‘Risk of maternal deaths higher in low-risk or normal deliveries as safety is taken for granted’

The first cry of the baby often signifies jubilation, signals for distribution of sweets, and sets frayed nerves to rest. But all is not over with the birth of the infant, gynaecologists caution, for the mother still requires close attention — something that is often overlooked.

“The State government extends monetary support to women for deliveries, provides medicines during pregnancy, and operates a fleet of ambulances. Despite all this 85 of every one lakh women who deliver in Tamil Nadu die during childbirth; so there is something wrong in the picture,” says Jayam Kannan, president, Tiruchi Obstetrics and Gynaecological Society (TRIOGS).

TRIOGS in association with its parent association FOGSI (Federation of Gynaecologists Societies of India) is training doctors and nurses in conducting safe deliveries, with the objective of bringing down maternal mortality ratio in the district which is 71 per one lakh deliveries.

Although the district and State ratio are relatively better than the national ratio (105), the organisation is keen on leaving no stone unturned.

“Tamil Nadu may have already achieved the Millenium Development Goals of reducing maternal mortality, but we must aim at European and international standards where women dying during childbirth is 8 in one lakh pregnancies,” says Ramani Devi, vice-president, TRIOGS.

Normal deliveries

“It is of utmost importance to monitor the mothers for one or two hours after the delivery,” says A. Charmila, secretary, TRIOGS.

Contrary to popular notion, it is not the high-risk pregnancies that are common cause of maternal deaths. “When it’s a high-risk delivery, the doctor is highly prepared to face any complication. The chances for maternal death are higher in low-risk or normal deliveries as they are taken for granted.”

The initiative to check maternal mortality is a joint collaboration between FOGSI and Jhpiego, a non-profit organisation affiliated with John Hopkins University, U.S.A.

Dr. Jayam Kannan and Dr. Ramani Devi, senior obstetricians from Tiruchi, were among the handful of doctors from South India, trained by Jhpiego.

As master trainers, they impart practical training to various obstetricians, apart from nurses. “It is not enough to talk about preventing maternal mortality, but to deal with the ‘how’ of it and also apply the methods practically,” says Dr. Jayam Kannan, summarising the statement by Hema Divakar, president, FOGSI.

Check bleeding

“We are focussing on two major causes of maternal, mortality post-partum haemorrhage or bleeding after delivery and eclampsia (seizures which may occur due to high blood pressure), which account for at least 65 per cent of maternal deaths,” says Dr. Jayam Kannan. A small act like massaging the abdomen of the mother for 15 minutes after delivery to ensure the dilated uterus has contracted can help in preventing maternal deaths, doctors point out. “Nurses are often the first persons who come in contact with pregnant women and equipping them to prevent maternal death is important,” says Dr. S. Chitra.

Training PHC workers

More than 30 per cent of maternal deaths occur in primary health care centres and reaching out to paramedical staff there is crucial, say doctors.

Although nurses and nursing students in GH and more than 200 nursing staff from private hospitals in Tiruchi have been trained, (most at Indian Medical Association Hall on Friday), workers in primary health care are yet to enrol.