by Isabelle Ligner
Gbarna, Liberia - Patricia is lucky and her mother relieved. In a country with one of the highest mortality rates for women giving birth, the 21-year old Liberian has made it to hospital in time after a difficult birth.
"It is her first child, she lost too much blood," her mother Rose Soko said. "So many women of my family died when giving birth."
Patricia got to the hospital in time but many women die of haemorrhage before they reach the Phebe hospital in Gbarnga, the only one in Bong county in central Liberia.
"Women, especially in the rural areas, deliver at home with traditional women because they are afraid of health centres which they sometimes can reach only after a seven or eight-hour walk," Willema, a midwife who did not want to give her last name, said.
"Some want to respect the decision of their family depending on their beliefs but they do not realise they are risking their life," said Willema, who works in the CB Dunbar health centre in Gbarnga, 170km northeast of the capital Monrovia.
Figures from the Liberian health ministry show that maternal mortality, the death of a woman during or shortly after pregnancy, has risen sharply across the nation since the 1989-2003 civil wars that ravaged the West African country.
In 1999, 578 women died out of 100 000 who gave birth. By 2007, it had risen to 994 women out of 100 000, putting it in the top 15 countries for maternal mortality.
"This increase seems enormous and is due to a shortage of trained midwives and delays in getting medical care for the women if there are problems with traditional home births," said Sybille Jaloux, a French midwife working for Medecins du Monde (MDM) a medical humanitarian organisation.
The health ministry says there are only 400 trained midwives in Liberia, which has a population of 3.5 million. Authorities say the country needs at least 1 600 midwives.
"Certified midwives, who study for two years, have a lower salary than nurses," said Abraham Taryor, manager of the CB Dunbar health centre.
"It is not an incentive to choose this job," he added.
Here 85 percent of women give birth in their own community with the help of traditional midwives. But these practitioners are often not able to detect and treat complications and they often wait too long to transfer their patients to health centres that are usually days away, said Joux, who trains traditional midwives in Bong County.
The biggest cause of maternal mortality is haemorrhage during the delivery - something that also happens often in developed countries where it is treated by giving blood transfusions that are impossible in Liberia.
Another major cause of death occurs when a baby is too big for the birth canal and the only recourse is a Caesarian section, which in Liberia can only be practiced in one of the country's few hospitals.
"Women also often die of infections or blood poisoning because of poor hygiene during home births. That could be treated by a shot of anti-biotics but is often not spotted by traditional midwives," said Jaloux.
There are also a large number of mortalities among women due to botched clandestine abortions with herbs or unsterilised equipment, she added.
Abortion is illegal in Liberia and not socially accepted, which leads to problems in a country that also has a high instance of rape blamed on a legacy of violence left by the long civil war.
Official figures indicate that 339 rapes were reported between January and June 2008 but many women and girls do not report incidents of rape because of the social stigma attached. - Sapa-AFP