MATERNAL DEATHS

By Ireene Mukami

“I could not believe that giving birth could cost one’s life till it happened to my beloved sister-in-law” Said Agnes Karimi amid tears.

She continues, “It was on a Friday evening after sunset when I came home from my shamba which is almost 20 kilometres from home. I had strapped a bundle of firewood on my back which I had collected slowly by slowly as I tilled my land during the day.

No sooner had I settled in my house than my nephew came running and panting like a dog calling for help. I quickly dashed out and held his hand firmly. He could not talk since he was in shock. He had cried for a long time in silence before he lost his control and started screaming out loudly.

“My mum is dying. Please help.” That is what finally came out of his mouth. I hurriedly run to their home which was about a kilometre from my house. Just has her son had said, my sister-in-law had started labouring for the last three hours and nobody was around to help her.

She was in deep pain hence could not talk coherently. The solitary dispensary that could help us was 10 kilometres away and the only means of transport that was available was a donkey. I called other women who could render help in case of anything on the road and fortunately, an old grandmother who once was a traditional birth attendant followed us.

By the time we got a donkey cart to carry her, it was almost 9 at night. My sister-in-law, Patricia Mwendwa developed complications on our way to the hospital and she could not hold back the baby any longer. Her cervical had fully dilated and the baby started coming out. The experienced traditional birth attendant who had accompanied us helped her to deliver a healthy baby boy. We were all happy and Mwendwa was equally happy. Though tired, she could afford a smile at the sight of her son.

There was a nearby home where we scrounged a bow of porridge. We took it to Mwenda and she ate everything.

Mwendwa gained energy very fast and we chose to get back home given that it was raining and we were remaining with 7 kilometres before we get into the dispensary.
The following day, I woke up very early in the morning to find out how Mwenwda and her fourth born son were faring on. Since her husband was on a journey and her eldest son knew where their dad worked, Mwendwa and I sent him to convey the good news to his dad.

Mwendwa looked fine though she was bleeding profusely. I spent almost the whole day with her since she could not do anything on her own. But, as the day grew older, Mwendwa’s condition deteriorated and I suggested we go to the hospital.

We carried her on a bicycle and we got to Kibiru Dispensary where she was admitted together with her son. The nurses on duty cross examined her and they said that she had lost a lot of blood while delivering and she got infections too. Blood transfusion was to be done. At this point, we were taken to a word where blood transfusion was to be done and I could not believe what I saw with my eyes. It was at 10 in the morning. My sister-in-law called my name and requested me to support her to stand on her feet and she passed away in my hands while aiding her to stand up right as it was her wish.

Agnes Karimi who is also a mother of five and a peasant farmer is the one who takes care of the children Mwendwa left behind. Her mother is elderly and cannot manage to care for them.

“It is really challenging to care for a large family when you are a poor farmer. Still, I cannot leave them alone since their dad who works in a Jua Kali sector struggles day and night to look for their school fees and uniforms. They will tie him down and he won’t be able to provide for their basic needs.” Ms. Karimi said.
According to Dr Nancy Kidula, Obstetrician/Gynaecologist with the World Health Organization as the National Professional Officer in charge of Making Pregnancy Safer Unit., bleeding and infection following childbirth account for many maternal deaths, while preterm birth, asphyxia and severe infections contribute to two thirds of all neonatal deaths and appropriate care in the first hours and days after childbirth would prevent the great majority of these deaths.

“It is recommended that skilled health professionals attend all births, to assure the best possible outcome for both mother and newborn infant. A large proportion of women continue to lack such care and for Mwendwa’s case, that is what she lacked. Traditional birth attendants though have experience; they are not equipped with the right apparatus neither are they groomed with the best hygiene to carry out safe delivery.” Dr. Kidula said.

The gynaecologist further educated that poverty levels, poor roads and inaccessible roads contribute to high maternal deaths especially in developing countries.

“The fact that two thirds of maternal and newborn deaths occur in the first two days after birth, 5 to 8 testifies to the inadequacy of care.” She said

She further educated that care in the period following birth is critical not only for survival but also to the future of mothers and newborn babies adding that major changes occur during this period that determine their well-being and potential for a healthy future.

“In developed countries virtually all women and their infants receive postpartum and postnatal care, albeit the nature and frequency of this care varies considerably. In developing countries the need for care and support after birth was, until recently, less well recognized. Despite its importance, this period is generally the most neglected. Rates of provision of skilled care are lower after childbirth than during pregnancy or childbirth, even though both the risks for illness and the potential to improve longer-term outcomes are as great.” She said.

“There are few data on early postnatal care specifically in rural dispensaries, but clearly many women do not receive optimal care especially if they deliver with the help of the traditional birth attendants.” Ms. Nancy Mubwika, a midwife at Kibiru dispensary.

According to her, many women who give birth in facilities are discharged within hours after childbirth without any indication where they can obtain further care or support since the facilities cannot accommodate many people at once.

“Also, harmful health care practices are still prevalent and contribute to mortality. For example, care providers or institutions may not promote, protect and support early initiation of breastfeeding, and they may even delay or discourage breastfeeding, thus undermining successful exclusive breastfeeding.” Ms. Mubwika said