 Hi there, I'm just in the background kind of keeping an eye on things, so those of you have been here forever, my apologies, but for the rest of you, we would like to do a very quick summary of where you are from. So if I could ask you please, once I just clearly answer here, to put in your place of origin, we can see how the democracy of everybody is changing, because we're having fewer from Australia, et cetera, now, although I think we've got England and Australia there now, still, but people are coming in now from the States and such like, so I'd be delighted if you could all pop your place of origin into this box. There's about 30 people, alright? I think people are getting set up with this idea just now, so I will not labour the point, just a couple of seconds more, especially if you're from somewhere unusual, right? Okay, I shall end that one just now, okay? Another quick couple please, and if you didn't mind to get that in time, feel free to pop it into the chat box. Second poll, what is your main occupation? I'll just clearly ask if you're there already, and reopen it again if you'd be so kind as to pop it, oh gosh, some people have clicked off on that there, pop your profession or role in there, if you would, that'd be fabulous. Yes, I know, that's our opening speaker who has been there here from just about the beginning, I think Chris, you are here then, but you've got some seats in the room. Anybody else going to pop in there as well? Could you tell us what the other is to that other person is, if you'd like to hear what the other is? Okay, I'm not going to labour the point. Final poll then, I'm going to open the last one, which says, where are you joining the IDM from? I'll just clear those answers and reopen the poll, and could you please share where you are from or listening to this one? Ah, Chris, you are the other, fair enough. Okay, so just a couple of minutes, this one doesn't tell me how many people have answered, so I don't really know, and I don't want to hold back from the solo, so I'm going to end the poll now. Fabulous. Okay, let's move on then, that's Chris. Thank you very much Linda. I'd like to introduce our speaker and say a few words about her. We're delighted to have Odubaluza, I sure won't pronounce this properly, Adik Benjo, who was trained as a midwife in Nigeria and works in Nigeria, although currently she lives in Montreal in Canada. The presentation is around African concerns. Maternal and child morbidity and mortality rate remain a major global concern, especially in developing countries. Home delivery is one of the safe methods of delivery in the developed world, while it is one of the major causes of maternal and child morbidity and mortality rate in developing countries like Nigeria and Africa. Hence there was a need to study factors affecting and influencing the attitude of pregnant women and mothers towards home delivery. The study was carried out among 200 pregnant women and mothers at Ilialfi in Osin State in Nigeria in West Africa. Semi-structured questionnaires were distributed and the results showed that the high cost of the hospital bills, unfriendly attitude of health workers, lack of access to the hospital during labour, are the factors affecting pregnant women from going to the hospital for delivery. And the study showed the need for more effective community midwives to work among traditional birth patients. I'd now like to hand over to our presenter. Thank you, please. Good day, everyone. And I'll be presenting a piece of study carried out in the west side part of Nigeria. And the topic is factors affecting the attitude of pregnant women and mothers towards home delivery. I realize that there are many women that will come to the hospital over the years with complications. And this really brought up a concern within my heart that why with the hospitals that are, we have hospitals, tertiary, the teaching hospital is there, the state is there, the local, the local centers are there, but people will still come down with different complications. And this took me down to really see why are people still going to the homes. And in this home delivery to my concept here is the delivery of a child outside healthcare facility, which includes wish on houses, homes, traditional back attendants and the TBs. And I know it will be a surprise to some developed world that home delivery is a plant work. Even they will plant it, they prepare it and people always like even to deliver home, I mean at home, even in developed world, but we cannot encourage it even in developing country, like a country. And because it's one of the major cause of maternal and child death, even in this developed and developed world. And why? Home delivery is really discouraged due to the lack of facilities that are needed at home. For the delivery of qualified workers are not many, if they are not present, no ready made ambulance vehicles to transfer this client even to the hospitals and they come back with many complications, as I mentioned here. Talking about postpartum hemorrhoids due to assertion, prolonged obstructed labor, ruptured uterus, eclampsia, safety simia, superior sepsis, fitter dates and maternal dates. And after going through this prolonged labor at home, both in mission homes, traditional back attendants and other places where new qualified hands are present with good referral system, it ended up increasing the mobility and the mortality rates, even of the women and even both the children. And I realize that maternal and child mobility and mortality rates remains a global concern, especially in this developing country. And according to the Minister of Health in Nigeria, I said 36,000 women died during pregnancy and child birth, but each year in Nigeria. And I think percent of global maternal death rates, and which is very, very, is not really encouraging. And that is why we have to really look at the reason for this study, to really understand the factors that is affecting them, that is influencing the attitudes of this pregnant woman and mothers, even towards home delivery. And the objective of this study is to examine the risk that has been involved as a result of mismanagement from home deliveries, to identify the various complications that have resulted from home delivery, to identify factors influencing the pregnant mothers and their attitude towards