Maternal Death – A Lethal Enemy Waiting to Snatch its Next Victim

Even in urban areas, mothers continue to die unnecessarily from easily preventable causes

By Dr. John Nduba
February 23rd, 2011


I have a mechanic named Macharia* who looks after my wheezy old tractor. He wakes it up every other season to plough my small rural field. But that is not why I am writing this note. Macharia* comes into it only because I discovered the other day that he is also a very special fellow, a man that the community can rely on.


He called me early last Saturday morning. He was unusually abrupt and asked if I could help him get a sick newborn admitted to a hospital. Macharia and his friend Muturi*, the father of the infant, had been at the emergency wing of a major hospital in Nairobi Kenya since 4pm the previous day, trying in vain to get the baby attended to.


They were desperate because they could sense that if they didn’t get help soon, the baby would die. Macharia was sure that Muturi, a fellow mechanic wouldn’t be able to deal with this – he was already in the grey zone as a result of the trauma he had suffered in the previous 24 hours.


Naturally the first question I asked was, what were two men doing in a hospital with an infant that early in the morning without the baby’s mother? The mother had died, was the abrupt reply.


Now that was serious – had there been an accident? No, he said, she had died at a nursing home in the East of the city after giving birth normally barely two days before. I went out to see Macharia and his friend, and was confronted with the reality of an emergency department in a busy public hospital in the city.


I suggested that we get the baby seen urgently elsewhere as she appeared already dehydrated and sluggish, as well as showing early signs of jaundice. Muturi agreed and we were successful at a not-so-expensive mission facility north of the city. The little baby is receiving good care in the hospital’s neonatal ward and is now well on the road to good health, though clearly in an already challenging situation in life.

Lack of Basic Care Causes Death 


Meanwhile, the incredible story emerged as we went about our task of looking after the baby girl, about what had led to this difficult situation. Apparently the mother had a retained placenta (the afterbirth would not come out after the delivery) although she had had a smooth and uneventful labour leading to the delivery of her second baby.


Her doctor was contacted, said he was coming but did not. He seemed to have been out of town and apparently called a midwife to assist, but she too did not go to the nursing home and only called late in the evening to inquire about the condition of the patient. She was told that the patient appeared to have no other problem besides the retained afterbirth, at which point the midwife said she had no transport and would not come till morning. Instead, she asked a nurse at the facility to attempt removal of the afterbirth, but the nurse did not feel confident to do so and did not try.

 


The baby was well and in fact breast fed, and by about midnight Muturi was asked to leave. He had to anyway, to take care of their older child who was with their neighbours.

 


Muturi came back early in the morning to find his wife dead.

 


The nurse on duty had discovered her at about 3am, already cold in a pool of blood that had soaked all the linen and overflowed to the floor. It is needless to say that this would have been a very unlikely event had the necessary care been provided in time. The patient should have been referred to another hospital if the care was not available, or at minumum she should have been observed regularly as the rules of care for the post-delivery period stipulate, especially for mothers with complications.


Suffice it to say that suddenly Muturi was faced with the reality of making arrangements to move his wife’s body to a mortuary, in the middle of which he was called to take the baby away as she appeared ill (and presented with the bill for services given to his now dead wife)

 


The poor man was close to collapse from the weight of it all, but fortunately he had informed Macharia of his wife’s condition the previous night, and Macharia had decided to check on him in the morning and was able to run to his rescue. Muturi is depressed and sleeps very poorly. He constantly wishes he had never agreed to go home and leave his wife alone. He shudders visibly, probably thinking of the pain and terror she went through alone in the night.

 


The most incredible aspect of this sequence of events is that it all happened in the capital city of Kenya, not some backwater or remote rural area where it is generally assumed that such maternal deaths take place.

 


Unless AMREF and other like-minded institutions and individuals continually push for improved care for mothers and children, and work with the public health service to make sure that the health system is supported and regulated to provide such care, African mothers will continue to go through this kind of preventable suffering and death. Let us all keep the light of our joint concern burning. Such preventable maternal deaths are completely unacceptable and should not be allowed to continue in the 21st Century.

 


*Not their real names

 

Read other AMREF field diaries