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MALAWI: Putting Knowledge Into Practice in Childbirth

Claire Ngozo

LILONGWE, Mar 31 2011 (IPS) - Post-partum haemorrhage is the leading cause of maternal mortality worldwide, according to the World Health Organisation. A decade of applying research to midwifery practice in one Malawi district demonstrates that PPH is quite easy to prevent.

One in four maternal deaths worldwide is due to post-partum haemorrhage (PPH) – excessive bleeding after childbirth; for Africa the figure is one in three.

Malawi has an extremely high rate of maternal mortality, at 807 women per 100,000 live births, with 25 percent of these due to PPH. But these figures represent an improvement over 2004 when maternal mortality was 1,120 per 100,000 live births.


Maternal deaths are overwhelmingly preventable, if warning signs are noted, timely action is taken, and affordable and easy-to-use drugs are available to birth attendants.

Elimase Kamanga, the reproductive health coordinator at Dedza District Hospital in central Malawi, told IPS changes to birthing practices have brought great success to the unit.

“We used to remove the placenta manually before a policy was put in place to for the placenta to come out naturally. The women would bleed uncontrollably in such a situation and many would die due to loss of blood,” said Kamanga.

Research shows that active management of the third stage of labour – during which the umbilical cord is tied off and the placenta is expelled – is key to preventing post-partum haemmorhage. This involves giving the labouring woman oxytocin, controlled cord traction as needed (assisting delivery of the placenta), and massage of the uterus once the placenta has been delivered.

Kamanga said skilled birth attendants are no longer allowed to conduct manual removal of the placenta in Malawi.

“Now a deliberate policy is in place for the administration of active management of the third stage of labour (AMTSL), a medical process for preventing and treating PPH,” said Kamanga.


But challenges remain, says the senior midwife. Many women in Malawi give birth outside of a health facility and this is frustrating the efforts to manage birth complications. The 2004 Demographic and Health Survey says up to 43 percent of pregnant women in Malawi give birth without skilled attendants.

“Many women still go to traditional birth attendants and some give birth at home where they are attended to by their mother or mother-in-law. In this case the women do not have quality care and when they bleed heavily they die. Most times such women are brought to a medical facility when it is too late to be given medical help,” said Kamanga.

But the Dedza district where Kamanga works an area where initiatives to reduce maternal mortality are working; a community maternal health programme was set up here in 2000, and not a single maternal death has been registered in Chaponda village since 2006.

The maternal health programme involves local people and traditional leaders in task forces and committees on safe motherhood. Pregnant women are encouraged to visit clinics for antenatal care and to deliver their babies in hospital if possible. The community has enacted by-laws against giving birth at home or at the hands of traditional birth attendants.

Evelyn Kaphuka, 43, a mother of four from Chaponda village, is one woman who had a narrow escape due to post-partum haemmorhage. “I went to a traditional birth attendant when I gave birth to my first born child, who is now 24 years old. I bled a lot soon after he was born.”

She was rushed to the hospital after she fainted. “I was lucky because there was a vehicle in the village belonging to one of my nephews who was visiting from town. I surely would have died otherwise, because it takes close to three hours to get to the hospital on a bicycle, but my nephew was able to get me there within 30 minutes,” said Kaphuka.

For more than a month afterwards she was too weak to even nurse her son.

“I realise the importance of going to hospital to give birth and I encourage all pregnant women in my area to access medical care at birth. The other three children I have given birth to were born at the hospital,” Kaphuka said.

Malawi is working towards sustaining and expanding implementation of measures against PPH, according to Eliza Chodzadza, a lecturer in maternal and child health at University of Malawi’s Kamuzu College of Nursing.

“Active management of third stage of labour is one of the major issues in the midwifery curriculum. It is traditional practice now in every labour ward in Malawi,” said Chodzadza.

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