Lagos Island Maternity Hospital is one of the best known public health facilities in Lagos, which has for many years, served communities on Lagos Island and the larger area commonly known as the Island. Located in the heart of Lagos Island, a few metres away from the privately-owned St. Nicholas Hospital, it provides maternity care to pregnant and breastfeeding women, as well as young children. Today, in a room on the ground floor, a large number of pregnant women sit patiently, waiting for the daily antenatal care service run by the midwives. As they arrive, each pregnant woman is handed a piece of paper with a number. As each number is called out, the pregnant women go to two midwives seated behind a table; one checks her weight and the other measures her blood pressure.
In a few minutes, the lead midwife, Mrs Eunice Akhigbe, arrives with two other midwives. After greeting the women, she announces: “Let’s shake our body small’’. Akhigbe and her team of midwives carry out a program called ‘’Mamacare” across 20 health facilities in Lagos state. The program is implemented by the Wellbeing Foundation Africa, a non-governmental organization working to improve maternal health in Nigeria.
Through the Mamacare antenatal and postnatal education programme, the WellBeing Foundation provides mothers with critical information on their pregnancy, nutrition, birth preparedness finance and care of their baby. The uniqueness of this programme lies in its delivery through Wellbeing Foundation trained midwives at primary health care facilities. The programme was established in 2015 to support health workers in the provision of health education during antenatal days and immunisation visits. Mamacare uses a network of midwives who rotate between the 20 health facilities every day of the week to give these talks, while the facilities’ health workers focus on screening and provision of other services.
According to Miss Olubukola Oyedeji, Mamacare programme officer for Lagos State, the information is broken down into topics and every week, a different topic is discussed across all the facilities. The topics include nutrition-knowing the right kind of food a pregnant woman should eat to prevent malnutrition, making sure the pregnant woman and her baby maintain a healthy weight, and identifying signs of malnutrition and anaemia; and family planning – its advantages and the various contraception options available to the pregnant women after they give birth. Other topics include actions to take to prevent and manage malaria in pregnancy, how pregnant women should care of their breasts in anticipation of childbirth, how to maintain good body hygiene, preparing for labour and what to expect as the delivery date approaches.
Thursdays are set aside as registration days for newly pregnant women into the antenatal clinic. Time is devoted to teaching them how to manage challenges associated with the early days of pregnancy, such as mood swings and nausea. The midwives also take advantage of immunisation days to give women who have given birth health talks, in which they emphasize exclusive breastfeeding and complementary feeding, says Oyedeji. According to her, the main aim of the postnatal talk is to prevent child mortality, and exclusive breastfeeding is a critical factor in achieving that.
“Today we are going to discuss labour,” Akhigbe says after about five minutes of singing and dancing with the pregnant women. She starts by asking what they know about labour, especially the signs. In the now light-hearted atmosphere, various women take turns to answer amidst laughter and applause. Starting with when a pregnant woman should start expecting the signs, Akhigbe and her colleagues explain what labour is. They go on to explain in detail the three stages of labour, what happens at each stage and the likely duration. It is an interactive and engaging session, as the midwives give the women the opportunity to comment and ask questions. At every point, the importance of facility delivery is emphasised with the statement ‘’Come to the hospital once you start having signs,’’ repeated time and again.
Highlighting the many ways to have a less stressful labour and delivery, the midwives explained the important role that daily light physical activities such as walking, play in a pregnant woman’s body as she prepares to give birth. They also explained the importance of calmness during labour to help women retain strength and manage pain during the labour and delivery process.
Funmilola Aina, who is currently six months pregnant and is attending her fourth class, said the most important lesson she had learnt was on the topic of proper breast hygiene during pregnancy. She learnt that pregnant women should devote some time to cleaning their breasts daily using cotton wool and water from the seventh month of their pregnancy. This, she says will ensure that the breasts are clean enough to prevent their babies from possibly getting infected from microorganisms when they start breastfeeding. She also believes she has learnt more about managing pain during labour from the day’s lecture. “My main lesson today is taking deep breaths between the stages of labour to get more strength”, she said.
Aina wants the midwives to include caesarean sections (CS) in their health education in order to help expectant mothers gain knowledge and diffuse fear. She herself had her previous baby through the procedure. She says some women attend antenatal but end up running to traditional birth attendants to give birth for fear of undergoing a CS if they present at a health facility. Aina’s claim could be supported by the disparity between antenatal coverage and health facility delivery rate in Lagos State in the 2018 National Demographic and Health Survey. While the former was more than 86%, the latter was hovering around 75% in Lagos State.
Mrs Kenku Olaide is a 36-year-old mother of two who is attending her 8th antenatal class. She is eight months pregnant and believes the lecture she received on her second visit about nutrition has helped her eat the right kind of food throughout her pregnancy and has also made her more compliant in taking her routine pregnancy medications like folic acid. Today, she says she will go home armed with the knowledge that labour actually happens in stages, and she is sure of what happens at each stage and how long the stages last.
Pregnancy, labour, delivery and postnatal periods are critical times in the lives of both the mother and child. Not only do changes occur physically, emotionally and physiologically in the mother, they also form part of the first 1000 days of a child, which is arguably the most important period of development for every human being. Antenatal and postnatal services are essential avenues to ensure that both mother and child are in a healthy condition during this period, and any potential danger to their health is identified and treated. These avenues provide unique opportunities for health workers to discuss extensively with pregnant women about the many events that happen during pregnancy and breastfeeding and how to handle them. This health education is the cornerstone of the Mamacare program.
The World Health Organisation (WHO) identifies health education as an important pillar of antenatal and postnatal services for pregnant women due to the lifelong positive behavioural changes it instills, and its ability to provide better health outcomes for both mother and child. The Mamacare health education program not only impacts the knowledge of pregnant women, but also provides opportunities for experience sharing between its midwives and those of the Lagos Island Maternity Hospital, according to Deputy Head of Department of Maternity Care Mrs. Hafsat Bola Salaudeen.
While the Mamacare program appears to have contributed extensively towards improving maternal care in Lagos State, it could have more impact if it could also target women who do not present to health facilities for antenatal care in a way that shows them the benefits of registering and attending. The 2018 National Demographic and Health Survey revealed that antenatal coverage in Lagos state is around 86% and although this is commendable compared to states like Gombe (46%), Bayelsa (51%) and Kebbi (14%), there is room for improvement. Mamacare with its network of midwives could support the Lagos State government with technical expertise through collaboration, particularly with community and religious leaders.
Mamacare could also build on its existing laudable work by working to reduce pregnant women’s fears of caesarean section, perhaps by including it in their topics of discussion in all the health facilities where the program is being implemented. Lagos State has noted the disparity between antenatal coverage and health facility delivery rate within the state and the aim is to encourage women to attend at least eight antenatal classes, over the current four visits. In addition, the state government encourages women to give birth in health facilities. However,further research is needed to better understand the possible differences in the usage of health facilities to give birth and attendance of antenatal classes. This would be in order to develop interventions to bridge the gap.
For now, thanks to the work of midwives like Akhigbe, with the support of the Wellbeing Foundation Africa, women like Funmilola and Kenku are able to understand fully how to take care of their bodies in preparation for childbirth and their newborn child.
Do you know of other maternal health programs that work to educate women to prepare them for childbirth andhow to take care of their bodies during pregnancy and once their baby is born? Tell us on our Nigeria Health Watch social media Twitter handle @nighealthwatch and our other Nigeria Health Watch social media platforms.