in this country as it will greatly improve
our maternity outcomes. Obstructed labor
results when the woman either has a very
small pelvis so a normal sized baby can’t
be delivered or if the baby is very big i.e.
more than 4.5kg.
We thank God for our women from
Western who deliver 5-7kg babies
vaginally. Skilled workers will able to
easily detect that there is a problem as
the baby will not descend properly into
the pelvis. With home deliveries you find
some attendants want to be paid and will
unnecessarily put the woman and her
baby at risk and not detect this problem
early with the risk of the uterus rupturing
leading to bleeding, death of the baby,
and sometimes even the mother. Should
the mother survive a good number will
remain with severe complications such as
infection or even fistulas.
My most shocking episode I remember
was a woman when I was still working in
the coast province who came with baby
stuck at shoulders. Due to the length of
time that it had taken the baby was not
even blue but black and the patient had
Unfortunately around the world 830 women
die daily from preventable causes related to
pregnancy and childbirth. This equates to
about every 2 minutes a woman somewhere
has lost their life due to pregnancy. I usually
tell my clients that they are walking time
bombs and I only exhale about them once
we’ve done the 6 week visit and they are
well.
to be taken to theatre for a destructive
delivery i.e removing the baby in bits.
Even though the baby was dead it’s a
memory I think I will never forget.
Abortions: The medical term for a
miscarriage in the first 20 weeks of
pregnancy is an abortion. Certain chapters
in this country have made the term sound
as if it is only those who went to have a
termination of pregnancy and mostly
back street abortions. Abortions can both
be induced and spontaneous and the vast
majority are spontaneous as 15% of all
pregnancies will end up as a spontaneous
abortion.
Regardless of cause an abortion can be
complicated by severe bleeding, infection
and other issues. For me my lasting
impression was a young girl also in coast
province whom I was called to review. The
patient was referred as having a retained
placenta with “umbilical cord” hanging
out from the vagina and it had even been
cut and a tied with some form of string.
At immediate assessement it was clear
that this “cord” was actually intestines
(due to presence of faeces) and on enquiry
of the gestation it was evident the foetus
could not have such a big cord.
Intra-operatively it was found that the
young lady had a uterine perforation and
the inner lining of the rectum intima is
what had been pulled and cut as a cord.
She had to get a colostomy i.e. when you
pull part of the gut through the abdominal
wall and stool is diverted to come out
through this opening. I’m not sure if they
were able to reverse the colostomy but the
talk was that it was going to be permanent.
In as much as the last patient cited didn’t
die it is realizing that for every death
there are about 20 women who get severe
complications and some of them are
lifelong complications.
More and more women are dying
due to clots in the lungs (pulmonary
thromboembolism). This is the most severe
form of clots and only about 50% survive
and this is in developed countries. Have
you heard of a woman as there are many
in the media who delivered well especially
after caesarean section went home and
developed cough or difficulty breathing
rushed back to hospital and died?. This is
a real threat and warrants everyone to be
vigilant and consider use of blood thinners
especially after surgery and the worst is
caesarean sections as pregnancies make
getting clots easier.
46 MAL29/19 ISSUE
Indirect causes of maternal death would
include things like malaria, anaemia,
HIV/AIDS, heart disease and so on.
Women are pregnant so that they can
have children and more common than
maternal deaths are perinatal deaths.
Especially if this happens prior to
delivery or at the time of delivery the
responsibility of giving this news lies
squarely with the obstetrician. Like any
death there will be grief and this will start
with denial and in this stage reactions are
varied.
We recently saw in the media how one
of our nurses was assaulted and landed
in hospital following breaking the news
of a relatives’ death. I’m shocked and
horrified and sympathize with both
parties. For the woman for losing her
son and for the health worker who did
not have to receive such punishment for
doing her work.
This leads to the last part of the article
that everyone is affected by the death.
We know obviously the relatives are
most affected but no one wants a patient
in their care to die or get complications.
Other than psychiatric cases no normal
health worker leaves their home to cause
harm to patients or their relatives.
There are two schools of thought one that
encourages medical workers to express
their grief even in presence of relatives
and the other that promotes empathy
where you do not reveal your emotions
about the death but try to explain the
death or bad outcome to relatives. Most
health workers have been schooled with
the latter and because we don’t openly
show our emotions it can lead to stress
and burnout. I personally get joy and
fulfilled when you complete a difficult
surgery and when that woman on death’s
door can tell you ahsante daktari.
When you have an undesired outcome
remember that the caregivers are also
stressed and have usually put their
best foot forward to try and alleviate
suffering. I wish to urge the government
to continue to add resources allocated to
healthcare so that no one needs to die
from preventable deaths. We doctors
treat. But healing is by the hand of God!
Dr. Maureen Owiti is a practicing
Obstetrician Gynaecologist and
fertility consultant based in
Nairobi. You can commune with her
on this or related matters via email
at: [email protected].