Midwife Magdalene Juliet Acquah's pioneering work gets more mothers delivering their babies safely
NEW YORK (TrustLaw) - In Ghana, taxi drivers consider it a bad omen if a woman delivers a baby in their car. As a result, women in labour often find it difficult to get to hospital to give birth.
At the same time, Ghanaian women, particularly those in rural areas, often avoid hospital deliveries because they prefer kneeling or squatting to give birth rather than lying on their backs as required by many health facilities.
Magdalene Juliet Acquah, prinicipal midwifery officer at the Metropolitan Hospital in Ghana’s Cape Coast, knew both situations posed problems with potentially tragic outcomes.
And she was determined to find a way to solve them.
Initially on her own and later with assistance from the United Nations Population Fund (UNFPA), Acquah devised a birthing stool to accommodate the desire to deliver in a sitting or squatting position.
Through an education initiative supported by UNFPA, she also worked to dispel superstition among taxi drivers and arranged a scheme under which members of the Ghana Private Transport Union agree to respond to calls from pregnant women in exchange for chits, issued by midwives, which they then cash in.
For her achievements, Acquah, a 59-year-old mother of three, recently received the Friends of UNFPA Award for the Health and Dignity of Women at a ceremony in New York.
Acquah, a robust, direct woman whom her patients call “Auntie”, was inspired by the work of her own aunt, who was a nurse-midwife, she told TrustLaw in an interview.
Dressed in the brown and cream uniform of the Ghana Registered Midwives Association, Acquah said she was looking forward to showing her 92-year-old aunt, Cecelia Foli, the award upon her return to Ghana.
“When I show her the award, I am going to say, ‘Auntie, this is what God has brought to our family. I’m proud of you.’,” she said.
Acquah, who gave birth to all her own children in hospital, knew that some Ghanaian women were dying from delivery complications because they were giving birth at home without supervision.
One of the major objections the women cited was the fact that health professionals wanted them to give birth lying on their backs.
“After listening to these people I realised they wanted a more conducive position, a position more comfortable to women and that position is either sitting or squatting,” she said.
CHAIR
In 2007, using her own money, Acquah designed a birthing stool - a chair scooped out at the front with an armrest, backrest and raised platform for the feet - and had a wooden prototype made by a carpenter in Cape Coast, a large town west of the capital Accra.
“If they sit, the backbone becomes straight and the pelvic region opens by 1.5 centimetres and (the baby) falls by gravity.”
At first, she said, she faced resistance. “My fellow colleagues said, ‘We can’t bend down to do deliveries.’” To which she responded: “But wouldn’t you catch the baby if it fell to the floor?”
Now, the birthing stool is being used in hospitals and clinics in all 10 regions of Ghana at a cost of about $100 per chair. However, the stool is not usually used for first deliveries which may require an epidural or other anaesthesia, she said.
Acquah is also involved in efforts to educate women and their often tradition-bound families that assistance is important not just at the moment of delivery but in the prenatal period.
In her region of Ghana, supervised deliveries have risen from 48.5 percent in 2007 to 63.7 percent in 2011. That exceeds the national rate of 59 percent.
This is partly because it is easier for women to get to hospital thanks to the taxi initiative which is funded by Ghana’s health service with support from UNFPA.
Depending on the number of women they ferry to hospitals and clinics, the taxi drivers are eligible for an annual prize, such as a TV or refrigerator. They also get T-shirts with the slogan “Save Mothers’ Lives".
Although Ghana now has about 3,700 trained midwives, Acquah said there was still a shortage because midwives in rural areas do not usually last long due to the difficult conditions. These include lack of electricity and running water.
Maternal mortality in Ghana has declined by 44 percent since 1990, but the rate remains high - 350 deaths per 100,000 live births. Nearly 2,600 women die in childbirth annually.
But the work of midwives like Acquah is helping bring this down. In her award acceptance speech, Acquah told the story of a woman in a remote area who delivered late at night, suffered a tear in her cervix and began bleeding.
The family called Acquah, who dispatched a taxi to bring the mother to hospital. The family thought the mother was dead, but Acquah was able to resuscitate her.
The system that Acquah had pioneered helped save the life of this woman and her child.
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