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Wrong use of bleeding-control drug by birth attendants causing maternal, newborn deaths –Gynaecologists

Angela Onwuzoo

Maternal health experts have raised the alarm that the illegal and wrong use of misoprostol to induce labour by traditional birth attendants is fuelling maternal and newborn deaths in the country.

Misoprostol is indicated for the prevention and treatment of stomach and duodenal ulcers. It is also used to induce labour, cause an abortion, and treat postpartum bleeding due to poor contraction of the uterus.

The gynaecologists stated that some pregnant women who had earlier delivered their babies through caesarean section also indulge in the use of misoprostol with the connivance of traditional birth attendants with the hope that it would help them avoid a repeat CS.

They lamented that some of the pregnant women indulging in this unsafe practice do not live to tell the story.

According to the experts, misoprostol, is usually used by physicians to stop bleeding after delivery so that women won’t have a postpartum hemorrhage, adding that the drug is also used for abortion.

An Associate Professor, College of Medicine, Lagos State University, Dr. Yusuf Oshodi, in an exclusive interview with PUNCH Healthwise, said using misoprostol to induce labour could rupture the uterus and damage the womb.

The gynaecologist said there are indications for induction of labour that must be established before this intervention is instituted.

Dr. Oshodi, who is also a Consultant Obstetrician & Gynaecologist at the Lagos State University Teaching Hospital, Ikeja, explained, “The one that they are using now that you are not paying attention to is misoprostol.

“This one has more dangers because people have ruptured their uterus because of using misoprostol to induce labour.

“They have torn their womb, their babies died and some of them don’t live to tell the story.

“It is very common in our environment. The drug is meant to help people when they deliver the placenta after delivering the baby for the womb to contract and stop bleeding so that they won’t have postpartum hemorrhage. It is the same drug that people are using to procure an abortion.

“The traditional birth attendants use misoprostol to induce labour illegally. They are using it like pure water to induce labour.

“Why it is even illegal is that the dose they are using is like eight times of what we use when we want to induce labour.

“So, the work will be like eight times, some of them without contracting and bothering.”

Dr. Oshodi who is the Vice Chairman, Society of Gynaecology and Obstetrics of Nigeria, Lagos State chapter, said induced labour was associated with a higher caesarean rate.

“Also, some of them that have done CS before will just go and swallow this tablet just because they don’t want to have another CS. And the condition that will merit them to use it, they don’t care whether they meet it or not.

“So, many of them have come to the hospital with ruptured uterus, some of them don’t survive it, some of them are brought in dead with their babies.

“The use of misoprostol to induce labour is the in-thing now and the drug is meant to help in stopping bleeding after delivery so they don’t have excessive blood loss. If they want to induce, it is not acceptable for labour to be induced if the baby has not matured.

“Then, what we also know is that if they make labour start, what is the guarantee that the woman is going to deliver? Once the woman is in labour as the womb contracts, the blood supply to the baby shuts down at that time.

“Now, a healthy baby will cope but the baby that is weak inside, the condition will worsen if they keep doing that. The traditional birth attendants don’t even know how to resuscitate a baby,” he said.

Giving further insight into the risks associated with induced labour, the maternal health expert said it is not everybody that falls into labour that will deliver the baby by themselves.

The gynaecologist noted, “We do not interfere with labour until the pregnancy has gotten to 41 weeks before we induce if labour does not start.

“The way it works is that we give an average of 40 weeks for all pregnant women. If a woman does not fall into labour by 41 weeks, then we can now counsel them towards making labour start.

“The reason behind that is that pregnancy if pregnancy extends beyond that 40 weeks, something may happen to the baby. This is what is called a placenta clock. So, around 40 weeks the function may begin to reduce instead of progressing.

“So, after 40 weeks, if the function of the placenta reduces, it simply means that less oxygen and nutrients will get to the foetus because it is the placenta that links the mother and the baby.

“We have conducted research and compared the outcome of people who fall into labour on their own and people who we have to induce for a genuine reason. So, women should fall into labour on their own.

“However, if the labour passes 40 weeks and we don’t have the opportunity of monitoring, by 41 weeks, we can interfere and make labour happen. This one is what we call induction of labour.

“For people that are using things to induce labour, they must ensure that the baby is matured enough up to around 38 weeks. They should avoid using anything that will affect them or their babies negatively to induce labour.”

In a 2017 article published in the Tropical Journal of Obstetric and Gynaecology titled, “Feto‑maternal outcome of induced versus spontaneous labour in a Nigerian Tertiary Maternity Unit”, the authors including Dr. Oshodi concluded that induction of labour was associated with an increased risk of caesarean delivery and postpartum haemorrhage compared with spontaneous labour.

Also speaking, a Consultant Obstetrician and Gynaecologist at the Lagos University Teaching Hospital, Idi-Araba, Dr. Babasola Okusanya, says labour induction is not what anybody can do.

Okusanya explained, “There are indications for labour induction. The most common indication is a prolonged pregnancy. Other indications could be hypertensive disorders in pregnancy, intrauterine growth restriction, and diabetes mellitus in pregnancy.

“Induction of labour has reasons and when the reasons have been met, it is usually planned. It is never an emergency procedure. The main reason for labour induction is to achieve vaginal delivery.

“TBAs should not even think of labour induction. Private health facilities that don’t have skilled birth attendants and cannot do CS should not induce labour.”

According to the World Health Organisation, induction of labour is the process of artificially stimulating the uterus to start labour. It is usually performed by administering oxytocin or prostaglandins to the pregnant woman or by manually rupturing the amniotic membranes.

WHO says induction of labour should be performed only when there is a clear medical indication for it and the expected benefits outweigh its potential harms.

The American College of Obstetricians and Gynaecologists says sometimes, labour induction does not work.

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