Bouake – In Cote d'Ivoire, in 2017, the maternal mortality rate was 614 maternal deaths per 100,000 live births, a long way from the target of 140 maternal deaths per 100,000 live births expected by 2030. Gbeke is one of the health regions with one of the highest mortality rates in the country.
Faced with these maternal deaths, most of which are preventable, the Ivorian health authorities have approached the World Health Organization (WHO) for technical and financial assistance to reverse the trend.
In 2021, the WHO, with the support of the Swedish Government and the French MUSKOKA fund, supported this health region through the "Gbeke Là-Haut Là" initiative.
The aim of the programme is to strengthen the skills of midwives in the management of obstetric complications, in particular post-partum haemorrhage, which is the leading cause of maternal death in Côte d'Ivoire. The initiative, planned over three years, aims to reduce avoidable maternal deaths by 75% between 2022 and 2024, with an annual reduction of 25%.
The initiative includes the implementation of a childbirth preparation or delivery plan, starting with the first prenatal consultations, an emergency trolley in the delivery room and capacity-building for midwives in the management of risk factors during pregnancy and childbirth.
"Last time, it was difficult. I found myself alone at the maternity hospital because my husband was away on business and there was no one to accompany me. We lived a long way from the family", she recalls.
Fatoumata arrived at the maternity hospital at the last minute under stress, with a slight rise in blood pressure, and could have suffered complications during delivery. For her first childbirth three years ago, she didn't have a birth plan.
It is a real tool for anticipating complications that could lead to death. Thanks to the birth plan, the pregnant woman communicates her wishes and needs to the medical team, which helps to reduce stress and anxiety during childbirth.
The maternal health initiative involves women and their spouses in planning and monitoring their pregnancies. By 2022, 46% of pregnant women attending antenatal clinics had benefited from a childbirth preparation plan, compared to none before the initiative was implemented.
And to do that, the midwives themselves need to master the content and the steps involved in implementing a birth plan. This is precisely where capacity building has been crucial", said Dr Fatim Tall Thiam, acting WHO Representative in Côte d'Ivoire.
A total of 181 midwives from the 18 health facilities involved in the initiative have been trained in key life-saving clinical skills. Measures aimed at reducing avoidable maternal deaths have been taken, with a focus on post-partum haemorrhage, which was responsible for 49% of maternal deaths recorded in the country in 2020, high blood pressure and its complications, and infections due to abortions, which are the main causes of maternal death.
"Our midwives have mastered the protocol of treatment to lower the blood pressure of parturients before they are evacuated to a higher level for better care. The cases that go to the CHU are only those that require treatment beyond the capabilities of the health centre".
Between 2019 and 2022, the proportion of maternal deaths at Bouake University Hospital from the 3 urban health districts of Gbeke fell from 93% to 36%, a reduction of 57%, and the proportion of maternal deaths due to post-partum haemorrhage fell by 27%, from 56% to 29%.
Follow-up after childbirth is one practice that helps to limit unpleasant surprises after childbirth. "When a woman finishes giving birth, she spends at least two hours in the delivery room and we monitor her. Then we move her to the immediate postnatal ward. If there are no complications within 24 hours, we put her in the late delivery room for 72 hours before releasing her", explains Nene Sidy Balde, midwife at Beoumi General Hospital.
"Every Tuesday, we have refresher courses as part of this initiative, which are a great help to us.”
After being educated by the midwife, she is breastfeeding her baby, and promises to breastfeed him exclusively for the next six months.
"The midwives are always attentive and very kind. They gave me lots of advice for my own good and that of my baby. They helped me prepare for the birth step by step, right up to D-day," she adds. "The birth plan has helped me a lot."
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