Expert Identifies Obstructed Labour as Leading Cause of Maternal, Child Morbidity, Mortality in Rural Areas

Photo credit: ICRC

By Josephine Idiovwan

An obstetrician and Gynecologist, Dr Chukwuma Ossai has said that Obstructed labour remains one of the leading cause of maternal and child morbidity/Mortality in rural areas.

Dr Ossai, a senior register in the department of Gynecology and Obstetrics at Federal Medical Center, Asaba made the explanation in an interview with Nigeria Wave recently.
He said that during delivery, a halt in the progress of labour due to a mechanical cause despite adequate uterine contraction indicates obstructed labor which requires an emergency Caesarian Section.

Highlighting lack of health facilities and inadequate skilled birth attendants as factors associated with obstructed labour, he stated that a tool has been invented to help birth attendants in rural areas track progress of labour so as to enable them know when to refer patients.

His words “ Obstructed labour is a halt in the progress of labour due to a mechanical cause despite adequate uterine contraction.However cephalopelvic disproportion is often a prelude to obstructed labour- when a baby’s head doesn’t clear the opening of the pelvis during childbirth.

“Obstructed labor has caused both maternal morbidity and mortality. It actually occurs more in rural settings than tertiary or secondary health facilities because those in the rural setting do not really know the signs of impending obstruction ,So they manage the labor into obstruction .

“It becomes as issue where the skills of the birth attendants monitoring the event of labor are not adequate and where they do not have facilities for doing CS. it is something that is supposed to be addressed as soon as it is noticed.

He noted that “ a tool known as parthograph is now being used to prevent obstructed labor and that tool was actually generated to help those in the rural settings to know when there is poor progress of labor and then refer. It is like a chart used in monitoring the events of labor”

“ So the people in rural setting are taught how to use it . If the parthograph is well used in monitoring of process of labor, they will be able to know if the labor is progressing normally and Should know when to refer.

“It gives them time to be able to refer the patient so that the patient can be able to get to a place where intervention can be done.

“ For those who have obstructed labour, it is important that the obstruction is relieved and the only way to relieve that obstruction is by doing a Ceasarean Section to bring out the baby.

“ those whose labor became obstructed and was not properly managed are at the risk of developing Vesicovaginal fistula , where a woman starts leaking urine or death. These are some of the complications that can come from a poorly managed obstructed labour.

“So for those who have obstructed labor, there are things that are supposed to be done to prevent VVF. Not just delivering the baby but care after delivery . One of the ways is to pass the urinary catheter and leave it for some days to rest the bladder so that of VVF will not occur.”
He however observed that prevention is key in the management of obstructed labour.

While advising that “parturient/ intending mothers should endeavor to register their pregnancies in Centre’s with skilled birth attendants as well as ensure they attend antenatal clinic regularly”, he emphasized that pregnant women should by all means avoid traditional birth attendants.