How to ensure safe motherhood

Safe motherhood implies that no woman should die due to pregnancy or child birth. As per reports of W.H.O., more than 90% of maternal deaths occur in developing countries. Maternal mortality is defined as death of a woman during pregnancy or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy. It may be due to causes directly related to pregnancy and childbirth or its management. The causes may be indirect like due to an accident or homicide or other diseases not directly related to pregnancy. Many of the causes of maternal mortality are preventable. Hemorrhage or excess bleeding remains one of the principal causes of death of women during child birth. It may be due to abnormal location of the placenta which can be managed by careful monitoring of the antenatal woman and considering safe time and mode for conducting delivery. Infections causing sepsis during pregnancy or during delivery form a major cause of maternal deaths. Many women deliver at home by unskilled or semiskilled mid wives, who are ignorant about the necessary hygiene to be followed when conducting delivery. The result is tetanus, an entirely preventable disease causing many maternal deaths and also other infections which can be prevented or treated early.Due to bleeding and infections, clandestine abortions also cause many deaths. Hypertension during pregnancy leads to eclampsia of pregnancy, a potentially fatal condition if not treated urgently. Very high or low blood glucose levels can cause metabolic complications and death. Other avoidable but indirect causes of maternal mortality are infections like HIV and malaria, conditions like cardiac failure and renal failure which are aggravated during pregnancy and which complicate pregnancy. Amniotic fluid embolism, post partum thrombo embolism, DIC (disseminated intravascular coagulation leading to excess bleeding), are unpredictable, unavoidable causes of death during delivery. Multiple pregnancies make women more vulnerable to rupture of uterus and other obstetric complications, which are potentially fatal. Apart from these, there are indirect causes of maternal deaths like domestic violence. Maternal mortality ratio, i.e. the ratio of maternal deaths per 100,000 child births is one of the indices of health status of any country. Causes of high maternal mortality in developing countries are multiple. Lack of money for transporting a pregnant woman frequently to antenatal clinics, makes a pregnant woman miss the much needed surveillance during pregnancy. Thus many conditions like hypertension and diabetes which can be detected early and suitably managed are left unattended. Due to ignorance and poverty, a woman does not get enough rest and adequate nutrition which is needed during pregnancy, thus making her sick and vulnerable to diseases. Due to ignorance regarding potential complications of pregnancy and child birth, family members do not consider it necessary to make use of the facilities provided by the government at primary level. For them, the time spent in taking their pregnant wives to antenatal clinics can be used for doing some work and earning some money. There also exists a typical male mentality, “what is so special about this one being pregnant, millions of women in the world conceive and deliver everyday”. Little do these men realize that pregnancy is an altered state of the body that causes change in hormonal levels, increased need for nutrients like iron and calcium, and increased vulnerability to diseases? Due to this kind of mentality men also do not hesitate to inflict violence on pregnant women. Maternal mortality is not a question of merely one woman dying. It disrupts the family as a whole. The baby born if is able to survive, lives the life of an orphan deprived of maternal love and care. Entire management of the household goes awry. Therefore, there is need to sensitize people regarding good antenatal care. They should make use of facilities for regular check up and immunization of pregnant women. They should be counseled about nutritious diet so that in the available resources, a lady can get necessary balanced food during the antenatal period. Attention to personal and environmental hygiene is important and should be emphasized to avoid infections. Pregnancy and child birth, is the prime time when a couple is acquiescent to advice regarding family planning. Thus by adopting contraception, they can avoid multiple unwanted pregnancies and maternal sickness and deaths. To ensure a safe motherhood, good team work and coordination of social workers, counselors and health care providers is needed. When all concerned in the society work together for this objective, it is only then that we can ensure that no woman dies while giving birth. rachna212002@yahoo.co.uk