FOCUS GROUP DISCUSSION WITH TRADITIONAL BIRTH ATTENDANTS
AT DUKE TOWN CALABAR, CALABAR SOUTH, CROSS RIVER STATE
ON FRIDAY, 18TH NOVEMBER, 2016
The group members were tagged No (numbers) 1-5 from Prof’s right hand side and L for the only person sitting by her left hand side. There were 6 TBAs in attendance totally.
Prof: My name is Professor Gina Piane. I am a faculty member from the University of Calabar, Department of Public Health and a Fulbright Scholar from the United States of America. I am conducting a qualitative needs assessment to identify the local influences regarding maternal mortality in Nigeria. As part of this research, you have been selected because of your knowledge of maternal health, health systems characteristics and community practices. I have prepared a few key questions for this interview that should take approximately 60 minutes to answer. Your participation is strictly voluntary and you can opt out at any time. Be assured that the information gathered here will only be used for the purpose stated. I ask your permission to record and take notes during the interview. May I use your name and title in our notes?
Let us begin by remembering the women in our families who have died in pregnancy or childbirth. Choose one woman and mention her name, age, who she left behind and briefly the circumstances.
I will start, In my family, the last woman that died in childbirth was named Mary Cellino. She was 18’ having her first baby. She left behind six brothers and sisters and her parents. The year she died was in 1916 that was 100 years ago.
Awatt: the last person I know that died was Sandra, she used to be my neighbor, she already had two male children and wanted to have a daughter. She died during the birth of the daughter. She left behind her parents, husband, siblings and two sons including the daughter who survived and is five years old now.
No 1: A pregnant woman I know died three years ago because she refused to give birth through CS that no body in the family had ever done a cs,and its against her believe even after the doctor had advised her. She was my family member and she left behind her child, husband, parents and siblings.
No 2 : I dont know any direct person related but i have being hearing such incidences in the hospital , as a result if negligence on the side of the mother because the mother will say she will not pass through CS.and they do not want to have blood transfusion because of their beliefs, like some churches don’t allow their members pass through CS and have blood transfusion.
Nos 4 &5: we have not had any experience. We only hear about that but have not had any experience.
L: No, I don’t know of any woman particularly.
Prof: Can you tell me how many women come to you and they want your advice, how many women come to you
No 1: some times they i have three to women weekly.
Awatt: Tell us about the women who seek your advice about pregnancy, antenatal care and delivery.
No 1: it depends, they come once a while and I advice them on what to do about hygienic practices and pregnancy.
No 4: I have an average of 15 women monthly
No 3: I have ten or eleven women come to me monthly
No 4: some times, 5, 3 or 12 women inthe month.
Awatt: can you tell us if its only pregnant women that come to you?
No 5: other women that are not pregnant come to me for advice both for family planning and how to care for themselves as women and women who want to get pregnant also come to me.
No 1: when women who dont want to get pregnant again I refer them to the hospital for proper education and attention
Awatt: why do they come?
No 3: because they are pregnant and I know the exact kind of medication to give to them and if the women want herbs i know the exact herbs to give to her because its not all kinds of herbs that they need to take. there are herbs for a particular need and there are particular drugs for particular purpose.
No 4: they come if they feel complications and if I can’t manage it, I refer them to the hospital i also advice them to go to the hospital,
No 3: some come when they feel abdominal pains and we check them up
No 2: some come to know their blood levels, the percentage of their blood and the kind of drugs that they can take du Ina pregnancy.
No1: they come to me to find out the progression of their pregnancy.
Prof : do teenage girls also come to you?
No1: yes, they usually come.
Prof: what is the estimated rate of teenage pregnancy?
L: about 5 came to me in the last October. An average of less than 18 years old and they deliiveried very well. In fact, the last one was about less than 13 years old. And she gave birth to a boy.
Awatt: when do they normally come?
L: some women come about eight months into the pregnancy and most times it complicates issues. There was one that came and her labor started at night, I helped her deliver a baby boy but she bled till afternoon the next day before the bleeding stopped. some of them are stubborn, some of them when they see us in church the talk to us and we refer them to come to TBA ,some of them will weit until whem they want to deliver they will rush them to TBA and we will deliver them if we cant we refer them toi the hospital,
No 1-3: some come four or five months into the pregnancy.
Awatt: when is the most appropriate time for a woman to come?
Nos 5,4,2 and L: two months into pregnancy is the appropriate month.but these women will not want to register at that time.
Awatt: why do they delay in reporting their pregnancies?
No 4: some complain of money, some have family background issues like the fear that someone will kill them if they find out about their pregnancies and so hide out, they keep their pregnancies hidden. Some fear for being operated upon.
Awatt: why do you think they choose TBA?
