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BENIN: Skills Upgrade for Midwives Saves Lives

Ulrich Vital Ahotondji

COTONOU, May 11 2011 (IPS) - Training of midwives in the active management of the third stage of labour targets one of the most common causes of maternal deaths: bleeding after delivery.

“In Benin, the maternal mortality ratio is 397 deaths for every 100,000 live births, and bleeding after delivery alone is responsible for 25 percent of these deaths,” says Dr René Daraté, director of maternal and child health at the Ministry of Health.

“The government of Benin has therefore found it necessary to introduce, among other things, the Canadian technique of active management of the third stage of labour (AMTSL) to save women from post-partum haemmorhage,” Daraté said.

According to Daraté, himself an obsterician and gynaecologist, AMTSL is an intervention introduced in Benin which allows the placenta to be easily delivered and ensures the contraction of the uterus.

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. It 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.

To introduce the practice of AMTSL, a vast training programme for health workers was launched with the support from the national budget and several of Benin’s development partners. “All 34 health districts of Benin were covered by the training,” says Daraté.

Some private clinics in Benin have also benefited from training courses. According to Laurence Odounlami Montéiro, president of the Association of Midwives of Benin, his group trained staff in about thirty private health centres who are now using the technique.

Flore Abalo, a midwife who underwent the training, thinks “AMTSL is a very important technique that all midwives in the country should know. It has considerably improved the quality of our services.”

Marcelle Totchénou, head of the maternal health division at the health ministry told IPS that during the pilot phase of AMTSL, an evaluation showed that deaths due to post-partum haemorrhage were reduced by 50 percent.

A national evaulation report on emergency obstetric and neonatal needs is currently in progress currently. Daraté anticipates the report will give a clearer picture of if Benin is on track to achieve Millennium Development Goal 5, which seeks to reduce maternal mortality rates in 2015 to three-quarters their 1990 levels.

Simultaneously, the country’s Fourth Demographic Health Survey is being conducted. “The results will allow us to evaluate again the many techniques in use,” he said.

According to Daraté, not all health workers have properly learned the technique. “During the first evaluation of AMTSL, about five years ago, we observed that less than 13 percent of those trained were practicing it properly. So we had to intensify the training.”

Midwives are very pleased with the results. Yollande Johnson says, “AMTSL has contributed to successful deliveries in the clinic. What remains a priority need is the supply of blood [for transfusions].”

According to Professor José de Souza, head of the University Clinic for Gynaecology and Obstetrics in Cotonou, AMTSL has certainly yielded good results, but he calls for effective medical surveillance to accompany the technique. It’s important, he says, that people are truly educated and visit health centres and that pregnant women attend prenatal consultations.

De Souza also wants healthy people to donate blood to save lives, because in spite of everything, women sometimes still haemorrhage after delivery, requiring a transfusion.

While training in the public health system continues, in the private sector the strengthening of the capacity of health workers has slowed. Montéiro is asking for a quick resumption of training for the private sector. “Today we have nearly 4,000 private clinics in Benin, registered or not. To truly have conclusive results, we have to reinforce the private sector, because often the danger comes from quarter,” she said.

Daraté shares this view. “We have to continue tirelessly with training because if we are to achieve the Millennium Development Goals, there is still lots to do.”