this home delivery. You know, like many, maternal health has a high priority on the global agenda. Mentioned under the Millennium Development Goals 5, which came out improving on maternal health. But many developed countries encouraged home births because they have this facility. They have paramedics that are available in case of emergency. They have ambulance, but all these are not really made available, even in the developing countries. So, this study was carried out among pregnant women and mothers in this town, in Leifei, where we have many hospitals. We have the Teaching Hospital, where I worked, Obafemahulo University Teaching Hospital. We have the State Hospital, which is the secondary, at the secondary level. We have local governments, the health centers, they are there. We have good private demissioned hospitals, but despite that, people still deliver at home. And we look at it as, oh, why all this? And they will come back with complications. And so, after distributing this questionnaire to ask the question to really explore why are these people really delivering at home and so I'm coming back even with complications. You know, this research was an explorative one to really explore the factors really affecting their attitude. And I realized that with the results, looking at the factors influencing their choice of home delivery, the 69.1% of them agreed that the time of labor affects their choice of home delivery, the longest time between the home and hospital, 66.7% agreed that the high hospital bill, which is 61.4%, really agreed that high hospital bill is really affecting it. In family tradition, 35% believe that that is the norm in the home. That's the way they practice it. Oh, you must not go and deliver outside. You must deliver within the home. Then that 9.1% believe that in their religion, their faith does not allow you, especially if they said, oh, we have to have this reception. Oh, they reject it and said their faith will not take it. And at the end, we lose the mother or lose the child. Then 58.8% believe that ignorance is one of the causes, cause the lack of access to the hospital, 61% believe that. And 46.3% agree that unfriendly attitude of health workers make them to run away even from this home delivery. And during this study, I realized the majority of them have good antinatal clinics. They are good at antinatal clinic very well. But when it comes for them to come and deliver, they won't come to the hospital. But when it got complicated, they would be rushed back and few would survive even the pain. And I also look at the risks that are associated with this home delivery. Infection, bleeding, eclampsia, tearing of homes like those that were under uterine rupture, bladder rupture, vesicolo, VVF, vesco, vagina fistula. Then the baby also, they are at risk. There are injuries even to this baby, tetanus injury to the mother. The death of the mother, death of the baby, we have a template center and poor outcome even of delivery. And in application of my findings, this study revealed that there are many well-reformed, many of them they are well-reformed about home deliveries and the dangers involved if care is not taken. But still, some would deliver at home against their wish maybe because of the time of the delivery or not having access even to go to the hospital when they are in labor. This study also revealed that there is need for more effective community midwives who will not contain the TB, both supervise and train them within the community because no matter how few will still prefer home delivery and the skill professional also needs to be present even in order to recognize the risk factor for prompt refirer if need be but how many of them are we really having? And also many still believe in their traditional but attendants from elderly women. So, but we need to train them. We need to have the volunteers workers. We need to train the community midwives who will work with this TDA and the volunteers workers so that they'll be able to recognize the risk on time and be able to refer them even to the hospital. And looking at the study, I realized that home delivery can be encouraged as in developed world if the following provisions can be in place if we have good health workers like midwives community midwives if they can be trained if we have more and also their availability of necessary equipment like delivery kits if there can be good transportation like having ambulance then good referral system with this home delivery can be encouraged if not hospital delivery needs to be emphasized and if you have to do that no many complain of the eye hospital bill hospital bill must be affordable and health insurance system also must be made that will really make this health care accessible and affordable and also workers need to change their attitude and many really complain about this that most of the health workers the midwife will shout on them and they will not really they don't feel comfortable but when they are at home they will feel with them they will feel their pain so health workers also needs to change their attitude and also the government policy that will promote this patient-worker relationship the law have to really be enforced so that people will really know that patients also have their rights so my recommendations in patterns of home delivery should be emphasized if all those things will not be in place that will really encourage even the hospital and mid-home delivery the medical services should be free and should be affordable then also the health workers attitude they need to be checked and necessary disciplinary action needs to be taken against any misbehavior and government policy also helps should facilitate provision of community midwives for this safe home delivery thank you thank you very much Brusola yes, if there are any questions okay are there any questions for Brusola please either raise your hands or put the question in the chat box we'll need the questions in the chat box anyway and it looks like a couple of people are chatting before you so there will be some questions so Gloria asks are hospitals ready if all women wanted to go to hospital for delivery the question again please Gloria asks are all the hospitals in Nigeria ready for all women to deliver in them many hospitals are available if I during this study I went to some of