Pregnancy complications are usually undetectable during early stages and often become apparent during labour, especially if expecting mothers do not go for regular checkups.
By Phyllis Mbanje
For women who live far away from health facilities, such complications can be fatal.
Serious postpartum haemorrhage (bleeding within the first six hours after delivery) is one of the leading causes of death of women and babies in Zimbabwe and other African countries.
According to World Health Organisation (WHO) statistics, the maternal mortality ratio (MMR) for Zimbabwe declined from 960 to 614 deaths per 100 000 live births between 2010 and 2014.
However, despite this decline, WHO still feels the death rate remains unacceptably high as Zimbabwe’s millennium development goal (MDGs) on reducing maternal mortality was to reduce the maternal mortality rate to 71 deaths per 100 000 live births by 2015.
As a way to achieve MDG5 which has to do with reducing maternal mortality, the maternity waiting home strategy was designed to counter and mitigate these challenges, and became an option to ensure safe motherhood.
According to WHO, it was generally accepted that more women from remote areas would be able to access maternity facilities in time if they were accommodated at maternity waiting homes before the onset of labour.
The Zimbabwe Maternal and Perinatal Mortality Study (ZMPMS) says the risk of maternal and, or neonatal death is increased by delivering outside a health institution. The study identified maternity waiting homes as a facilitating factor for delivering at health institutions and recommended that all rural women in Zimbabwe be offered this facility for at least three weeks before delivery.
The practice has for years been in place at many state health delivery centres in rural areas and has substantially contributed to the reduction in maternal and perinatal mortality.
Many women have benefitted from these homes, commonly referred to as “matumba” (temporary shelters). In a recent tour of health institutions in the Midlands province, it was evident that the waiting shelters were critical in the reduction of the maternal mortality rate which is still very high in the province.
Twenty-eight-year-old Oripa Siyaurembo from Mutimutema, Gokwe, who is expecting her fourth child, said she lost her baby while giving birth at home.
She said since then she had vowed to deliver all her babies in the presence of qualified health personnel. We met her at the maternity waiting home at Gokwe hospital.
“I nearly died when I had my second child. The waters broke while I was alone at home. Had it not been for my neighbour, I could have died,” she said as she narrated her ordeal in a small yet determined voice.
“I was on my way to the borehole after seeing off my husband who had gone to the next village to visit a sick relative.
“The waters broke on the way. The contractions were very fast. I knew it was time, but the clinic was very far and there was no one to take me there in a scotch cart,” she said.
She said she then rushed to her neighbour’s home, scared the baby would come any minute.
Unknown to the women who assisted her, the baby was in breech position. Breech means that the baby is in a bottom-down position and such cases require surgery if the baby does not turn on time.
“My first birth had been uneventful so I did not expect any challenges but after a few pushes, I knew something was wrong. It felt like the baby was stuck and no amount of pushing would yield anything,” Oripa said.
Word was sent to a local traditional birth attendant who, upon arrival quickly picked that the baby was in breech position.
“I remember her saying ‘baby is coming feet first.’”
A local businessman came to the rescue and provided transport to the nearest hospital where health personnel helped her deliver but unfortunately, the baby died.
After this experience she said she made sure she went to a maternity waiting shelter early, before labour, to avoid another frightful experience.
Although many women have benefitted from maternity waiting shelters, there are challenges such as overcrowding that are besetting the waiting shelters. It is a result of many expecting mothers turning to the shelters, health officials said.
At Gokwe hospital, the available shelter is overcrowded and has no ablution facilities, forcing the expecting mothers to use the bush system to relieve themselves.
Constructed by a generous donation from the Japanese government, some of the structures at the home are now badly in need of repair.
“They [Gokwe maternity waiting homes] are currently being run by the local authority and the women are charged $10 for their stay,” said Takunda Sola, the district medical officer for Gokwe North. He said as long as council remained in control, there was little that the hospital could do.
“We have plans to adopt the waiting shelters but until then, our hands are tied,” he said.
Several partners have joined hands with the health ministry in constructing more homes. In April the Organisation for Public Health Interventions and Development (OPHID) officially handed over 11 homes to the Rushinga community.
Speaking at the function, the OPHID director Barbara Engelsmann said: “Increasing facility births is not only a priority for the success of maternal new-born and child health programmes, but also for prevention of mother-to-child transmission of HIV and elimination of pediatric infections.”
Meanwhile, Zimbabwe has been experiencing a sharp rise in teen pregnancies and according to the Zimbabwe Demographic Health Survey for 2010-2011, fertility rates for girls aged 15-19 increased from 99 to 115 per 1 000 girls.
More rural teenage girls fell pregnant compared to their urban counterparts, largely due to poverty which drove them to marry early, the report says.
“My first child is 11 years old. I married early because as an orphan it was very hard to survive. I just wanted someone to look after me,” said Oripa.
She said early marriages and teenage pregnancies in rural areas could have been one of the reasons why maternity waiting shelters got overcrowded.