No 2: because we, TBAs pray a lot.
No 1: TBAs can understand with them and even discharge them free of charge when they don’t have money.
L: hospitals give them a long list of what to buy. One woman that came to me had already gone to the hospital and was given a very long list, after she had bought all the list requested, she was told that she would deliver through CS. She was afraid and came to me. I prayed with her and when labor set in, I helped her deliver by herself, we consider their condition
Awatt:. what is their first choice of where to deliver?
L: their first choice of antenatal most times is hospital but when they want yo deliver, they come to TBAs even after going to the hospital. some of them are afraid of the expenses in the hospital. So they still come back to the TBA.
Awatt: what factors keep them away from delivering at their first choice, the hospital?
No1: they say the hospital people do not have empathy on them.
No 4: they pay for almost everything in the hospital including checkups, and they keep buying papers and tissues and are asked to buy the same drugs over and over again. They need up spending less at TBA places and deliver safely too.
Awatt: is it important for a woman in labor on have a family member with her at all times during labor and delivery?
No 3 yes, it is very important
No 1: yes, it is
Almost all echoes: yes, it is important
Awatt: what kind of spoort do the need from the family members.
No 4: for support and encouragement during labor and childbirth
No 1: yes, because of food. The person they come with goes to prepare food and come to give her. But most times, before the persons comes, she is already tired and needs to push so, we cook food and give to them before the support comes with the food.
Prof: who do they want around
No 1: some times, their Husnbands
L: it could be a sister or a family relative
No 2: sometimes, when the labor sets in, their husbands may have gone for work. So, they call a family member.
Awatt: Does religion affect their choice of antenatal care and delivery location?
All echoes: No!
L: anyone who says that is telling lies. Religion does not
Awatt:: what do the churches say about childbirth??
No 3: but some churches preach against women going in for CS as a believe and this makes women not to go for CS and this can cause a woman to die during labor complications.
Awatt: How do women here prefer to give birth? Do they lie down, squat?
No 1,3,4: the women here always lie down during labor and childbirth
L: there was a case I had. The lady came to give birth in my place, climbed the protector and was shaking it. The baby’s head was almost coming out. At a time, she hid under the bed and the baby was pushed out. She refused coming out from under the bed for sometime.
Another woman, she bit the carpet in my house and thore the whole carpet into pieces with her teeth
Most women behave as if they are crazy during labor some of our women are wicked.
Prof: What is done with the placenta?
No 1,2: if the placenta is complete, it comes out with lobes and we bury it.
Awatt: what if the placenta is not complete?
No 2: we put our hands into the woman’s vagina and bring out the remaining we were hand gloves when checking for the placenter.
Prof: how do you measure blood loss to know whether they are normal or not?
No 2: we measure with the weakness of the mother. If blood come out and the woman is weak, we observe and know that the woman has lost much blood and needs a replacement.
Awatt: what do they do when the blood loss is much.
No 2, 3,5 & 4: we give injections
No 1: I give glucose too
Awatt: there are modern drugs like misoprostol to help a woman stop bleeding and so she won’t go into convulsion during labor. Are these drugs available?
No 4: yes, i know of a drug I attended a seminar once, the people came from London and gave me some drugs,
mother also asked us to give two tablets to every woman after they sliver the placenta.
Awatt: so you make use of these drugs?
No 4: Yes. They gave me enough and also hand-gloves and I make use of them.
Awatt: have you heard of misoprostol?
No 4: yes, that is the drug the London people gave me. I make use of it.
No 1: I use misoprostol which I buy from the chemist I run short of them.
No 4: I also make use of Ergometrine
Awatt: do you use magnesium sulphate?
No 1: when women come, I check their body weight, body temperature and blood pressure and after childbirth, have never given them magnesium sulfate.
No 4: I refer them to the hospital when I notice abnormal blood pressures.
Awatt: how about someone like me who has unstable blood pressures where it goes up now, it is normal then, and it drops and so on. What would you do with such a person?
No 4: even when the Blood pressure is irregular, I refer the person to the hospital.
No 3: I refer the person to the hospital
Awatt: what are the most important things that a woman needs to stay safe during pregnancy and delivery…?
No 5: They don’t need to do so much work; I eat a lot of vegetables.
No 2: I eat a lot of fruits
No 4: I eat a lot of fruits and vegetables too well
No 2: I need not to quarrel and I try to be at peace with everybody and also with my husband. I eat all too. And I drink a lot of water.
Awatt: does a pregnant woman need to take alcohol?
No 5: if a pregnant woman takes alcohol at the early stages of her pregnancy, it can cause miscarriage
All other: concurs with what number five says
Some women take alcohol, which is not espercially at the early stage of pregnancy.
