THE CHALLENGE OF QUALITY VS QUANTITY IN MIDWIFERY CARE

By Luseshelo Sinwinga White Ribbon Alliance-Malawi, Citizen Journalist/Midwife

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“Let us work where we can….is a common saying among midwives in Malawi. In this statement, they are basically acknowledging their heavy workload and trying to maximize their workforce to achieve what they can manage based on the number of midwives that is available. While this is commendable, in most cases, it takes away the concept of respectful midwifery care, compassion, accountability and responsibility from the midwifery care practice. Most midwives focus only on delivering the baby without taking into account the needs of the mother and the unborn baby. This kind of thinking puts the lives of mothers and unborn children at risk.

As a Safe Motherhood Coordinator and a Maternal Health Quality Team Leader, I was recently invited to the scene to witness firsthand, a maternal death that happened at the district hospital.

The midwife had mistakenly administered lignocaine (a drug used for pain relief for minor surgeries) during labour thinking she was administering an intravenous push of 50% Dextrose (glucose given for energy).

The mother was failing to push the baby during the second stage of labour and the midwife was prompted to administer the dextrose to aid in delivering the child. The midwife went ahead to perform an episiotomy and delivered a healthy baby. An episiotomy is a surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent rupture of tissues.

However, the mother started showing signs of confusion. Upon rechecking, the midwife realized that she had administered lignocaine. She panicked, consulted and commenced the mother on intravenous fluids; the client received about five liters within the next eight hours.

But the series of toxic effects continued. The mother became swollen due to the third spacing with the administered fluids coupled by the vasodilatation from the toxic effects of intravenous administration of lignocaine. The mother developed signs of pulmonary edema.

Pulmonary edema is a condition caused by excess fluid in the lungs. This fluid collects in the numerous air sacs in the lungs, making it difficult to breathe. The effects could not be reversed. The midwife administered the lignocaine around 12:00 PM and the mother died 14 hours later at around 2.00 am.

The midwife administered the wrong drug due fatigue and an excessive workload, together they would have confused her.

This death which was avoidable was so painful, sad and depressing. What bothers me most is that 90% of these maternal deaths are as a result of health workers related factors and above all, these deaths are preventable. The greatest factor is the constant shortage of midwives at the institution and the surrounding peripheral health facilities.

Looking at statistics, Ntchisi District Hospital and its peripheral health facilities serve a catchment population of 295 592, with a population of 67 986 women of child-bearing age. The district has 14 780 expected pregnancies and deliveries. The above population has to be served by 32 bedside midwives (Survey 2016; WRASM). Yet the district requires 388 Midwives as per WHO recommendation of 175 women of childbearing age per midwife.

The few available midwives are subjected to an immense workload , to the extent that they fail to balance quality versus quantity of the given care. There is a burden of work and work-related stress at the departmental level, resulting in substandard quality of midwifery care rendered to the women in the maternity wards. Clearly, there is need for recruitment of more midwives if deaths like these are going to be avoided.