Giving midwives access to further training in life-saving skills could prevent up to 80 percent of maternal deaths in the Philippines, says Rosalie Paje, division chief of the Family Health Office under the Department of Health (DOH). “Midwives play a crucial role in providing maternal healthcare, especially in geographically isolated and disadvantaged areas and those affected by armed conflict where doctors and nurses are scarce,” Paje said.
According to the 2007 UN Development Programme (UNDP) Philippines Mid-Term Progress Report on the Millennium Development Goals (MDG), the number of maternal deaths per 100,000 live births has declined from 209 in 1993 to 162 deaths in 2006, but it is unlikely the MDG 2015 target of a maternal mortality ratio (MMR) of 52 will be met.
“The MMR here in the Philippines is atrociously high,” says Alberto Romualdez, former DOH secretary and now vice-president of The Family Planning Forum, an NGO that supports programmes in effective reproductive health.
Midwives crucial to maternal care
According to Patricia Gomez, president of the Integrated Midwives Association of the Philippines (IMAP), there are an estimated 17,500 midwives registered under the Professional Regulation Commission (PRC) working in the public health sector. Midwives usually earn between US$100 and $300 a month.
But that is barely enough to service the 41,841 barangays (the smallest government unit) throughout the archipelago nation.
According to the National Demographic Health Survey (NDHS) of 2008, only 44 percent of births in the Philippines occur in health facilities; 56 percent of children are still delivered at home.
Under Philippine law, licensed midwives are authorized to carry out the supervision and care of women during pregnancy, labour and management of normal deliveries, including the administration of an oxytocin drug to prevent and treat haemorrhage after the delivery of the placenta.
According to Yolanda Oliveros, coordinator of the joint programme on maternal and newborn heath at the UN Population Fund (UNFPA), “Midwives are not allowed to handle emergency cases alone such as high-risk pregnancies or administer life-saving drugs such as magnesium sulphate and steroids.”
Empowering midwives However, health experts are lobbying for amendments to the midwifery law to allow midwives to administer such medicines.
The leading causes of maternal deaths include pregnancy-induced hypertension, post-partum bleeding and post-abortion complications.
Photo: David Swanson/IRIN
56 percent of all births take place in the home
According to the DOH Maternal Mortality by Cause Report, updated in June 2009, hypertension complicated by pregnancy comprises 29 percent of the causes of maternal deaths, and partum haemorrhage 15 percent - the second and third leading causes of maternal death. Others are sepsis, obstructed labour and complications around unsafe abortion - most of which are preventable with proper diagnosis and intervention.
“To address these direct causes of deaths, giving oxytocin during active management of the third stage of labour [after delivery] is very important to prevent and treat post-partum bleeding. Magnesium sulphate is very important to prevent and manage occurrence of eclampsia or convulsion brought about by severe hypertension. Giving of antibiotics is also essential to control existing infection,” says Oliveros.
However, this suggestion has met resistance from the Philippine Obstetrical and Gynaecological Society (POGS).
“Magnesium sulphate, if not properly administered, can cause respiratory failure and kidney shutdown,” Regta Pichay, POGS president, says.
However, given the urgent need to curb the MMR, Pichay says the POGS is ready to train mid-wives to administer magnesium sulphate and oxytocin after the third stage of labour.
“Midwives are already administering oxytocin during the fourth stage of labour or after the expulsion of the placenta, as prescribed by law. But many times, this is too late. We would like to be able to accredit them to issue it after the third stage of labour or after the delivery of the foetus,” says IMAP president Gomez.
Countdown to 2015
POGS, with the UNFPA, has started the MDG Countdown Programme where midwives will be trained and supervised in tertiary hospitals for the administration of oxytocin and magnesium sulphate. An estimated 600 midwives will undergo the pilot programme.
“After six months of training, they will be issued a certificate of proficiency based on performance. Only then will they be deployed to the marginalised communities such as the mountain provinces of Ifugao, Leyte, Samar, Bicol and the ARMM [Autonomous Region of Muslim Mindanao],” Pichay said.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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