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The face of midwifery in Nigeria

These had led to the lamentations by  Federal Government authorities. “Recently I visited a local government area in Katsina State; a very rural area. We…

These had led to the lamentations by  Federal Government authorities. “Recently I visited a local government area in Katsina State; a very rural area. We found a settlement, in this settlement the houses were still made of corn stalk; and in this place, a woman gave birth, but there was no midwife in that vicinity, thank God there was no complications, she delivered safely, but if there were complications, she would have died or the baby would have died, because there was no facility for miles”.
“I also visited Anka Local Government Area of Zamfara State, 30km from the next town and two hours by road. The terrain was very difficult, the roads were bad, no light and it has no amenities, but we found a hospital and it has three midwives. The settlement was called Bega. These midwives were from Anambra State and they have been there for 18 months and doing their work, preventing the deaths of both women and their babies. They are our heroes”.
These were the lamentations of the Minister of State for Health, Dr. Muhammed Ali Pate at an event recently to commemorate the just concluded International Day of the Midwives. He was speaking on the need for the country to deploy more midwives to the remotest areas of the country to reduce   death rates among women and children.
Another noticeable challenge Pate stressed is that despite the presence of midwives in some rural communities, expectant mothers still prefer to deliver at home unaided or with the assistance of traditional birth attendants.
The journey so far
The Federal Government introduced the Midwives Service Scheme (MSS) in 2009 and so far, over the years about 5,000 midwives had been deployed across the country.
According to Dr. Pate, with the coming of the SURE-P, it has given the government another avenue to increase the deployment of midwives to breach the gap of 88,000 midwives direly needed to reduce the rate of maternal and infant mortality.
Recently, with the SURE-P, the government also commenced the Conditional Cash Transfer (CCT) scheme to encourage women to attend antenatal. “Under the CCT, each woman will be eligible for upwards of N5,000 accruing from the point of registering for anti-natal clinic during pregnancy.
“They get N1,000 for each of four anti-natal visits, plus N2,000 when she comes to deliver and N1,000 when she brings the child to hospital for immunization,” Pate said.
He said the intervention is aimed at encouraging women to visit hospitals where they can access care for themselves and their babies.
However as strategic as midwifery is in the health sector, not many Nigerians are willing to go into the profession. Experts had at various fora raised alarm over the acute shortage of midwives across the country.
Dr. Pate noted that though opportunities exist for vacancies for midwifery, especially in the North West and North Central, but women in these areas do not join the profession to make up for the gap being witnessed in the provision of services, which according to him, is unfortunate.
Meanwhile,  Adeniji also has   complaint against regulatory agencies, saying, the association observed the rate at which government and schools of midwifery are accredited by regulatory agencies without due consideration for the availability of  adequate and qualified personnel and infrastructures of the training institutions.
He advised that funds be expended in that direction, while also raising alarm over the situation where midwives working in tertiary institutions are deprived from their primary assignment of delivery, which noting that such is a short circuit to chaos in the health sector.
He revealed the patients are used for guinea pigs for doctors in training and so most chief medical directors rather prefer that doctors teach those learning under them than a midwife.
Adeniji also noted that such practices if not checked are capable of reversing all the laudable programmes carried out by partners and government over the years.
He urged the Federal Government to “accelerate the process of commencement of internship for graduate nurses and midwives in the country, as it will certainly boost the supply of adequate skilled personnel needed to improve health care in the country.”
He stressed that apart from the gynaecologist, the next person who is specialised to take delivery is midwifery and that no where during their course of service have they fallen short of any expectation.
He also decried the inability of state governments to retain midwives who have been posted to work in their states by aiding them, while also blaming the growing insecurity for exodus of midwives from the country.
Breaking grounds.
The UNFPA country representative to Nigeria, Victoria Akyeampong however said intervention by stakeholders has begun to yield fruit.
She said birth related deaths has drastically reduced across the country.
IPAS Country Director, Dr Ejike Orji who is often called the champion of women causes, said, “ a matron, who is a midwife taught me my first delivery, and she also taught me all I need to know about delivery.
“We as a nation need to ensure that midwives who have served this country greatly be looked after and well equip to do their primary assignment of saving lives.”
Essence of the Midwives day
May 5th or 6th was designated by the International Confederation of Midwives (ICM) as a day when all midwives from all organisations express worldwide solidarity and highlight their knowledge and skills.
National chairperson, Commission of Professional Midwives of Nigeria, Comrade Moji Akinsola said   the day would give them an opportunity to show case their skills, promote safer motherhood and the midwifery profession both in the country and worldwide.
The first international day of the midwives was launched in May 1991 with the theme, “Towards safe birth for all by the year 2000”. The theme for the International day of the midwife each year until 2015 is, “The world needs midwives now more than ever”.
Between a nurse and a midwife
According to Akinsola, “a midwife must be able to give the necessary supervision, care and advice to women during pregnancy, labour and the postpartum period, to conduct deliveries on her own responsibility and to care for the newborn and as the baby grows.
Her duties, she added, include “provision fo preventive measures, detects abnormal conditions in mother and child, procures medical assistance if needed, executes emergency measures in the absence of medical care.
“She also provides health counselling and education  not only for the woman, but also within the family and community, antenatal education and preparation for parenthood, gynaecology, family planning  as well as infant and  child care,’’ she said.
Speaking on the duties of a nurse,   National President, National Association of Nigeria Nurses and Midwives (NANNM) Nurse Abdulrafiu Alani Adeniji said   a nurse is a generalist, specialist and diversified in all areas of medical profession.
According to him, midwifery is a specialised aspect of nursing, which deals with couples from their initial desire to have children, through pregnancy and after it.
He explained that nursing covers all aspects of care and caring for the patients, adding that after general nursing one can decide to specialise in midwifery, psychiatry, obstetrics, public health, surgical nursing or any other specialised field in medicines.
He said   what is supposed to be the right thing to do is  all those interested in midwifery must first go a school of nursing before specialising in midwifery. A school of midwifery, according to him, was created to shorten the course to accommodate   and train them to be specialist in the field.
Qualifications of nurses and midwifery
Adeniji explained that a person interested in midwifery must undergo three calendar years of training in a school of nursing which is about four academic sessions, then go to specialise in midwifery for 18 months, adding that those who come through as community health midwifery are trained for two calendar years.
He said for those who are interested in studying nursing, the person would need to have five credits including Mathematics, English, Biology, Chemistry and Physics.

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