MASERU – While most attention is given to grieving families after the death of a nursing mother, little is thought about the impact of such deaths on healthcare workers. Midwives, often at the forefront of childbirth, face the weight of these losses first hand, while witnessing a mother’s death leaves lasting emotional scars on some. Maternal death is a pervasive problem for society that needs to be addressed in Lesotho. However, as widespread as this problem is, far too little attention has been paid to the experiences of midwives concerning maternal death in Lesotho’s context.
A recent research by a former National University of Lesotho (NUL) student Lethato Mohale, who focused his master’s research on understanding how midwives coped with loss of mothers in childbirth, has shown that there are unseen struggles of these dedicated professionals when performing their duties. The study seeks to explore the psychological experiences of the midwives regarding maternal death in two regional hospitals in the Thaba-Tseka district.
Psychological experiences such as trauma, shock, fear, stress, depression, loss of trust, helplessness, bad dreams, and insomnia were reported by the midwives after the occurrence of maternal deaths. Since there is no standard procedure guiding their recovery from the trauma, the results continue to reveal that they end up finding comfort in employing unhealthy coping strategies as well as interventions to cope and recover from the trauma, for instance, substance use, alcohol use, and self-isolation.
The continuous exposure to incidents such as maternal deaths interferes with their mental well-being, thus impacting their ability to cope. Participants claimed to have experienced trauma following exposure to maternal death, all the time. They remain shocked after experiencing the tragedy of maternal death to the extent that their minds became occupied with fear of experiencing it again whenever they are conducting a delivery.
“We cannot deny the fact that all healings come from the Almighty God, and we are just the servants facilitating the healing. It is very traumatic and psychologically draining,” they explained. Another participant experienced trauma, depression, and shock all at the same time after witnessing a maternal death. “I was shocked, traumatised, and depressed at the same time after experiencing a maternal death. Even at night, I encounter challenges while sleeping, at times, I do feel like it is our fault and something needs to be done,” she says.
Others never experienced a direct maternal death, but still, they were affected by its occurrence in their unit. All the midwives who participated in the study were aware of the coping mechanisms that the midwives employ after experiencing a maternal death in the two referral hospitals in Thaba-Tseka. They mentioned positive adaptive strategies, negative adaptive strategies, alcohol-related strategies, and substance-related strategies as the coping mechanisms they frequently use.
“They resorted to individual coping strategies such as crying, alcohol and other substance-related use, and recreational activities. Unfortunately, these strategies were not guided, hence the need for trained healthcare professionals who will take care of midwives’ psychological and emotional problems emanating from maternal deaths,” the research notes. Maternal deaths is one of the leading causes of death in Sub-Saharan Africa, often resulting to preventable causes at pre-conception, antenatal, and intrapartum stages.
Mohale describes them as a pervasive problem that frequently occurs in developing countries, driven by socio-economic issues, healthcare service-related issues, pre-existing health conditions, health professional-related issues, and sociocultural issues. Mohale further recommended that there be wellness corners where hospitals can create dedicated spaces staffed by trained professionals to offer guidance to midwives struggling with emotional trauma.
He also recommends that Lesotho can learn from developed countries by implementing trauma support programmes specifically designed for midwives. According to World Health Organisation (WHO), maternal mortality remains a key issue affecting women of reproductive age across the country.
The current maternal mortality ratio for Lesotho is 566 per 100,000 live births. This according to WHO, is categorised as very high and is above the regional average of 545 per 100,000 live births. To address the high maternal and neonatal mortalities in Lesotho, the technical expert for Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) and Ageing of the WHO Multi-Country Assignment Team (MCAT) had an in-country engagement in Lesotho to assess the situation as well as the general health context of the country.
In a meeting with the national Sexual Reproductive Health and Rights (SRHR) advisor to the ministry of health, Dr Nonkosi Tlale, highlighted the need to reduce preventable maternal and neonatal mortalities by identifying key areas for immediate action and how WHO can facilitate and support them.
Some key challenges outlined by Tlale were human resources, limited numbers of Obstetricians and Gynecologists, and the capacity of medical officers and midwives, availability of blood products for the management of obstetric and other essential commodities for emergency care.