Women troop to traditional midwives despite waiver on maternity charges

Pictures of newborn babies adorn the walls of Petty Akoth’s house. They are a treasured decor in the improvised maternity ward in her two-roomed corrugated iron-walled house.

Hundreds of women have trekked the dusty and curvy road to Ms Akoth’s Homa Bay home, judging from the many pictures.

Dressed in a nylon apron, Ms Akoth is attending to a pregnant women. In a busy month, she delivers over 60 children, according to her well-kept records.

Her small house acts as a labour and a delivery room. Ms Akoth is among traditional midwives who assist women at child birth, mostly in areas which lack infrastructure and trained health personnel.

But Ms Akoth’s clients do not lack hospitals. There are a number of health facilities in the region, but some pregnant women prefer the traditional birth attendant. They say they are more comfortable with her than obstetricians and trained midwives.

Ms Akoth learned the midwife’s skills at a tender age. When she was 15 her late grandmother, who was a midwife, placed herbs in her right hand and some coins in the left — the traditional way of transferring the skills to her, she says. This has since been her job.

When we visit her home she has just helped a 15-year-old girl deliver a baby boy weighing 3.2 kilogrammes as other pregnant women line up in waiting.

Labour pain medicine

She hands pounded herbs to the other women. The herbs reduce labour pains, she says. Ms Akoth is among Kenya’s 35 registered traditional birth attendants who work with hospitals to ensure safe deliveries.

“Some clinics contact me to attend to mothers with breech births and at times they are brought to my ‘clinic’,’’ she says.

Her maternity services are similar to those in health facilities. She records clients’ details in a book and weighs infants on a weighing machine given to her as a token.

To battle mortality and new HIV infections, the Jubilee government slashed maternity fees to encourage deliveries in hospitals. Years later, some women still prefer traditional birth attendants.

Speaking to the Business Daily, Ms Akoth’s clients said that harassment in public hospitals is one of the reasons they still troop to traditional birth attendants’ clinics.

‘‘The midwives harass us and we are often left in the hands of inexperienced trainees,’’ said Irene Awuor who delivered at Ms Akoth’s clinic.

‘‘I had complications in my previous pregnancies and she assisted me deliver safely,’’ she says, adding that the midwife can detect when a woman has strength to push the baby or not, or if the baby is in the right position.

Emily Atieno, another pregnant woman, says she will only seek assistance health facilities if her problem cannot be handled by a traditional birth attendant.

“Here in the village, we run to midwives first and only seek assistance from nurses if there are complications,” she says.

Ms Atieno, a mother of five, says she gave birth to her first two children through Caesarean section and was told she would have repeat surgeries for other births.

“When I went to deliver my third child at a health facility, they recommended a Caesarean section. I refused and came back to Ms Akoth and I delivered normally,” says Ms Atieno.

Maize or beans

She has since developed confidence in the untrained midwives. The traditional midwife is paid between Sh200 and Sh500 per delivery, but even a tin of maize or beans can suffice.

Poor roads have driven some women to the birth attendants. For some, labour pains start at night and the closest person they can think of is a nearby traditional birth attendant.

By mid-last month Ms Akoth had delivered 60 babies, a figure that even some county hospitals cannot match. For infertile women and impotent men, Ms Akoth is also the go-to-person.

She displays dozens of herbal remedies that she says boost fertility and treat sexual dysfunction.

As a number of pregnant women turn to traditional midwives, the Health ministry’s challenge is taming mother-to-child HIV transmission. Home deliveries by traditional birth attendants are also considered to be a major contributor to maternal deaths.

Last year, the number of births in hospitals stood at 61 per cent, according to a health survey. This means that close to 39 per cent of women still gave birth at home assisted by midwives compared to 57 per cent in 2009.

Registered traditional birth attendants undergone training on ensuring safe deliveries, use of gloves and how to handle HIV positive mothers who prefer giving home births.

Ms Akoth says she only attends to women who know their HIV status. She ensures that HIV positive clients have anti-retroviral (ARVs) drugs given by a doctor, which she gives to the child immediately after tying the umbilical cord.

The ARVs prevent transmission of the HIV from mother to child.

Hospital deliveries

However, Allan Mayi, the deputy project director at Elizabeth Glaser Paediatric Aids Foundation, says the birth attendants should not attend to expectant mothers because they lack the skills needed to offer safe deliveries.

The organisation encourages women to deliver in hospitals and even offers incentives to birth attendants to take them to health facilities.
“Most mother-to-child HIV transmissions are recorded at midwives’ homes,” says Mr Mayi.

Dr Lawrence Koteng’, the Homa Bay health executive, acknowledges the role played by traditional midwives but encourages expectant women to deliver in health facilities.

He says the county health department is training community health workers to discourage unsafe home deliveries.

“We do not support expectant women to deliver at home or anywhere except at health facilities where there are experts who can help whenever there is a complication,” says Dr Koteng’.

Dr Elizabeth Ogaja, the Kisumu health executive, says that midwives are an integral part of the healthcare system.

“We have realised that they are very important. Mothers trust them and we want to integrate them as much as we can. We advise that they bring pregnant mothers to hospitals so that we can take it from there,” she says.

Ms Akoth has now transferred her ‘‘blessings’’ to her sister-in-law who takes care of the pregnant women in her absence.

‘‘If the government wants mothers to deliver in hospitals, then the health care providers should change the way they handle them. Treat women with respect,” she says.

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