CHAPTER ONE/INTRODUCTION
The process of pregnancy and delivery is meant to be risk-free when it is well handled, but there are instances in which it poses significant health hazards, even to women who did not have any health issues prior to becoming pregnant. Issues directly related with pregnancy, childbirth, and its complications cause the deaths of thousands of women all over the world every single year (Maya, Buntugu, Lovelace, Emmanuel, & Srofenyoh, 2015). According to the World Health Organization (2012), sub-Saharan Africa is responsible for approximately sixty percent of all maternal deaths. The total lifetime risk of maternal death in sub-Saharan Africa is as high as one in thirty-nine pregnancies, whereas in Europe, that risk is one in two thousand and nine hundred. Even though it only occurs in around 4% of pregnancies (Combs, Murphy, & Laros, 1991), postpartum haemorrhage is the greatest cause of maternal mortality across the globe.
According to the most recent findings from the World Health Organization (2008), it is estimated that postpartum haemorrhage, regardless of its cause, is responsible for twenty-five percent of all maternal deaths worldwide. Nevertheless, figures from the same organisation showed that there was a variance in the recording of findings as record might go as high as 40% in some countries in Africa, Latin America, and South East Asia. Postpartum haemorrhage is the leading cause of death for mothers in Guatemala and Afghanistan, accounting for over 50% of all maternal deaths (Miller & Martin, 2008). There were a total of 529,000 women who passed away every year as a result of difficulties related to pregnancy and childbirth (Ojengbede, Morhason, Galadanti, Meyer, Nsima, & Gamin, 2010). In a similar vein, studies have showed that there are 358,000 female deaths that can be attributed to complications during pregnancy and childbirth (WHO,2010).
According to Adesokan (2010), postpartum haemorrhage (PPH) is defined as excessive bleeding from the genital tract after the birth of a baby that continues for up to six weeks and is greater than 500 millilitres or any amount that is sufficient enough to cause cardiovascular collapse and endanger the woman’s life. PPH can occur at any time during the postpartum period. According to Reynders Sentennm, Tjalma, and Jacquemyn’s (2006) research, the majority of these maternal deaths occur within the first four hours after the birth of the baby. The majority of pregnant women are at risk for postpartum haemorrhage, which can develop as a result of insufficient or improper care of stage three of labour by experienced midwives and birth attendants. Therefore, it is necessary for midwives to have the knowledge and skills necessary for managing the third stage of labour, as well as the ability to recognise abnormalities, treat excessive blood loss, and prevent postpartum haemorrhage.
Postpartum haemorrhage is a leading cause of maternal mortality, but it is also one of the obstetric problems that has a recognised and effective management. This intervention makes use of a low-tech device known as a non-pneumatic anti-shock garment, sometimes known as a life wrap. The Neoprene Articulated Suit Garment (NASG) is a device that takes the form of a lower bottom suit and is made out of articulated neoprene with Velcro parts. It provides lower body circumferential counter pressure that supplies blood to the vital organs of the body, thereby reversing hypovolemic shock and reducing postpartum haemorrhage. There is evidence to show that this potentially useful technology assists in preventing more damage and plays a function in sophisticated modern care units by stabilising women while they wait for decisive haemorrhage remedies such as blood transfusions and procedures.
The inability of the uterine muscle to effectively contract after delivery is known as uterine atony. This condition can be controlled with the use of appropriate uterotonic medicines like misoprostol (International Confederation of Midwives and International Federation of Gynecology and Obstetrics, 2007). Misoprostol is a prostaglandin-based medicine that has piqued the interest of important others as a potentially useful uterotonic treatment as a result of its convenience in terms of administration, safety profile, cost, and the simplicity with which it may be stored. Despite this, research on the effectiveness of misoprostol as an auterotonic drug in the treatment of postpartum haemorrhage has been carried out at a number of different centres (El-Refaey & Templeton, 2006).
In addition, the Nursing and Midwifery Council of Nigeria recently held workshops and training sessions on the use of NASG for midwives and nurses in Nigeria, both in clinical settings and academic institutions, with the goal of educating these individuals on the availability of the garment and the appropriate ways to use it in the prevention and treatment of PPH. However, there is a dearth of evidence on the subject of nurses’ knowledge of intervention strategies for postpartum haemorrhage in general hospitals’ maternity units. [Citation needed]
1.2 A Concise Description of the Issue
Postpartum haemorrhage, often known as PPH, is one of the five primary variables considered to be responsible for maternal mortality. It accounts for around 25 percent of all maternal fatalities globally. In impoverished nations, where there were 99% of these maternal deaths, there were an average of 290 deaths per 100,000 deliveries, but in developed countries, there were only 14 deaths per 100,000 live births. Uterine atony was responsible for 80-90% of haemorrhage (WHO, 2007).
The nation of Nigeria is the fourth largest country in the world and has the highest maternal mortality rate in the entire world (The World Bank & United Nations Population Division, 2014). According to the performance track for the Millennium Development Goals (MDGs) in Nigeria, 2015, the maternal mortality rate was 350 per 100,000 deliveries in 2013, which was still 40% lower than the projection of 250 maternal deaths per 100,000 deliveries for Nigeria in 2015. (Nigeria MDG 2013 Report, 2015)
Postpartum haemorrhage is one of the rare obstetric problems for which there are documented treatments that are proven to be successful in reducing the risk of death to the mother. It is necessary for the midwife to have knowledge of how to use misoprostol, which is an effective medication for managing postpartum haemorrhage, as well as skills in the use and application of non-pneumatic anti-shock garments. These garments are designed to reverse the hypovolemic shock that can occur during childbirth. Both India and Nigeria are rated third worldwide with former at 19% (56,000), and later at 14% (40,000), (United Nations, Population Fund, WHO, UNCF and World Bank 2012), with postpartum haemorrhage still being the leading cause of maternal mortality. Despite the introduction of this evidence-based and low-cost first aid device into Nigeria in 2008, there has not been a significant reduction in maternal morbidity and mortality. As a result, Nigeria is the country that has the highest maternal mortality ratios (MMR), with the official national statistic standing at 814 maternal deaths for every 100,000 live births (United Nations Population Division, 2014).
Evidence also suggests that non pneumatic anti shock garments and misoprostol are not been effectively utilised by midwives in the course of managing clients with postpartum haemorrhage in many health care center’s as investigated by Onasoga, Awhanaa, &Amiegheme, (2012), as maternal mortality indices are still very poor. This was found by Onasoga, Awhanaa, &Amiegheme (2012). As a result, the purpose of this study is to evaluate the level of knowledge on postpartum haemorrhage intervention strategies held by nurses working in maternity units in general hospitals.
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