This article was contributed to TechCabal by Dorcas Bello via the bird story agency.

Determined to prevent loss of life through childbirth in a country with one of the highest rates of maternal death in the world, this paediatrician went online to help pregnant women. The result? “Ice cream births”.

“If we have science that can tell you precisely what your blood pressure is, or how much fuel you have in your tank, or exactly what your pulse is, why do we not have something that’ll tell you exactly how much blood a woman has lost in childbirth?” asked maternal health specialist, Dr Idara Umoette, indignantly.

She was speaking from the rooms in which she runs her practice – and a fast-growing online support group for women preparing to give birth.

Umoette recently gained online notoriety for her digital pre-natal courses and their results – what women in her WhatsApp and Telegram groups have begun calling “ice-cream births”, referring to natural births that go well. Which is why I found myself in her rooms.

Somehow, the online term “ice cream births” had passed me by. Not surprising, perhaps, given the incongruous, even outrageous nature of such a term. But when a friend told me I “had” to take a course when I was pregnant, I took note. And when the opportunity arose to find out more, for a story, I jumped at it.

Nearly 20% of all global maternal deaths occur in Nigeria. Between 2005 and 2015, some 600,000 women lost their lives during or as a result of childbirth. A lot of that has to do with the low level of doctors in the country.

The Nigerian Medical Association states that there are only 40,000 doctors for an estimated population of 196 million. The latest data from the World Health Organization (WHO) reveals that Nigeria’s physician-to-patient ratio is four doctors per 10,000 patients, and patients often wait hours to be seen. That wait can be too long for women suffering from internal bleeding after childbirth.

Which is where Umoette and her “ice cream births” comes in.

When the medical doctor of 17 years experienced her own internal bleeding for a year – thanks to a tumour that was removed – she came to understand, very personally and for the first time, the thin line between life and death.

“The fragility of life really hit home,” she said.

The experience resonated sharply with what she had been seeing around her on a regular basis as a General Practitioner and public maternal health specialist – women dying during childbirth. As a doctor and as a woman, she said, she couldn’t bear the fact that women continued to lose their lives, often due to blood loss.

She realised she had to act.

Her first initiative was an audio-visual tool to help measure blood levels (specifically, PCV, or, Packed Cell Volume in the blood). A colour-coded, digital tool was designed to be easy to use and after presenting the idea to the Niger Delta Development Commission, she was given the nod to conduct a pilot in nine states. The tool has since been distributed to pregnant women through partners such as the Medical Women’s Association of Nigeria and the Office of the First Lady, in Benue State.

But Umoette quickly realised that this wasn’t enough. She could, she felt, help decrease mortality rates and improve the chances of successful childbirth by educating more women.

So, in August 2020 she started giving online prenatal advice. She called her service BirthSafe.

To get started, Umoette dug deep into her early training experiences. As a junior doctor in a paediatric posting at the University of Uyo Teaching Hospital in Akwa Ibom State in southern Nigeria, Umoette had dedicated herself to the well-being of neonatal babies, safeguarding them from risks in the weeks and months following childbirth. To do this, she set up an initiative to ensure no child was left behind in receiving medication – by educating mothers.

“I would always support initiatives that encouraged mothers to prioritise the availability of necessary medications for their babies. Throughout my time there, I never encountered a single instance where a baby’s life was lost,” she recalled.

Through her Instagram posts, Umoette now offered a similarly thorough program, teaching pregnant women how to prevent problems during pregnancy and during childbirth. In October 2022, she organised the first webinar on Zoom for her WhatsApp community.

The service has since grown to provide virtual consulting sessions via digital platforms such as Zoom, Telegram, YouTube and Instagram, with group meetings on WhatsApp. She has a team of professionals who help and who have also signed partnerships with service providers in the maternity sector to increase offerings to women.

The antenatal classes focus on three key “protocols”; a PVC Protocol focusing on nutrition – to ensure sufficient iron and other elements in the blood to maintain the correct PCV levels and to help with dilation during the birth; an NIL Protocol (meaning no complications) focusing on exercise to improve blood circulation and agility; and a Birth Recovery Protocol, focusing on how to recognise symptoms requiring immediate first aid, or professional medical assistance in the postpartum period, for both caesarean and natural births.

“This runs for 42 days from the time a woman gives birth, any number of things can occur that could result in either injury or loss of life to the woman. The two most common in our environment are hypertensive events and excess bleeding,” Umoette explained.

By establishing dedicated, digital antenatal care support groups on social media, Umoette was able to start improving the pregnancy experiences of women.

“When the doctor told me I was 3cm dilated, I already knew what he meant and the next step to take. Being a member of the BirthSafe group had equipped me with adequate knowledge and I knew I would have a safe delivery. With that knowledge, I began the drills just as instructed by our Doctor Idara. It was almost like I could hear her voice in my head giving me instructions,” said Praise Hans, a mother and midwifery nurse who gave birth to a baby girl on April 5, 2023.

Even with her own knowledge, Hans sought out BirthSafe because of the success stories she had encountered.

“As a midwife who has knowledge of pregnancy, childbirth and delivery, I can say that I learnt a lot more things from Dr Idara’s teaching in our group… the tips she gives us that make pregnancy life stress-free,” she disclosed.

Umoette encourages her social media followers to use easy, local solutions to improve the pregnancy and childbirth experience.

“I also teach women how to significantly raise their blood levels and avoid anaemia in pregnancy and childbirth using easy, local solutions,” she said.

Preye Eghove, who gave birth to her first child in February 2023, increased her Packed Cell Volume after following advice from Umoette’s online sessions.

“When I checked my PCV at a lab after being advised by Dr. Umoette, the lab attendant attested to the fact that my PCV was low. She wanted to prescribe a blood booster drug for me. With the therapy from BirthSafe group, it took me one month to boost my PCV from 32% to 47%,” Eghove said.

While the growth of online medical advice, support and diagnostic services has grown phenomenally across Africa in the past few years, a number of health specialists warn that online services should always be carefully researched by users and that they should be run by qualified medical personnel.

“Even though the efforts are laudable, there must be a kind of way to check the activities of mobile health support groups to avoid misuse and misleading,” wrote Abuja-based healthcare practitioner, Dr. Ebenizer Okoh.

Others are more encouraging.

“If properly managed by a qualified doctor, this is a good solution that will reduce our work and boost our productivity because the health care system in Nigeria is strained and the exodus of doctors out of Nigeria is not helping. So this reduces the pressure on us,” responded Dr Ralu Okeke a medical doctor at Victoria Memorial in Jos, going on to explain that online services could also proffer quick responses to issues so that pregnant women need not wait until the next antenatal appointment.

Umoette’s Instagram followers have since increased to almost 20,000. After growing her social media presence to include Telegram, and with women following her from a Web App is also in the works. She has also started charging for the full service, including a follow-up “package” with regular check-ins. Sign-up costs some 7,000 naira (around US$10).

More importantly, a number of women have reported easier-than-expected births, which is where the “ice-cream birth” moniker comes in.

“It started in 2023 in a WhatsApp group and moved to Instagram. The term is now used generously in the blue testimonials posts on our page,” explained Umoette.

“I want more women to give birth safely… Testimonies from my BirthSafe mothers’ experiences make me feel fulfilled every night,” Umoette said.

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