“Serving a hard to reach community like Alikalia comes with a lot of challenges. The good thing, however, is my contribution in promoting safe motherhood and in reducing maternal mortality which I am proud of as a midwife,” said Regina Conteh, a midwife attached to the Alikalia Community Health Post, Koinadugu district, north of Sierra Leone.
With 717 deaths per 100,000 live births, according to the 2019 Demographic and Health Survey. Sierra Leone is still among countries with the world’s highest maternal mortality ratio.
Midwives remain the basis of UNFPA’s work in achieving the three transformative goals of zero preventable maternal deaths, zero unmet need for family planning, and zero gender-based violence and harmful practices against women and girls.
With funding from UK aid, UNFPA, through the Saving Lives Programme, supports the Government of Sierra Leone in training midwives in the three schools of midwifery (Freetown, Makeni and Bo), to improve the availability of skilled birth attendants as well as to help reduce the gap in the country’s midwifery workforce.
Regina Conteh is a midwife trained at the School of Midwifery in Makeni. By 2012, as a State Enrolled Community Health Nurse, she served at the Community Health Post at Matotoka where she witnessed women losing their lives giving birth to their babies, something that pushed her to enrol in 2017 to become a midwife.
“This [midwifery] came with a lot of challenges,” she explained, adding that “it however was a way one could contribute in promoting safe motherhood and in saving lives of mothers and babies.” Reflecting on the numerous trainings she got, she said, “The trainings at the school of midwifery are largely contributing to my work in successfully saving lives.”
With no maternal mortality reported since 2019 when she was posted to the Alikalia Community Health Post, Regina believes this is due to the significance attached to the quick referral of major cases.
“When a case is detected to be serious at the antenatal care stage, we immediately do a referral to the Kabala Government Hospital. This is sometimes difficult especially given the terrible road network.”
Delivering babies comes with required skills and expertise and this is more so with twins or quadruplets. In September 2020, Regina successfully delivered quadruplets, the first midwife to have done so.
A pregnant mother, BondoThoronka, arrived at the Community Health Post for health care services but was referred to the Kabala Government Hospital.
“She failed to travel to Kabala as advised. Days later, she came to the facility, fully dilated. There was no ambulance. In a bid to save her and the babies, I used the skills I was taught at the School of Midwifery to deliver her,” a proud Regina narrated, and added that, “delivering that pregnancy was a lifetime experience.”
With bleeding in pregnancy accounting for about 40 per cent of maternal deaths in Sierra Leone, Regina was worried about possible postnatal complications like bleeding which has the potential to lead to death. “This was my major concern. I couldn’t sleep as I was constantly monitoring her and the quadruplets. It turned out to be one big success. Today the mother and her four babies are all alive,” said Regina.
Community advocacy is critical to ending preventable maternal deaths. When Regina was first posted to the community, she felt like returning. “When I first arrived, there were cultural challenges too added to the fact that it was my first time coming here. Changing the mentality of people was a problem; more so, getting women to visit the health facility to deliver babies.”
There was a high number of home deliveries by traditional birth attendants who lacked the required skills and medical equipment to ensure safe delivery, contributing to women dying during childbirth.
When Regina realized this was a major problem, she embarked on outreach visits to different communities, talking to TBAs about how they could help in getting more women to the health facility.
“I developed a scheme wherein, when a TBA brings to the health facility a pregnant woman, some amount of money is given to her as transport fare. It was a difficult drive but it helped to create impact. Now, we get huge turnout of pregnant women visiting the facility daily with a minimum of 20 deliveries a month.”
Looking back, Regina, who by midday of Friday, 23 April, had received over a dozen women for maternal health care services said that working in a Community Health Post she never knew was something else especially being the only midwife with a Community Health Assistant.
“We lack the infrastructure and tools. There is need for more support. However, I am happy to be serving the community and helping in promoting safe motherhood by conducting antenatal clinic, clean and safe deliveries, detecting complications and doing referrals and eventually contributing in reducing maternal mortality rates, thanks to the UNFPA and donor support.”