Herbs use a challenge in cutting maternal deaths

21Oct 2019
Lusekelo Philemon
Dar es Salaam
The Guardian
Herbs use a challenge in cutting maternal deaths

AT 36 years old, Diana (not her real name) is an expectant mother who uses labour-inducing herbs to quicken the process without considering their side-effects, the reason mainly being to ease the painful experience women go through during labour.

She travelled to Sekou Toure regional hospital in Mwanza from Maswa district, Shinyanga region to seek what she says better maternal and child health services, taking into account that during her fourth delivery she used labour-inducing herbs, a procedure that stimulates contractions and quickens delivery so that she would deliver from home.

But, after realizing that she couldn’t make it, Diana was rushed to the district hospital. She managed to deliver a healthy baby boy, but, when she conceived the fifth pregnancy, doctors told her that her uterus wasn't strong to deliver normally, so she will undergo a cesarean session--a surgical procedure used to deliver a baby through incisions in the abdomen and uterus.

Diana now admits that the use of labour-inducing herbs put many pregnant mothers and unborn babies at risk of dying.

She says: "My and the child’s survival during the fourth pregnancy was due to the grace of God. That's why this time around I attended all the training offered at maternal and child healthcare (MCH) clinics and doctors advised me thoroughly on the need to go as early as possible to the hospital because of my uterus problem. That's why I'm here in this maternity ward."

"I discourage my fellow women from using these herbs. They are very dangerous to us and the unborn babies. I witnessed one pregnant mother and unborn baby die because of these herbs," she says, adding that herbs are still in use as many women believe that the delivery will be eased, "something which is not true as negative effects are many compared to positive ones."

"I encourage pregnant mothers to inculcate a habit of visiting nearby health facilities once they conceive,” she suggets.

Diana is one of many women in Lake Zone region of Mwanza and the country at large who use different types of herbs during delivery and some of them use them to terminate pregnancies.

Some of those herbs include leaves of spider plant-cleome gynandra (mgagani), roots of marijuana plants and male pawpaw.

Midwives are concerned that expectant mothers especially in rural and other remote areas of Lake Zone regions use herbal inducers to quicken the process of labour, which they say it poses a threat to both the mother and the unborn child.

Diana is not alone. Tatu Lussesa, nurse in-charge maternity ward at Sekou Toure         , says the number of expectant mothers using herbs to speed up labour is cause for worry. “Every day, we receive expectant mothers experiencing abnormal labour pains caused by the use of local herbs.”

Tatu says despite several maternal health interventions, which are in place to end maternal deaths, expectant mothers continue to use the herbs in different forms.

 “Labour is supposed to be progressive, with the cervix becoming thinner and wider (dilating) gradually. But most women don’t adhere to the natural process as most of them want to ease discomfort during pregnancy, widen the birth canal and speed up labour,” Tatu says.

"We're discouraging expectant mothers to use any type of traditional medicine or herbs to induce labour because it may result to complications during birth,” the nurse in-charge says, noting that some use labour-inducing herbs by either chewing or drinking.

 “Because we have put in serious and tough measures to address this challenge, some of the expectant mums nowadays use the herbs in tea, porridge or food,” she says.

According to Tatu, labour-inducing herbs are dangerous to the users and unborn babies as it cause hyper-uterine stimulation, whereby contractions occur frequently and do not allow the baby to rest, hence the frequent contractions put the baby at risk of distress because there is no time for the uterus to recover.

“The mother may also end up distressed. Under normal circumstances, a mother should not exceed five contractions in 10 minutes,” Tatu says, adding that the expectant mother is also prone to miscarriage, suffering a uterine rupture because of hyperstimulation, which may lead to severe bleeding and premature.

The specialist says the situation can put a mother in a cervical dystocia—difficult labour due principally to failure of the cervix to dilate and to be effaced within reasonable time despite frequent and forceful uterine contractions.

At some point, if a mother is unlucky, she may end up with a tear of the cervix extending down to the vagina. Usually when such a condition presents, operation is done to deliver the baby, she says

It has been a common trend to see expectant mums to come with such herbs, whose doses are not clear.

“It’s difficult to stop women from using traditional herbs as they claim even their mothers used the same and are the ones advising them,” Hospital Nursing Officer in-charge Uyanjo Nkumbi says, adding:

 “We’re investing heavily in education to discourage the practice, is one of the serious challenge derailing the government’s effort reduce maternal deaths in the country.”

 “This is a dilemma to many of us as expectant mums seem to have been refusing to through away that belief and myths,” says Cecilia  Mrema, Reproductive and Child Health Coordinator (RCH-CO).

According to Mrema, most of the expectant mothers get those herbs from family members—aunt and grandmothers and some buy from the market outlets—as there people who sell those drugs openly as there is no law that bars them.

“What we do is continue with education and sometimes a team of medical specialists does go the burial of the victims and tell the community members on the cause of death and even showcase herbal medicines used by the diseased before going to the hospital.”

She cites the use of community radio as an effective tool towards encouraging women to access health facilities as early as possible and encouraging men to be part of the campaign as change agents.

“Responsible maternity healthcare is our slogan that compels healthcare workers to provide competitive services to expectant mothers in all health facilities,” she states, adding: “This move came after realizing that many expectant mothers prefer home delivery due to abusive language they kept encountering with often poorly trained midwives in health facilities.”

According to Mrema, the the slogan has been useful in encouraging expectant mothers to use health facilities during delivery..

The challenge came at the time when reports have it that Tanzania’s maternal and child deaths rate is one of the highest in the world at 556 per 100,000 live births and the government target is to reduce the mortality to fewer than 70 per 100,000 live births by 2030.

“But, this challenge is what derails the campaign,” says Regional Medical Officer, Dr Thomas Rutachunzibwa showed that in 2017 maternal deaths stood at 195 and last year dropped to 151 deaths, while from April to September this year, recorded maternal deaths were 78.

Chief regional physician says a number of expectant mothers have died due to the use of toxic herbs to hasten labour.

“As regional authorities, we’re also working on polishing up skills of medical practitioners so that they properly assist expectant mothers in their health facilities, he says, noting: “We’ve built 14 new health centers and refurbished 24 others contributed to addressing maternal health problems and curb deaths in the region.”

Rutachunzibwa says in every district, two health centers are empowered with all the facilities so that they provide surgery services. “This is one way of bringing services to expectant mums.”

 “We’re also building capacities of our healthcare workers. In this we’re empowering them with best ways of providing healthcare services to expectant mums in health facilities,” he states.

This year alone, 20 health workers undergo training in different colleges across the country and last year we sent 17 for the same purpose. Apart from that the official says that more than 400 workers who have undergone short and long term courses on Maternal and Child Health (MCH) services.