A birth plan for an expectant mother in the west entails planning for things like: ‘Which comfort level do I need, and what can I afford? What type of birth do I wish? Lying down, sitting, crouching? In a bathtub perhaps? With or without music? What music do I want? Do I want sedation or not?’
Of course this comfort oriented birth plan also includes calculating the approximate date the baby is due, the choice of hospital or clinic, if a midwife will assist you or an obstetrician, and a reminder to get a set of clothes ready for yourself and the baby.
For an expectant mother or couple in rural Tanzania however, a birth plan means something more basic. It is a check list of vital decision and action points for a safe delivery for mother and child, and hence will be an important part of the JamboMama! application. It is safety oriented and runs through questions and issues such as:
- ‘Where will you give birth?’
- ‘How much will it cost? When and how do you start saving money to pay for the transport and other expenses?’ Indeed, much as deliveries are free of charge, health facilities face frequent challenges in ensuring that all essential items for a delivering woman are available, including medicines and supplies such as gloves, syringes and linens. As a result, women or families are asked to bring what is missing.
- ‘Who will accompany you to the hospital? Your husband, mother, neighbour, friend, mother or sister in-law?’ The father of the child escorting his wife to the clinic is gradually becoming the norm, especially in the city, but it is not so common yet in the rural areas. The government encourages it, and we of JamboMama! also think it is a good thing if the fathers are drawn into the planning and anticipation from the day they know they have fathered a child. But there is no forcing, only facilitation. JamboMama! is a modern, democratic tool for progress, not for controlling and imposing behavioural change.
- Discussion of the danger signs during pregnancy, delivery and immediately afterwards, and which actions to take when encountered.
- ‘Where will the baby sleep? Have you got a clean cardboard box or something else that can serve as his crib the first weeks?’ Dr Magoma, a Tanzanian gynaecologist/obstetrician and advisor to JamboMama! told us this is not an issue raised in the current Tanzanian birth plan, for the baby sleeping with the mother is normal practice. It is considered good for the bonding , while the risk of accidentally smothering the baby is seen as minimal, unless there is a specific contra-indication. But times they are a changing, and so may ideas about the safety of this sleeping arrangement. This issue will be proposed to the local JamboMama! working groups. If they consider it a non-issue, it will not be included in the birth plan screen.
- ‘Go and visit the hospital, clinic or dispensary where you will give birth at least once before you are actuellay due, to meet the maternity staff working there.’ This is another advice that is not in the present birth plan in Tanzania. It is assumed women have been there for antenatal check-ups, but if a woman went to the mobile clinics for villages far away from the hospital, she may never have been there or met any of the doctors or midwives. So this advice would mean a novelty, to be subjected to the user groups’ decision.
- The birth plan also foresees in the provision of immediate postnatal care, including basic elements of newborn care: Mothers/couples are introduced into care of the mother and newborn after delivery, including newborn feeding, with emphasis on exclusive breast feeding in the first six months. Danger signs for newborn health are also discussed.
Postnatal care is the weakest spot in the chain from conception to safely surviving childbirth for mother and child, so this part of the screen is going to be a challenge to design well. In consultation with the end users, we may even decide it deserves a separate screen.
Each screen should refer to a form of care that exists and is accessible, so when a screen of the app is made operational, JamboMama! must make sure the service proposed is available. This may be a special challenge to meet for the screens based on access to quality postnatal care.
Dr Moke Magoma and his colleagues found that developing a proper birth plan led to much higher use of skilled medical services for childbirth (as opposed to home birth), to better uptake of after care and to generally more awareness of the importance of good care, counselling and surveillance throughout*.
This screen still has to be built and it costs 400 Euro to do it properly. Will you help us?
*Source: Trop Med Int Health. 2013 Apr;18(4):435-43. doi: 10.1111/tmi.12069. Epub 2013 Feb 5.
The effectiveness of birth plans in increasing use of skilled care at delivery and postnatal care in rural Tanzania: a cluster randomised trial. Authors: Magoma M, Requejo J, Campbell O, Cousens S, Merialdi M, Filippi V.