the hospitals they were empty virtually empty especially the state hospital they were virtually empty the staffs are not doing anything some of them are etubed but some are not because of maybe government or mismanagement or lack of maintenance of the property okay there are a couple more questions there that you might be able to see there Brusola do you have access to distance midwifery training I presume by that means that distance training and perhaps online or something like that well in Nigeria I don't think so we don't have access but they started this community midwifery but it was more in the northern part of the country in order to encourage the community midwifery but there is no distance midwifery training presently I saw that Gloria also was saying that why are the hospitals empty these are the reasons that I am talking about here people are talking about the high hospital bill the unfriendly attitude of health workers also even though some will still prefer to be at home I mean because of their religion or the family practice they want to pray they believe in their religion that they want to go so have you uncovered two main problems which is if I think I've understood you correctly there are not enough midwife and related workers community midwives and related birth attendants to help with home births and you've got very poor hospital service for delivery as well so in fact it's very difficult for people whether they have home births or hospital deliveries have I understood that correctly if we have to look at this hospital delivery hospital is still acute you can imagine if the hospital I realize that some of these hospitals are not well acute but if you have to compare the two if hospital is not well acute can you now talk about a home unlike in developed world where they have everything made available you can even call the paramedics and they will come right away and deliver the baby if the hospital is partially acute or not well acute which will still be better or preferred than having to a home where nothing will be used even to save this both mother and child hospital delivery will have been very good if we can have all those things in place okay thank you for that Layla has raised a hand and I've given her the microphones I think she may have wanted to ask a question verbally Layla you have the microphone your microphone is enabled if you want to ask your question I quite agree with Elena that was talking about the reports of disrespect and abuse in the hospital and I think that one also is under this unfairly attitude of health workers also and which we need to the policy government have to really make this policy and our association also needs to enforce this though people are getting to know their right now so because of that disrespect and abuse many are running away from getting to know you from coming to the hospital to deliver Layla is saying to the majority of home deliveries go well well some but most women are dying even from this home delivery are coming with complications even so though some will tell you no one woman that said he had all her babies at home and she's doing fine but the last one she had got complicated that the baby had tetanus maybe due to now using I mean using an hygienic equipment using something like non-sponsored sterilized to cut the umbilical cord so but if we have well trained community midwives like the presentation of gloria that was well if we can have more people to be trained if we can have the community midwives if they are well trained definitely it will really help this and we can encourage home delivery okay thank you thank you for that answer any more questions on fashota's presentation we'll wait a few minutes in case anyone has any more questions for you okay so gloria has a question that's a good question from gloria um if you have the resources would you advocate more community deliveries or for home births or would you advocate that women should go to hospital if you resolve the problems in hospitals well if we have good community we have resources both in terms of material personnel why home delivery home birth is very reliable advocate for home birth if we can have because it will be good everybody has their opinion which has to be respected to be amid the family if somebody was complained that the hospital would not allow his relations to be with him I mean with her so definitely home birth should be I will really advocate for it if we can have this community I mean the resources made available in the community but we don't have it so before we will get to that point and that's why I'm saying that we have to just encourage and emphasize hospital delivery but as soon as we can get all this in place fine home birth should be encouraged because it will reduce the maternal and child immobility and mortality rate do you know anything about how many of these women your study have assessed to or receive pinata who recommended I realize that in the study most of the women that I carried I mean that were in this study they attended they have good and pinata clinic in fact the WHOD for pinata checkup we are not really doing if they come regularly even more than for pinata checkup most of them have more than that because some people even the TB as well then go to the hospital go and get your injection go and do this they have to go to the hospital to deliver so they go to the hospital to have they have assessed to the hospital to the state to the local to the private hospitals or to the traditional hospitals they have assessed they have good pinata care but they will see end up even in home delivery they are working on soup any more questions who sold that on very interesting presentation I think I was very fast I'm sorry that's okay it was a very interesting subject and we still have 10-15 minutes if people have any more questions for you on the other hand if no one has I'm not going to tie you to the chair for the next 10 minutes soup typing again and in case you have people to share their own experience about the especially people in the developing developing countries their experience is like apart from Nigeria we have people coming to the hospitals even with complications from home delivery but we have experienced that only in those of you who are easy for you to read no problem I think this the slide will be