The mention of labor and childbirth evokes images of women in
pain followed by the cry of a newborn. Obstetrics, the medicine of pregnancy
and childbirth, is one of the most controversial aspects of the practice of
medicine. It is also the most litigated worldwide and Kenya has not been spared
either. A quick look at the professional negligence complaints filed at the
Kenya Medical Practitioners and Dentists’ Board reveals that at least 70% are
obstetric in nature.
Traditionally, the role of attending to birthing was a
women’s affair and generally men kept their distance, even from the newborn. In
the western world, the male relatives came together at the baby’s christening
to officially meet the new family member. In Kenya, cultures vary but childbirth
was and largely continues to be, distinctly a female affair.
In countries such as the United Kingdom, approximately 95% of
women are accompanied by their partners in labor. Nevertheless, the concept of
fathers as birthing partners is still fairly new in Kenya. Despite being provided
for in private hospitals for many years, it has taken very long to take root.
Most men prefer to wait for the baby to be born and they are generally ill at
ease in the labor ward. I have witnessed many men fall at the sight of blood
and despite trying to be strong for their wives, couldn’t handle the sight of a
needle.
Is there a scientific basis to having the fathers attend to
the delivery of their offspring? High level research evidence has shown that
having a birthing partner who provides continuous support during the process of
labor, results in significant reduction in the number of caesarean sections and
operative deliveries required, increase in the number of normal births, reduction
in the use of analgesia and reduction in
the length of labour (Hodnett
et al. 2011)
For the woman in labor, the companion that she comes with to
the hospital may be the only truly familiar person in that space. While among
the Asian, Somali and Swahili communities, the woman is accompanied by a several
female family members who will stay until the baby is safely delivered, this
support is greatly waning among the rest of the communities. Urbanisation with
emphasis on the nuclear family, single motherhood and family separation due to
career choices has led to women turning up in our labor rooms unaccompanied.
The husband may have travelled for work and the woman may be taken to the
hospital by the driver with no family member present.
On the flipside, women from lower socio-economic background
may be worse off. Domestic workers who may successfully hide the pregnancy from
their employer until labor sets in will show up at the hospital even without
basic necessities for themselves and the baby! Single mothers going into labor
in the dead of night may have no one to call upon and will arrive alone in a
cab clutching their baby bags, ready to get over and done with birthing and go
back to the privacy of their houses. In the villages, with husbands away in the
city toiling to sustain their families, the young wives will be escorted to
hospital and everyone leaves, waiting to come and take the new mom and baby
home after discharge the next day.
In this wanting picture, the County of Kisumu, with the
support of partners seeks to turn things around. The County has spruced up the
maternity unit, providing patient privacy, which allows spouses into the labor
ward to be with their wives/partners during this very crucial time in a
mother’s life. The benefits expected out of this intervention are immense. Whereas
in the first world the primary concern is lowering caesarean section rate, in Kenya,
we the participation of the men in maternity is a sure way of recruiting their
support in reducing maternal mortality and morbidity.
The major challenge to effective emergency response during
pregnancy, childbirth and post-delivery period is what has been aptly
categorized by the World Health Organisation as The Three Delays resulting in
maternal death:
1.
Delay
in seeking care: This can be occasioned by failure to recognize the emergency
and failure to make the decision to seek care in good time.
2.
Delay
in identifying and accessing a suitable health facility: This results from
financial constraint; lack of roads, ambulances or even just a taxi at the
critical time; lack of knowledge of the level of care a facility can provide
hence wasting time in uncoordinated referrals; and lack of social support
structures to escort the mother to the hospital.
3.
Delay
in accessing quality care: This falls squarely on the hospital and results from
a wide array of system failures internally such as lack of adequately
experienced staff, lack of equipment, drugs and overcrowding.
It is therefore fairly obvious why men, who continue to be
major decision makers in the family, should be involved intimately. They learn
to appreciate emergencies and timely response. Even more importantly, they provide
much needed emotional, physical and psychological support to the mother in
need.
Kisumu County most
certainly got this right. It demonstrated that being a public hospital should
not be a barrier in providing the highest attainable standards of care. It has
embraced the core tenets of primary health care by fully embracing community
involvement and changing mindsets for the good of society.
I don’t know about you but I want the fathers in my labor
ward any day. I want them to walk with us in this important journey as we
deliver the next generation. I want to never have to try and explain to a
father why we need to rush to the operating room and why his consent is
critical in a timely fashion. I want him to cut the umbilical cord of his son
and truly feel the need to be there to raise him into the type of man he should
become. I want him to look at his wife as not just the woman who cooks his
food, but as the one person who performed the wonder of bringing his child into
this world.
For surely, how can we possibly go wrong, if together, we can
avert maternal and newborn death?
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