In the Médecins Sans Frontières run maternity department of the Jahun hospital, staff are faced with multiple lives to save. From admission through to delivery care, to the neonatal unit, the combination of emergency obstetrics and newborn care is the key to safe delivery and recovery for mother and child in the early days after birth. Obstetrician and gynaecologist Dr Tane Luna explains why some women have such difficult deliveries in Jahun, Nigeria.
“Often they have had no antenatal care and when they’ve tried to deliver at home, they don’t have a skilled midwife with them. This means that there’s nobody able to identify if they have a complication, and what requires medical attention. Even if the pregnancy is not full term, when a problem is eventually identified it usually means that it is very severe. From that moment, through deciding where to seek care and how, and actually getting there, a lot of time has passed, and this exacerbates the mother’s condition and the circumstances for her unborn child or children.”
"As soon as a woman arrives at our hospital, a triage midwife or nurse takes vital signs to decide the severity of the condition, and then calls a midwife or doctor"
According to the World Bank, maternal mortality in Nigeria is estimated at 814/100,000 live births, but there are reports strongly suggesting it is higher in the rural north. The official estimate alone is at least 120 times higher than a higher income country rate of around seven women per 100,000 live births. Newborn mortality is also unacceptably high. “As soon as a woman arrives at our hospital, a triage midwife or nurse takes vital signs to decide the severity of the condition, and then calls a midwife or doctor. Typically, due to the severity, it is a doctor that must quickly perform the diagnosis, with an ultrasound for example. Then we decide the management plan; for example, admit for vaginal delivery or for an immediate Caesarean section. Often this decision means that whatever the baby has gone through already, he or she will be delivered prematurely and face complications because of that.”
Prompt diagnosis and quick action are necessary for problems such as hypertensive disorders (pre-eclampsia and eclampsia), which can bring on seizures, or coma. Some women experience heart failure. “Anaemia is also a very prevalent condition in northern Nigeria. This means that the level of red blood cells (haemoglobin) is low even before labour and delivery, when women necessarily bleed. So a woman can bleed to death,” Dr Luna said. In Jahun, as in all other comprehensive obstetric hospitals, Médecins Sans Frontières manages a blood bank to provide life-saving transfusions around the clock because haemorrhage can be catastrophic for mother and baby. For every new life ushered into the delivery room or operating theatre, MSF’s skilled birth attendants—midwives, doctors and obstetricians—are all trained in resuscitation, and their prompt action can avert a potential fatality. For newborns that are struggling or very sick, the newborn unit is just a few metres away. This is where a dedicated doctor, paediatrician or neonatal nurses can observe and treat the babies until they recover and can return home.
Médecins Sans Frontières has been running a comprehensive emergency obstetrics hospital in Jahun since 2008. Care is provided for free, 24 hours a day, 365 days of the year. Médecins Sans Frontières is also expanding the network of care through support of basic health centres so that women can birth safely closer to home or, if they experience complications, be transferred to the higher level of care in our hospital. We also provide staff and training for antenatal care in the same peripheral health centres.