Rwanda is among the developing countries with high maternal mortality rate of 1,400 deaths per 100,000 live births, and infant mortality rate of 114 deaths per 1,000 live births but this trend is going to change with the training to equip maternity unit personnel with emergency skills.

The trainees in this programme included Gynaecologists, nurses and midwives; post graduate students hoping to be specialists, clinical officers working in maternity and doctor interns.

Dr. Jean W. Kagia, a visiting consultant obstetrician/Gynaecologist and Kenya’s National Coordinator of Advanced Life Support in Obstetrics (ALSO) says it is achievable to save mothers from death risks by treating them as quickly as possible before they get life threatening complications during pregnancy and at child delivery.

Dr. Kagia recently officiated at a two-day training on needed emergency in maternity units called, ‘Advanced life support in obstetrics (ALSO),’ that took place at King Faisal Hospital. The training aimed at equipping maternity unit personnel with emergency skills.

Fertility rate

Nearly a quarter of the country’s nine  million people are between the ages of 15 and 24 years, with a total fertility rate of over five children per woman which exposes many women to risks of maternal mortality.

"Under the Millennium Development Goals, every country wants to reduce death rates, Rwanda is among the countries which would wish to have her death rates reduced,” Kagia said.

The consultant notes that with the necessary skills and improved way of handling new born babies and helping mothers before and after delivery, the death rate can be reduced.

The training looked at women’s health during pregnancy, especially women who may develop emergency cases who need quick attention before developing life threatening complications.

During the training, issues handled included conditions affecting early pregnancies which are the primary causes of the increased miscarriages and maternal mortality rates.

Others issues include pregnancies that develop outside the womb like in the fallopian tubes (ectopic pregnancies), which may burst and cause death to the mother if not detected and dealt with at an early stage. Bleeding after delivery or late pregnancy bleeding may also cause death.

"After giving birth, the bleeding comes because the uterus does not contract easily. If a mother lacks blood, she may die,” Kagia says. Some mothers tear during delivery.

"This is common with someone who has ever had a caesarean birth and goes to the hospital late. The uterus tears as a baby tries to come out, causing severe bleeding,” she said.

For people who have ever had miscarriages, bleeding occurs due to weak womb muscles. The other cause of bleeding is late delivery of the placenta or when half of it comes out, making it hard for the uterus to contract.

High blood pressure too leads to more problems for mothers, who acquire it before or during pregnant. In few cases, one may lose normal ability for blood to clot when pregnant, thus leading to bleeding.

This is normally possible if the fluids from the baby enter the blood streams of the mother, interfering with the blood’s capacity to clot.  

The other problem the consultant noted is the wrong side of the baby coming out first, such as when it comes with legs first instead of the head.

Sometimes, babies who are big compared to the mother’s size, in such cases mothers may fail to have a normal delivery leading to death.

Also, babies born under distress and cannot wait till normal delivery, according to Dr. Kagia, may die and cause problems to the mother.

To handle the above maternity problems, she says, ALSO helps medical personnel get to know the medicine to be administered and the tactics to be employed in such cases.

Death of babies after birth (prenatal mortality) Dr Kagia says can be reduced if maternity users know more about complications that lead to babies’ death.

It is normally hard for babies to pick up the breath due to prolonged labours, they get tired and lose breath in the process, she says.  She advises that as soon as the baby is out, they should clean its (baby) air way. And give it right drugs to support it.

"All means should be tried to give them oxygen, medically called neonatal resuscitation,” she said.

The 34 ALSO trainees from different hospitals in Kigali will have to do theory and practical exams in order to qualify and be able to train others.

There are other eight maternity users who were trained in Kenya undergoing assessment as to qualify to train more personnel.

Trainers use a humanist way of teaching, where people learn from the models (using plastic models to represent humans). Trainers say that this would help the trainees to remember what they did on the plastic models, while applying it on human beings.

Another formula used to remind maternity users on how to handle different situations is Pneumonic. Letters are used in formulas to remind them of the method to use on different cases. The trainers noted that there are people who work in the maternity wards yet they are not specialists in the field.

"The training gives them skills that help them to hand the babies to the specialists when every thing is fine and not to wait for specialists who may take long to reach the babies,” Kagia explains.

Efforts here are to ensure safe delivery to mothers, and skills of getting babies out through different approaches, and medicine that can be used. 

Safe delivery

The head of department, Obstetrics and Gynaecology at King Faisal, Dr. Janvier Rwamwejo, said the trainings would help the country see people deliver safely and have health babies.

He said if Rwandans would qualify to teach others on safe delivery, maternal and infant mortality rate would tremendously reduce.

Meanwhile, Gregory J. Raglow, Medical Director Family Practice Centre in Banner Good Samaritan Medical Centre in the USA, also an ALSO trainer donated maternity ward equipments worth $10,000 to Rwandan hospitals.

He said he mobilized the equipment from different dealers, citing OB manufacturers who donated OB vacuum devices, Simulaios and a friend who preferred not to be named gave Imanikin (plastic models).

The training equipments were to be given to Kanombe Military Hospital, Kibagabaga Hospital, Muhima, Rwinkwavu, Kigali Health Institute (KHI), and King Faisal Hospital (KFH), which were represented in the training.

"Now Rwandans have all the equipment they need for such trainings,” Rwamwejo said, adding that the American Academic family physician will donate more equipment.

Ends