For reference: Picture cards to stimulate discussion - Maternal contributing factors

MATERNAL CONTRIBUTING FACTORS – ROOTS OF SOME PROBLEMS

1.    Not going to Antenatal clinic:

This can be at the root of problems in the following ways:

·         Failure to check BP leading to eclampsia

·         No tetanus injection and baby dies of tetanus

·         Not taking iron, so becoming anaemic – and more likely to die from bleeding

·         Not getting HIV check, and so developing AIDS – both mother and baby

·         Not getting checked for other sexually-transmitted disease – eg Chlamydia – and going into premature labour. Premature babies can end up brain-damaged.

·         Not detecting problems such as breech presentation. Babies being born bottom-first in the community are more likely to die or be brain-damaged.

·         Some women are more likely to bleed to death – eg those with placenta praevia or those in their 5^th and subsequent pregnancies. At ANC, they would arrange for these to deliver in hospital.

2.    Having a poor diet:

The diet may be poor because there is not enough food, or not enough colour and variety in the food. This can be at the root of problems in the following ways:

·         It leads to anaemia which makes women weak and tired … and more likely to die from bleeding.

·         It increases the chance of infections, such as TB and other respiratory infections, as well as infections which cause diarrhoea and other illnesses.

·         It increases the chance of premature birth, which may cause the baby to be damaged or to die.

·         If long-term, then malnutrition can cause a woman to be too small to deliver the baby.

3.    Not taking malaria precautions:

Pregnant women and children should sleep under nets which have been regularly dipped in insecticide. The community should have cleared standing water pools from the village. This can be at the root of problems in the following ways:

·         Malaria can kill mothers and babies

·         If it does not kill, it can lead to anaemia and more risk of death from bleeding.

·         It can also lead to premature birth.

·         Catching malaria makes you weak and unable to do things, and costs money to get treatment.

4.    Being subjected to domestic abuse or neglect:

It is also an abuse to expect pregnant women to work too hard or carry heavy loads. Abuse can be at the root of problems in the following ways:

·         Working extremely hard in pregnancy can lead to early labour.

·         Exhaustion can increase risk of problems in labour, and of bleeding afterwards.

5.    Risky sexual behaviour:

This includes both unfaithfulness, as well as failure to use condoms – especially if HIV positive. Also, failure to take HIV medication risks developing AIDS, and risks passing HIV to the baby. All this can be at the root of problems in the following ways:

·         The mother may develop AIDS.

·         The baby may develop HIV or AIDS.

·         There may be premature birth, with brain damage or death of the baby.

6.    Not having a skilled birth attendant in a clean setting:

This can be at the root of problems in the following ways:

·         Women with obstructed labour can be left in labour too long, until they die of exhaustion or bleeding. (Or it is too late to get to hospital)

·         TBAs may give medicines which rupture the uterus and kill the woman.

·         Women who bleed are far from help, and simple treatments in hospital would have saved them.

·         If the woman gets dirt or germs inside her, (eg if the TBA has dirty hands and no gloves, or delivering on the ground with no sheet, or not being able to wash after birth), she can die of uterine infection.

·         If the placenta does not come out, the woman can die of bleeding.

·         If the birth is not a straightforward head-first delivery, the baby might die or be brain damaged.

·         If the cord is not cut cleanly, (eg with a razor blade cleaned in boiling water), the baby can die – eg of tetanus.

7.    Not going to Postnatal clinic:

This can be at the root of problems in the following ways:

·         Not getting treatment of any infections – some of which can kill

·         Not getting the baby checked for HIV means the baby can get AIDS

·         Not getting family planning help, so getting pregnant again

8.    Not practising family planning:

Family planning helps prevent getting pregnant when very young, or when you already have enough children, or when your most recent child is still a baby. This can be at the root of problems in the following ways:

·         Having more than 4 children significantly increases the risk of mothers dying from bleeding in labour.

·         Young girls are not fully developed and may not be big enough to deliver the baby, and so may die of obstructed labour.

·         Having too many children means you cannot feed and educate them all.

·         Malnutrition is a particular risk the more children you have under 5 years old.