Awatt: have you ever heard of misoprostol used to stop bleeding
No 2,3,5 : no we dont know
No 4 said yes i got it fron the Lonfon people.
Awatt: would you use the drugs if they are available?
All: if the drugs are readily available, we will sure use them.
Awatt: what are the roles of TBAs, Midwives, Nurses and Doctors in delivering obstetric care in Nigeria?
Do they work together?
No 1: we work together. A child came to me to give birth and she was 15 years. I feared and took her to the hospital and there, we worked together. In fact, the doctor’s advice us to bring cases to them when there are complications. there is a good referral.
Awatt : Are there referrals from hospitals. To TBAs?
No 4: No, there are none. But we will really like that if the are.
No 5: No, there can’t be. There is competition and the doctors will never do that. The Doctors feel that we are inferior to them.
All: yes, the doctors do feel we are inferior
No 4: yes, that is true.
Awatt : can there be a referall fron the hospital to the TBA?
Yes. we will like such referall but the doctors will never agry to that because the fill they are superior to us.
Awatt : do you agry that the doctors are superior to you TBA”
No 1:they know more than us but we were there before they existed.
Prof : do the doctors respect you.
All: yes they do
Awatt: is there anything you think a Doctor can learn from you?
No 4: yes, there are some things we can teach them.
Awatt: what are those things that you can teach a Doctor?
No 4: in the area of herbs, we know more than them and we can teach them.
No 3: we pray for them in cases of complications and God helps them deliver. Doctors don’t, they only refer them for CS
No 5: we help the women push by applying groundnut oil on our hands and we massage the woman’s tummy to help her push. Doctors don’t do that. Most of them are impatient. Doctors dont have patience at all.
Awatt: Can you work as a team with hospital personnel?
No 4: Yes, we can
Awatt: If there is a hospital and a TBA section is built in it. Do you think that can work?
No 1 yes it will be okey
No 4: we don’t even think it can be because the Doctors feel they are superior to us.
No 3: but the people believe so much in us and we can do More. while the doctors will not. A lot of the women trust and have confident in us than the doctors as such will always come to us.
Awatt: We have heard of some health workers like nurses and Doctors being being harsh with women in labor. Does that happen in this area?
L: I am bitter with the hospital. The nurses treat us as if their uniform confers this authority on them. In fact, there was an experience I had. I really felt like wearing that uniform so that I deal with the nurse too.
No 4 : 70% of the nurses are two harsh on the women
No 5: what she (no 4) says is true very few nurses are good they are rude.
Awatt: A report says that pregnant women are the ones who cause nurses to be harsh. Do you think that is true?
L: yes, some women themselves are harsh. But it depends on the response the nurse gives to her harshness. When a woman with pregnancy and the pains of labor, you don’t expect her to behave kindly. The nurse as a trained health worker should be the one to understand and respond well.
No 2: I agree with what L says some women are hearse becuase of the pains in labour and their responses will be hearse
No 1: some women go to the hospital almost empty handed. It can make a nurse to be harsh with her. A woman who wants to put to bed and she goes with nothing; no clothes, nothing at all.
No 5: some nurses are harsh because the women did not register with them. They sent the women to ‘Stubborn room’
Awatt: In your opinion, what needs to be done in order to reduce Maternal deaths in Nigeria
L: it is for them to personally decide to go the hospital
No 1: some women are afraid of going to the hospital so that they won’t be injected. They are afraid of injections.
No 3: some women collect drugs, when they get home, they throw them away and don’t drink them.its their personal decicision.
Awatt: what can the Government do?
No 1: The Government has been advertising and advising women to go to ANCs during pregnancies. Churches he too has been encouraging women to. Even me, I have been advising women to go to ANC centers too. I think it is a personal thing. It has gone beyond governments and churches.
Awatt: What does it mean to you personally to deliver care to pregnant women in Nigeria?
No 4: I feel so much joy when I help a woman deliver and she is safe, the baby is safe too.
No L: in my case, a lady had her first baby through CS and said it was painful.she was afraid for thes second pregnancy So when she took in again, she came to me and we prayed together in the church so When labor came, she delivered normally and safely and it was not through CS.
It gave me Joy that I could deliver a woman normally who was cut open in her first time delivery.
No 3: if a person delivers, she goes to tell other persons about me and refers another person that joy alone keeps me going on in my profession.
Awatt: How do you inspire others to follow your footsteps?
No 1: I will encourage her to go to school, learn and come back. I will teach her the ones I know and it will make her better.
Awatt: I want to say a big thank you for coming around. Even with the short notice given. thank you so much.
Thank you for taking your valuable time to speak with us today. The information that you have shared with us is very important and will help us to improve obstetric services in Cross River State. We would like to conclude and offer you a small token of our appreciation.