Agony for midwives

LERIBE – WHEN labour pains began for ’Mabakuena* late last year, her loved ones sensed disaster. The nearest health centre, Khabo Clinic, was 10 kilometres away and the only way to get there was by foot – a two-hour long walk.

So, to buy time, the women who were accompanying her to the clinic tied a stone on her lumbar spine.

Basotho believe that such a practice delays the labour process.

A woman who had accompanied her tried calling Mom & Baby services for a car without success.

The Vodacom Mom & Baby service is a free mobile health intervention that provides Vodacom subscribers with maternal, neonatal and child health information designed to encourage good health practices among pregnant women, mothers, partners and caregivers.

When that failed, that was when she thought of loading a heavy rock on ’Mabakuena’s lower back to delay the labour process at least until they could reach the clinic.

They called a village health worker who kept informing the clinic about the challenges and also asking for a car that never came.

The village health worker too believed in the stone ritual and they walked to the clinic with the expectant mother who was about to deliver.

A midwife who helped the woman told thepost last week that they were shocked when ’Mabakuena arrived, especially because she went into labour once the stone was removed as she entered the clinic.

The story was narrated during a media tour of clinics as part of International Midwives Day commemorations to be observed worldwide tomorrow and organised by the United Nations Population Fund (UNFPA).

Lack of access to health services because of long distances between some villages and clinics is putting many lives in danger, especially pregnant women who struggle to cover the long distances.

Such challenges inspired one villager, ’Mantabejane Ntabejane, to become a village health worker.

Ntabejane said she helped herself give birth to her first child 45 years ago because she stayed far from the clinic.

She is now part of several village health workers assisting people in over 50 villages that access services at Khabo Clinic. She became a community health worker in 1993, a voluntary role she took after getting basic training on health issues.

It is not only in Khabo where patients have to walk long hours to reach the nearest health centre. Rather, it is the norm in many mountainous and foothill regions, from Mohale’s Hoek to Leribe along the eastern side of the Maloti-Drakensberg ranges.

Tlaleng Motaba, a midwife since 2019 at St Denis Health Centre in Leribe, says the clinic serves 53 villages and people living in two of them, Ha-Makepe and Ha-Pentše, walk for three to four hours to access services.

Worsening the situation, the clinic suspended antenatal services in October last year because of drug shortages.

“Sometimes it happens that I am alone at the clinic so I have to manage everything. I have to do all I can by all means to bring joy to the mother,” Motaba told thepost.

Motaba recalled a case in which a pregnant woman did not go for an ultrasound scanner so they both did not know that she was expecting twins.

“I was awe-struck and happy at the same time,” she said.

“What shocked me was that I wasn’t aware that she was giving birth to twins and it was my first experience of helping someone deliver twins. At the end, I was excited because those girls were healthy and alive and there were no complications.”

She described her first experience as scary because she remembered the times in nursing school when she would watch midwives deliver small-sized babies who were already dead.

She said in another case, a baby was coming out buttocks first instead of head first and the mother had to be taken for quick surgery at a hospital.

In another case, the baby came out with crossed legs.

“I was told that abnormalities rarely happen and I was scared and afraid,” she said, adding that most women do not listen to instructions from midwives.

“You will tell a woman to breathe and instead of breathing she closes her legs and sits on her bums,” she said.

“Those things stresses you more than anything because my expectation is to receive a healthy baby so I have to be kind and tell the woman the risks of not following my instructions. This profession needs a kind, patient and praying person so that she can try as much as possible for everything to be good and normal,” she said.

Motaba added, “Sometimes you have to be tough on them to show the danger of not following instructions.”

She advised women that taking care of episiotomy requires them to “boil water, pour in a clean plastic bath tub, pour salt and wait for some time for water to be warm, then sit on it”.

“After a while, they should take a clean cloth and pad. They must avoid using tight panties, avoid sitting for a long time, avoid walking for long distances unnecessarily, carrying heavy things and sleeping on the bed because when they stretch their legs, stitches will cut and cause delays in recovery.”

Motaba urged authorities to provide essentials such as transport for staff, ambulances for patients, drugs and heating systems.

Motaba said community health workers are an essential pillar of the public health system who help with services such as accompanying their patients to the clinic and providing them with health education.

Lahlewe Kao, a midwife who worked at Tsatsane Clinic in Quthing before she was transferred to Khabo in 2019, said she won’t forget a day a woman in labour shocked her.

“Everything was still fine through labour but after delivery, that woman’s placenta retained and all attempts of removing it manually failed. We do not have a readily available car at the clinic, so I called M-mama (Vodacom’s sponsored car) but all the cars they had contracted failed to help,” Kao said.

“I called the hospital (Motebang Hospital) and was promised an ambulance but it did not come.”

Kao said after some time, the patient provided her brother’s number who came and she was referred to Motebang.

“This was my most challenging delivery ever.”

Kao said the pressure of work sometimes makes concentration difficult.

“Shortage of staff (currently there are only four midwives at the clinic) and pressure leads us to not focus like we are supposed to,” she said.

Thabo Makhakhe, a male midwife at Matlameng Clinic, said he cannot forget the day he delivered a stillborn.

“Monitoring was fine, the woman was still on the right process but after delivery, the baby did not cry or show any sign of life,” Makhakhe said.

“I was dumbstruck and did not know what to do or say to that woman. It’s not easy to forget that day,” he said.

Nearly all midwives in clinics that we visited had one complaint – staff shortages.

Statistics released in May last year show that Lesotho had 3 214 nurses and midwives and 3 253 nursing assistant professionals for a population of over two million people.

In 2021, the then Health Minister Nkaku Kabi acknowledged the critical shortage of nurses at health facilities and the need to hire more staff.

“Before I took office as minister, I thought I was going to fire all the alleged reckless and careless nurses and doctors because of what I saw in the media,” Kabi told a local weekly then.

“But when I got here, I realised that one nurse takes care of more than 50 patients,” he said.

“It makes it difficult for these nurses to effectively assist patients because if one nurse is in the maternity ward assisting a delivering mother it would be difficult for him or her to assist any other patient even when it is an emergency,” he said.

The UNFPA selected Leribe and Berea districts for the media tour after reviewing the Maternal Death Review Report (2015), that has shown that the highest number of maternal deaths occurred in Maseru (Queen ’Mamohato Memorial Hospital) where 102 women lost their lives as a result of complications of delivery or inadequate care during pregnancy.

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