High risk of maternal morbidity in Tobago

Tobago is at high risk for maternal morbidity despite a low maternal death rate.

So said Dr Leslie Bishop, Specialist Medical Officer in the Department of Obstetrics and Gynecology at the Scarborough General Hospital, who noted that while there were no maternal deaths of the 857 deliveries at the hospital in 2017, 28 percent of the births iwere done by caesarean section, and 10 stillbirths were recorded.

Giving the feature address at the fifth Interfaith Service to mark International Midwives Day last Thursday, Bishop said the risks of maternal morbidity include advance maternal age, obesity, births done by caesarean section and problems associated with Chronic Non-Communicable Diseases.

“We have a lot of over 35 mothers, we have a lot of obesity, we have caesarean sections, and we have a lot of chronic non-communicable diseases such as hypertension and diabetes. We have the risk factors for severe maternal morbidity and we cannot ignore that.

“We need to have quality care, we need to have competent and motivated human resources, we need essential physical resources, we need evidence-based practices for routine and emergency care. We need an information system where record keeping enables review and mechanism, we also need functional referral system between levels of care,” she said.

“We are fortunate in Tobago with nearly 100 percent of our attendance to mothers are from midwives. Our exception may be one or two patients who gave birth in the carpark. The second factor that we have been able to offer is antenatal care coverage of at least four visits to all our patients where all our women in Tobago have access to antenatal care at their district health centre of at the hospital,” she added.

But she warned midwives gathered at the event that because the maternal mortality rate dropped in 2015, does not mean that attention should be paid to safeguarding against maternal deaths, while still addressing maternal morbidity.

“Although we are not having maternal mortality, we can still have severe maternal morbidity…” she said.

The event was hosted by Midwives and staff of the Maternity ward of the Hospital.

Bishop praised the work of the midwives in reducing the maternal mortality rate as well as having a central role to play in reducing maternal morbidity in Tobago.

“We had a normal delivery rate of 71.4 percent last year, so it means 71 percent of our deliveries were by midwives. More than two thirds of women in Tobago are assisted by midwives and the majority of women have the opportunity to receive quality care from midwives, antenatal to intrapartum and postpartum. Seeing that 71 percent of our deliveries are by midwives, midwives are central in reducing maternal morbidity in Tobago.,” she said.The last maternal death reported in Tobago occurred in October 2015 where Leciana Mitchell-Sheppard and her unborn infant, Ajani Sheppard, both died during labour.