Christabel Ligami (Special Correspondent)

Pauline Letit, 27 years, is a mother of two and has just delivered her third born child at Lerata health facility in Samburu, North Eastern Kenya.

This is the first time Pauline is delivering in a health facility. She was referred here by Cecilia Appa, a community Health Volunteer and a traditional birth attendant in Samburu. Ms Appa accompanied Pauline from home to the hospital one week to her delivery date and stayed at the maternal shelter at the health center built specifically for mothers to wait days before their delivery and/or after delivery.

Pauline walked for about 50km kilometers to get to the hospital early enough to avoid rushing the last minute and also she did not want to take chances in case of a problem during delivery.

In Samburu, mothers live far from the health facilities and expectant mothers walk for about 70km to get to the hospital. As a result most of them choose to deliver at home.

For Pauline, three things encouraged her to deliver in the hospital- one is the maternal shelter built just like the Samburu cultural guts, the birthing stool that she will use during delivery and lastly, the comfort that her traditional birth attendant who helped her deliver her other two children will be with her at the hospital during delivery.

Demonstration on the use of the birthing stool to women at the Lerata Health Facility in Samburu

Culturally Samburu women prefer delivering in a crouching and not lying on their backs as is done in most hospitals.

In 2018, the World Health Organization recommended that for women without epidural analgesia, encouraging the adoption of a birth position of the individual woman’s choice, including upright position, is recommended.

“My assistant (Ms Appa) informed me that delivering in the hospital will be just the same as home delivery and that she had brought other women to deliver in the hospital. So I decided to come,” said Pauline. “It’s a new thing to see a nurse and a doctor. This is also my first child to come to the hospital.”

Pauline said that she was ready to use the birthing cushion because other mothers have used it and they liked it.

In order to encourage more women to come to the hospital on time and safely deliver their babies, Afya Timiza – A USAID initiative constructed a maternal shelter adjacent to the hospital and innovated the birthing cushion – a low-tech, cheap innovation that mothers can sit on while delivering so as to help reduce child and maternal mortality rates in the arid and semi-arid areas.

“The birthing cushion is an innovative model now being used to encourage women to deliver in hospitals while conserving their cultural beliefs,” said Halima Dahir, Afya Timiza project officer in Samburu.

“The main objective is to ensure that women are more comfortable delivering in the hospital and that is why we allow them to come with their traditional birth attendants. These are people they trust most.”

She said maternal shelter is fashioned along the traditional Samburu hut so that mothers can feel like they are at home. It serves as a waiting home for a mother who is about to deliver so that she can easily access the services of a nurse, can rest, get food as they wait to deliver.

the birthing stool used by women in Samburu who prefer the sitting/crouching position during birth

“The maternal shelter has improved the community’s attitude and perception towards skilled health care services,” said Ms Dahir.

“The birthing cushion and the maternal shelter are incentives to encourage women to deliver in hospitals. Traditionally, the mothers preferred delivering at home. But through outreach services between Afya timiza and government, mothers were encouraged to come deliver in the hospital.”

She said that the traditional birth attendants are also trained to offer the services and they accompany the mother to the hospital – for those mothers who insist to be delivered by the traditional attendants.

They are appointed by Afya Timiza as the CHV in the community. They sensitize the community on how to prevent the maternal and child mortality.

“The CHVs go round the community sensitizing mothers on the importance of hospital deliveries and general health for the mother and the child,” said Ms Dahir.

Samburu county is one of the regions with the highest maternal and child mortality rates in Kenya. According to the 2016 Kenya’s health report, only 37 per cent of the women in the region give birth in a health facility

So far, she said in just four months more than 30 mothers have delivered at the health center and because they liked it, they have helped with encouraging others to deliver in hospital and it is expected that more mothers will choose hospital delivery.

Chris Omeke, a nurse at Letit health center says that most complication that mothers in the region experience during delivery are haemorrhage which has killed most mothers, obstructed delivery,  infections like tetanus, psepsis and fevers.

“Most of the mothers either die on the way to the hospital or die at home. This is because of the distance to the hospital they cannot get an emergency assistance. Also they decide to come to the hospital late,” said Mr Omeke.

He said that before the mothers deliver, demonstrations are done on the birthing cushion to prepare the mothers in advance on how to use it.

“The most comfortable position for the mother during delivery is encouraged and so they choose which position they want. Most of them prefer squatting while others prefer kneeling,” noted Mr Omeke.

Delivery at the hospital he said is free because of the Linda Mama services (government initiative that offer free maternal services to the mothers and babies during delivery). After delivery the mothers are given the baby mother bags with baby’s things like clothes.

This story was supported by the African Academy of Sciences (AAS)