais’ on how to tackle 24 difficult labour situations.

Mahnoor Sherazee June 25, 2011


Noori Hussain, 25, a homemaker from rural Sindh, winces as she tightens her grip on the sides of the hospital bed. Four hours into labour, Noori is due to have her first child, a boy she is told. But that isn’t the only first for this young woman from Bhambore. She is also the first woman in her family to deliver in a healthcare facility. For women like her in underserviced villages, babies are born at home with the help of traditional birth attendants or ‘dais’.

“[Pre-birth] and post[birth] care are last, if at all, on the list of priorities for a major chunk of women living in the rural parts of the country,” explains Dr Mehnaz Memon, a gynaecologist and obstetrician and a research coordinator for an Aga Khan University (AKU) project on maternal and newborn health.

A glance at performance and diagnostic charts at the Rural Health Centre in Gharo, where Noori was admitted, reveals just under 1,000 women visited the facility for pregancy care so far this year. In comparison, during the same period, just 231 women were treated for post-pregnancy care. Women in both categories are a small section of the community with access to this centre which caters to a few surrounding towns and about 600 nearby villages.

“Until a pregnant woman begins suffering complications, her family does not bother bringing her to a healthcare facility (HCF). For post-natal care many families depend on lady health workers as they provide a door-to-door service,” explains Rukhsana Ansari, a healthcare official at the rural health centre.

The same is true for Noori’s case. “Three days prior to her delivery she began suffering intense pain and we figured she needed injections so we brought her here [to the centre],” says her aunt who is also a ‘dai’. If it were not for the excruciating pain, her husband Hussain admits delivery in a healthcare facility was not an option. Hussain is four years younger than his bride who he married barely a year ago. When asked if he planned to wait before the next child, he promptly replies, “Why? No. There’s no need. We’ll see what happens.” It is the same reaction in many other households.

Keeping this in mind, the AKU’s department of Community Health Sciences organises training sessions for birth attendants in smaller groups each week while larger groups meet once a month. The project started two and a half years ago and is still in the data-collection stage. It is scheduled to be completed this September.

The department’s community mobilisation specialist, Khadim Hussain Mangi, has 19 years of experience in the field. He understands attitudes, which is why he works with people from different cultures in a bid to persuade them to adopt new teachings and skills. “Even though some families have started taking their women to healthcare facilities, by and large men in rural areas are against this. It is therefore crucial to properly train and equip local dais who deal with village women on a regular basis.”

Training includes pictorial presentations depicting a step-by-step procedure of handling a woman shortly before and during labour, a demonstration with a life-sized model of the process of delivering a child, followed by a question-and-answer session in which the trained birth attendants get a chance to clarify any concerns.

The AKU team recently held a training session in Mirpur Sakro that 14 birth attendants attended. They are responsible for the care of pregnant women and safe childbirth in over 70 surrounding villages. They all have horrifying experiences to share. Prior to these sessions, they had no idea why certain complications were occurring and what was needed to be done. “I was once delivering a child who had turned upside down inside the mother. Finally, I managed to pull most of the baby out, but the head got stuck. When the child eventually came out, it began having fits and died 15 minutes after I cut the umbilical cord,” says 50-year-old Khaira who works in five villages. Some birth attendants did not give any importance to cleanliness or even washing their hands. One admits she still uses a scissor to cut the umbilical cord, which she now washes and reuses. The remaining women switched over to using disposable blades.

Birth attendants are trained to tackle 24 of the most common situations during pregnancy and childbirth. For example, they learn about the proper position for an expecting mother, the cleanliness of the surroundings where the child is to be delivered. Further teachings include steps to be taken when a child turns to the side while still in the womb.

Others teach them how to deal with a delay in delivery or how to treat a new born who is having difficulty breathing.

The role-play was perhaps the most interesting part of the session that was conducted by Dr Memon and her colleague Dr Lubna. Memon took on the role of the birth attendant, while Khaira was the expecting mother and another team member, Shahnaz, posed as the pregnant woman’s mother-in-law. As Memon’s demonstration reached its conclusion with the birth of a baby girl, Khaira mischievously began crying like a newborn baby. Giggles erupted among the birth attendants who had moved in to watch the demostration.

“That’s the sound of change,” remarked Mangi.

Published in The Express Tribune, June 26th, 2011.


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