made available or do you want to have the you can send your email or mail me if you need anything more on this that's for me I think the best chance we want to work out is to have a genitalia yeah do you realize that many also have this fear of caesarean section and that is why they are running away from the hospital the fear of oh I don't want to be sectioned that is where the ignorance also comes in you know about a light percentage for ignorance at all if you do caesarean section you are going to die so they run away from me I lost a friend recently in fact he is a master degree holder and she was asked to have this that means that she will have caesarean section because she has CPD but she rejected it and she said no she will not and she went home she was trying to label praying and all the rest and at the end we lost her and we lost the baby it was very painful and they have told us he will have elective caesarean but she said no she rejected it yeah concerning the caesarean sections in the with the hospital delivery I am worried the reason is I realized and I think that is another topic entirely that many of the doctors are taking over the gynecology they are taking over the midwives job I don't know maybe that is out of context that they are really taking it over the midwives there are some things that we were trained we can still manage and use our techniques our experience even to manage but before you know it the doctor would just say oh especially the resident doctors the next thing is caesarean section so I am worried about the increase of this caesarean section with the hospital delivery and that is why many also are running the with the body learning it doesn't matter they can't go even with it well Linda are you saying that in the UK do you have people delivering at all with complications we don't have people delivering at home with complications if we can help it it's all about risk assessment trying to encourage those with low risk people to have babies at home whilst only those that need to go into hospital because we well know that with absolutely nothing wrong with them and end up with caesarean sections purely because they have been interfered with and it's getting a balance right and I imagine that getting the balance right in Africa must be even harder because to me I would be less concerned now I am ignorant because I have never worked there I would be less concerned with getting skilled attendants to the birth of a woman at home than I would be talking about taking her into hospital where she is more likely to end up with caesarean section anyway so most women can give birth quite happily without any help so I would be maybe being a bit naive really but that's my kind of feeling you know it's a different situation in your country than it is to mine yeah in your country easily you can call the paramedics that will come immediately but in this situation you can't have the asset even if the risk factor you see a client with ebema and they will still be managing your patient with previous caesarean and these tbs they will still be managing even in the home and by the time they come back it's complicated with ruptured uterus because of the previous caesarean it's a very difficult thing getting things balanced so do we have any further questions for basola it's a very interesting topic oh I think Chris is back now anyway that's point sorry thank you that you were doing well lindas I didn't want to interrupt while you were in full flow well that's alright especially as I don't know the content I'm getting to learn more I know you're an honorary midwife Chris Chris is not a midwife or anything of a medical nature whatsoever so he does really well I think he quite enjoys working with us midwives he does he does it's true any more questions for basola perhaps we'll enter and give people a chance to stretch their legs and so on it's really really interesting to hear stuff from the developing world because so much of our attention especially in the developed world is on the developed world so it's really useful and timely I think to be reminded that there's an awful lot of the human population doesn't live in the developed world so hearing the challenges and experiences from the developing world is really really valuable thank you very much for your presentation let me just flick through to the end great photo great photo thank you thank you please I know we keep saying this and we'll keep saying it until the end but if you do have any photos of yourself and all your friends taking part in this year's conference please do click away and send them in the address is admin.vidm.org and we'd love to see those photos one of our fellow committee members will be is putting together a photo show that we'll show at the end of the conference we've done this for the last couple of years it's great fun it will make it available on YouTube as well recordings of the session will be posted so you'll see that on our web page and the Facebook page and again they'll also be available via our YouTube channel don't forget to download your certificate of attendance for your portfolio please also please please please do fill out our online feedback survey and Linda's kindly posted the link there so please do that that's the only way we can make what we hope is a good conference even better is by getting your feedback on what we can do also for those of you who are students in a few hours time in session 21 so just over three hours time we'll have the third of our student cafes I was at the second one and it was really really interesting lots of brilliant conversations from student myth-wide so if you are a student midwife and you can bear to take yourself away from the main conference for an hour please go over to the student cafe Linda's just posted the link for you there and I think that's it so thank you ever so much everybody those of you who have got the real stamina are in for the next session you're in for yet another treat we've got a wonderful set of sessions again this year so look forward to seeing you in a few minutes time and our next speaker will be Anna Lee Reed and so a great session to look forward to there okay thanks Chris if anybody got any other questions before I clear the chat box and prepare it for our next speaker shall we stop recording let's stop recording shall we