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  • Title: [The role of traditional midwives in the provision of primary health care in Rwanda].
    Author: Nkundakozera A.
    Journal: Imbonezamuryango; 1985 Apr; (2):8-11. PubMed ID: 12267099.
    Abstract:
    This article describes the important role that trained traditional midwives could play in providing maternal and infant health care at the primary level in Rwanda. Rwanda suffers from all the ills common to developing countries, including high rates of stillbirth and infant mortality. Stillbirths are the result of difficult deliveries, poor health status of mothers lacking prenatal care, adequate nutrition and rest, and perhaps suffering from intestinal parasites or malaria. Only about 20% of Rwanda's mothers give birth at hospitals, and many of the rest deliver at home in deplorable sanitary conditions assisted only by an older women with experience of childbirth but no scienfitic obstetrical knowledge. In the traditional milieu, the delivery is regulated by custom. In an uncomplicated delivery, the women is assisted by a trusted companion, usually the mother-in-law. Difficult deliveries are blamed on infractions of social rules, offenses against the ancestors, or bad spirits seeking vengeance against the woman by impeding the birth. Offerings or animal sacrifices may be used to correct these situations, but they take time, and further time may be consumed in transport if the decision is made to seek help at a health station. Training of traditional midwives should be based on the same education received by pregnant women during prenatal visits regarding hygiene, diet, obstetrical care, the desirability of giving birth at a health center, vaccination of pregnant women against tetanus, and immunization of infants. The principal goals of such training are to instill notions of elementary rules of hygiene and surveillance of a delivery, and to encourage immediate removal of the pregnant women to the nearest health center at the 1st sign of difficulty. Traditional midwives chosen by their communities could be trained in 4-week courses in proper procedures for prenatal visits, labor and delivery, postpartum, and for the newborn. The traditional midwife would then be incorporated into the primary health care system and should receive continuing education on a regular basis. Traditional midwives should be able to recognize the signs of high risk pregnancies and deliveries and refer the women to appropriate health facilities while conducting normal deliveries themselves.
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