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Ask the senior midwife

Sunyani Municipal hospital 
December 31, 2010 -- Today the Ghana News site posted a short article about birth complications and pre-natal care that relied entirely on expert comment from senior nurse midwives. The unsigned Ghana News Service (GNA) piece focused on the threat that unsafe abortions pose to later pregnancies, as well as the importance of pre-natal care in protecting mothers and newborns. The report does attribute one odd statement to its main midwife source, a comment that her hospital had not seen any infant or maternal mortality in the past year "as doctors responded promptly to emergency cases"--as if nurses themselves did not play a central role in emergency care. On the whole, though, the piece is an unusual and commendable example of media reliance on nursing expertise.

The piece is "Unsafe abortion leading cause of birth complications -- Nurse." It relies mainly on "Madam Elizabeth Yeboah, Senior Midwife at Sunyani Municipal hospital," who "has advised women to stop practising unsafe abortion as it could lead to serious birth complications in future." Yeboah told GNA that most of those who developed complications and delivered through caesarean section "were those who had engaged in a number of unsafe abortions." She explained that "excess abortion" causes the cervix to become hardened and hard to dilate so that the baby can pass through. Yeboah also urged women to get good pre-natal care and otherwise take care of themselves prior to delivery

Malaria and anaemia are the highest cases recorded at the ante-natal clinic, Madam Yeboah said, and urged pregnant women to sleep in treated mosquito nets and to eat balanced diets in order to give birth to healthy babies while preventing maternal mortality.

She asked expectant mothers to start attending antenatal clinics early and to co-operate with health workers to ensure that quality health care was provided to them to ensure safe delivery.

She entreated pregnant women to go for all the laboratory examinations required from them and to submit the report on time for medical care.

Yeboah also reportedly "said the hospital had not recorded maternal and infant mortality cases at the hospital this year as doctors responded promptly to emergency cases."

Sunyani Municipal hospitalThe remainder of the short piece consisted mainly of Yeboah and other midwives reporting on the number and general health of babies born at local hospitals around Christmas Day. One final note is attributed to Madam Mary Bio, "Midwife in-charge" at Dormaa Presbyterian Hospital, who reported one still-birth "as a result of the delay of the expectant mother at home." Bio also  "observed that many women believed in giving birth at home and appealed to them to attend ante-natal service in health facilities close to them," apparently not a plea that the women give birth in a hospital, but simply that they get good pre-natal care.

In general, this article is a great example of senior nurses providing expert comment and advocating for better care. This advocacy has the potential to improve public health--and public understanding of nursing. Yeboah and the others make clear that good outcomes are not solely dependent on luck or heroic measures at the time of delivery, but on pre-natal care, which reflects the holistic focus of nursing. The midwives also present caesarean sections as an inferior alternative to natural birth, something that does not seem to be well enough understood in the United States. And they offer not only general advice to get pre-natal care, but some specific ideas--mosquito nets, balanced diets, attending all examinations--to ensure that readers have a sense of some elements of that care.  Perhaps the most notable of these is Yeboah's plea that women avoid unsafe abortions, but here more detail might have been helpful--why does that occur? In fairness, it may not be easy for some women to get professional health care. Are there social or economic barriers for some women who want safe abortions, or adequate birth control?

The reported comment suggesting that physicians were solely responsible for the lack of infant and maternal mortality in the past year is unfortunate. Of course, nurses play a central role in avoiding those results, not only through their expert emergency care, but of course through the same kind of pre-natal care and advocacy that this piece describes. It would have been better to note that all needed professionals respond quickly in an emergency.

On the whole, though, we thank the Ghana News Service for a helpful look at nursing expertise and patient advocacy.

See the article Unsafe abortion leading cause of birth complications - Nurse, posted December 31, 2010, on the Ghana News Agency website.




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