MATERNAL MORTALITY is defined by the WHO as the death of a woman while pregnant or within forty-two days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. It is subdivided into direct and indirect maternal deaths.
Direct maternal deaths result from obstetric complication of pregnancy, labour, puerperium and from interventions or any sequelae of the above, whereas Indirect maternal deaths result from the worsening of existing conditions by pregnancy or delivery. Thus, death from pregnancy induced hypertension is a direct maternal death whereas death from sickle cell disease during pregnancy is an indirect death.
According to the United Nations Population Fund (UNPFA), about one woman dies every two minutes from pregnancy or child birth related causes and most of these deaths are entirely preventable. Although the actual incidence of maternal mortality is relatively unknown in Nigeria as majority of these cases are unreported, it is however estimated that Nigeria has the second highest record of maternal deaths (about 40,000 deaths were recorded only in 2010). Only India has more record than Nigeria. (India recorded about 56,000 deaths in 2010).
The five major direct causes of maternal mortality are haemorrhage, sepsis, pregnancy induced hypertension, obstructed labour and unsafe abortion while the major indirect causes are malaria fever, anaemia, HIV/AIDS, and cardiovascular disease. Most of these deaths are preventable and avoidable as the health-care solutions to prevent or manage complications are well known. The most important solution is that all births must be attended by skilled health professionals, as timely management, professional decisions and treatment can make the difference between life and death.
Factors contributing to maternal death include but not limited to poverty, lack of access to skilled medical care during childbirth, grand multiparity, lack of good transportation and communication, unavailability of safe blood services, lack of good ante-natal care, unsafe abortions, and inaccessibility of family planning services.
The government, the midwives, private organizations, the individuals and religious institutions all have a role to play in the prevention of this menace to the lives of our wives, mothers and sisters. Pregnancy and childbirth should be a thing of joy and not an occurrence that will claim lives and cause agony and grieving to families.
The roles of the government in the prevention of maternal deaths include funding primary health care centres and provision of skilled professionals to these centres, provision of good transportation system, provision of health technologies, training and re-training of healthcare providers, promoting health education and research, provision of access to emergency obstetric care, provision of access to safe blood services and policy making regarding reformation of health system and elimination of unskilled/quacks from the health system. The prevention/ reduction of maternal deaths should be given upmost priority by the government as incidence of maternal deaths tends to increase in the nearest future due to poor economy of the nation.
Certainly the role of the midwives in decreasing/prevention of maternal deaths is a great one as the decisions they make and choice of treatment have a great impact in deciding whether or not the woman will live. The most important role of the midwives is identifying the women at risk during ante-natal care. Identification of these risks ensures proper planning and preparation to combat these risks when they occur during pregnancy, childbirth or puerperium. Prompt referral of more severe cases, participation in seminars, conferences and workshops to improve their knowledge, scope and skills, provision of good postnatal care, providing health education and family planning services. In most communities, the midwives have a position of respect and honour, they are often consulted by both women and men. They are expected to give advice on pregnancy, family planning, sexuality and many unrelated issues, the midwives can exert a powerful positive influence on the lives of women using her position in the community.
The role of the pregnant mother is registering for ante natal care, keeping appointments dates, adhering strictly to therapeutic regimen, believing/ trusting the healthcare provider and maintenance of personal hygiene.
Conclusively, it is important that priority is given to the health of pregnant women and effort should be made by all parties concerned to cause maternal deaths to reduce drastically in our nation.

SAKA ABIODUN J. (RN)

http://sakajoe..com.ng/2016/12/prevention-of-maternal-mortality-roles.html?m=1

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