Traditional midwives in frontline of drive to cut maternal deaths

She felt more comfortable in the hands of Roselinda Akumu, the oldest midwife in the village of Manyatta, in Kenya's Kisumu county. Akumu, 78, delivered her first baby in the 1960s and has lost count of the number of mothers she has helped.

However, Akumu, one of the village's 10 traditional birth attendants who are attached to nearby Migosi Hospital, decided that the birth was complicated and the expectant mother should be admitted to hospital.

"I was in labour for a long time and gave birth in the morning of the third day," Salome told the Thomson Reuters Foundation.

"All this time, Roselinda was by my side," added Salome who now has a healthy, seven-month-old son.

Kisumu County in western Kenya has begun an initiative to involve traditional birth attendants in interventions to curb maternal deaths.

The midwives are taught about the dangers of unskilled deliveries and assigned the task of referring pregnant mothers to hospital.

For every referral, a traditional birth attendant at Migosi Hospital is paid 300 Kenyan shillings (around $3).

Health officials in Kisumu hope that hospital deliveries will improve the overall health of women and children.

Maurice Otieno, Kisumu county's director of health services, said that it was worrying that almost a third of pregnant women in Kisumu County were not delivering in hospital.

"The policy direction is to re-orientate traditional birth attendants, train them and task them with referral of pregnant mothers," Otieno told the Thomson Reuters Foundation.

According to a 2014 report from the United Nations Population Fund (UNFPA), 488 expectant mothers die per year in Kenya per 100,000 live births. This compares with just six deaths per 100,000 births in Germany.

Kisumu is among the counties with highest maternal mortality rate in Kenya with 495 mothers dying for every 100,000 births. In the remote and poor eastern areas like Garissa and Mandera, the maternal mortality rate is even higher.

Otieno hopes that once the hospital initiative is implemented throughout Kisumu county, the maternal death rate will fall.

So far, the number of women delivering in the pilot hospitals like Migosi has more than tripled since the intervention began in 2014.

MATERNITY WING FULL

On a typical day at Migosi Hospital, almost two dozen new mothers queue to be seen with their newborn babies. "Referrals by TBAs (traditional birth attendants) have increased the number of women coming in for clinics," said Kennedy Ondito, the doctor in charge of the hospital.

The maternity wing is also full with mothers who have recently delivered and others waiting to deliver.

"Before the intervention started, we could go a whole week without a single delivery and in a month we could deliver less than ten but now we are doing over 50 deliveries a month," Ondito told the Thomson Reuters Foundation.

In case of emergencies whereby the mother or child are at risk and where the hospital is too far, traditional birth attendants are encouraged to conduct the delivery first then rush the mother to hospital.

"Our skills are still recognised because we are the first ones that the mothers see before we take them to hospital," said Roselinda Akumu, the midwife. "I can still deliver an emergency birth but after that I have to take the mother to hospital where they have better equipment. Things have changed nowadays."

The training of the traditional birth attendants has also helped in preventing mother to child transmission of HIV. This was the case with Akumu's neighbour, Phoebe Awino, 20, who is HIV positive.

"Roselinda advised me to go to hospital when I went to see her when I had abdominal pains. It was during my pre-natal clinics that I was tested and found to be HIV positive," Awino said.

She told Akumu who insisted on the importance of delivering in hospital in order not to transmit the virus to her baby.

"I was happy when I was told that my child was HIV negative. I realised that it was a good decision to give birth in hospital for me especially," Awino said.