Childbirth in Trinidad and Tobago

95.7% of pregnant women have at least 1 prenatal care visit.[2] These visits most commonly occur at the woman's local clinic.[4] Diabetes and high blood pressure are two of the more serious conditions for pregnant women in Trinidad and Tobago. Often, if women do not have an antenatal visit early enough in their pregnancy, these conditions can be missed, leading to complications during birth. The biggest challenge for prenatal health is maintaining a healthy diet. Caribbean cuisine is mostly highly seasoned, with a high salt content, and, along with the common practice of frying and high saturated fat, this contributes to poor management of diabetes and increased risk of high blood pressure.[5]

For treatment of their diabetes and high blood pressure, during pregnancy or otherwise, Trinidadians and Tobagonians often view traditional Caribbean medicine as complementary to prescribed medicines.[6] For example, one study found the following plants used among half of Caribbean respondents for diabetes: cerasse/noni/caraili/bitter melon (Momordica charantia), cinnamon bark and pills (Cinnamomum verum), mauby bark (Colubrina arborescens), aloe (Aloe vera, Aloe barbadensis), bush tea (unspecified medicinal plants) and celery (Apium graveolens). Cucumber (Cucumis sativus), garlic (Allium sativum), and tamarind leaf (Tamarindus indica) were also used to control high blood pressure. These plants were crushed, liquefied, and consumed cold or steeped as a brewed tea. Momordica charantia was the most popular botanical that participants used to treat type 2 diabetes.[6]

Traditional medicine is also used for childbirth and infertility. One study, which conducted interviews with Trinidadians over a four-year period from 1996-2000, found the use of the following plants for childbirth and infertility: Mimosa pudica, Ruta graveolens, Abelmoschus moschatus, Chamaesyce hirta, Cola nitida, Ambrosia cumanenesis, Pilea microphylla, Eryngium foetidum, Aristolochia rugosa, Aristolochia trilobata, Coleus aromaticus, Laportea aestuans and Vetiveria zizanioides.[7]

The adolescent fertility rate in Trinidad and Tobago, as of 2013, is 35.5 births per 1000 women aged 15–19 years.[2] In 2007, a representative sample of all 13- to 15-year-old students in Trinidad and Tobago was surveyed about sexual health: 26.0% of students had sexual intercourse during their life and 13.2% of students had sexual intercourse for the first time before age 13. Male students were significantly more likely than female students to have sexual intercourse (32.0% of all males versus 20.2% of all females) and also to have it for the first time before age 13 (19.9% of all males versus 6.3% of all females). In total, 17.6% of students had sexual intercourse with two or more partners during their life. Male students (23.9%) were significantly more likely than female students (11.4%) to have had multiple partners. Among students who had sexual intercourse during the past 12 months, 59.1% used a condom the last time they had sexual intercourse, but only 22.4% used a condom most of the time or always during the past 12 months.[8]

Even though the above survey shows an early age of initiation of sexual activity and low utilization of contraceptive practices, a 2008 study of the twin island country showed both a decline in adolescent fertility rates as well as adolescent births over the past decade.[9]

In Trinidad and Tobago the abortion rate is the same as the birth rate; that is there is approximately the same number of abortions per year as births, around 19,000.[10] However, in Trinidad and Tobago, abortion is illegal in cases of incest, rape, social and economic reasons and only legal when the mother's life is in danger. Annually between 3000-4000 women are treated in the public hospitals for the consequences of unsafe terminations; it is the leading cause of maternal morbidity.[10] Abortion is not openly discussed in Trinidad and Tobago.[4] There is an impression that Trinidadians are greatly opposed to abortion reform law, due in part to certain vocal religious groups; however, a careful survey of 918 citizens conducted in 2005 found that even though almost half of the participants had an unfavorable perception of abortion, more than half of them were in favor of broadening the legal grounds for accessing terminations.

As for the prevalence rates for sexually transmitted infections: 1.7% of adults aged 15–49 in Trinidad and Tobago have human immunodeficiency virus (HIV) as of 2013.[11]

From the most recent study in 2012, 100% of births in Trinidad and Tobago are attended by a health professional.[12] 97.4% of total births take place in an institution.[2] Of total births in Trinidad and Tobago, approximately 2% occur in the home, 83% in public hospitals, 14.7% in private hospitals, and 0.0025% at the Mamatoto Birth Centre.[13] Except for in the case of home births, once labour begins, mothers generally proceed to the hospitals or birth centre as directed by health personnel, usually by telephone.

In the public hospitals, as the standard of care, midwives attend the delivery of babies. Only in the case of a complicated birth, for example one requiring Cesarean section or suturing, will the obstetrician on staff be called.[14] Cesarean sections are not available on request and the rate in most public hospitals vary from 10-14%, with higher rates occurring in hospitals that receive more referrals. There tends to be a high rate of episiotomies in the public hospitals, as high as 50%.[14] There is limited availability of epidurals in these hospitals and for the most part, natural childbirth takes place. Continuous fetal monitoring technology is not used.

The afterbirth or placenta in hospitals is discarded as biological waste and there is no particular country-wide ritual observed with it. Newborns, for the most part, remain at the mother's side after being examined by health professionals. Public hospitals do a better job of preventing the separation of Mother-baby in the hours directly after birth, in part because they have no regular nursery facilities as private hospitals do.[14]

Women typically stay in the hospital, public or private, for no more than 24 hours after birth. The tendency is towards early discharge due to overcrowding in the public facilities, and due to financial charges in the private facilities. Most hospitals have policy encouraging the initiation of breastfeeding before discharge.[14] However, the early initiation of breastfeeding rate in Trinidad and Tobago is only 41.2% as of 2013; that is the percentage of infants who receive milk from their mother's breast within an hour of being born.[2] Furthermore, as of 2013, only 12.8% of newborns are exclusively breastfed in the first six months after birth and 83.4% are introduced to solid or semi solid or soft foods in their first six to eight months.[2] In part, this phenomenon might be due to the often-spoken-of belief in Trinidad and Tobago that in order for the baby to sleep properly at night, he/she must be given cereal with his/her milk before bed.[14]

The under five mortality rate in Trinidad and Tobago is 21 deaths per 1000 live births and the infant mortality is 19 deaths per 1000 live births. The leading cause of death is prematurity.[2] There are only three Neonatal Intensive Care Units (NICU) in the country; all three are in separate public health facilities in Trinidad: in Port of Spain, San Fernando and Mount Hope. If there is suspicion that a baby will be born premature, the expectant mother will be referred to one of these hospitals for the delivery. Private facilities have no Neonatal Intensive Care Units (NICU).[20] If a newborn is admitted to the NICU, mothers have to adhere to hospital policy which does not allow them to stay overnight with the baby, and requires the pumping of breast milk for the infant.[14]

Postpartum depression is not carefully monitored or measured in the country. As part of the public health facilities, there is a six-week postpartum checkup, during which time this condition can perhaps be detected, but there is little follow up with the mother between discharge and this checkup. Although, if the mother chooses, she can visit a physician in her local health clinic at any time. In the private health facilities, mothers are assigned a specific pediatrician who examines the newborn at birth; this personal physician can be contacted by the mother if she chooses to do so, in regards to postpartum depression. At Mamatoto, discharge typically occurs four hours following birth, after which the health staff call the mother every single day for a week, and then once a week until the six-week postpartum visit. In this way, there is ample follow up to give health personnel the opportunity to ensure the mother's mental health.[21]