Baby's first cry, father's tears: Rare birth complication tears Kitengela family apart

A newborn baby. [Courtesy/iStock] Victor Ambula drove his wife to the hospital, excited to welcome their bundle of joy. Their hearts brimmed with happiness and anticipation. But that joy quickly turned to heartbreak - Zipporah died from excessive bleeding (post-partum haemorrhage - PPH) while giving birth. It was October 25, 2023 - the day Victor's life changed forever. Now, he was left cradling a newborn in his arms, while also caring for their two sons, aged 11 and 8. "I cannot describe the pain of losing my wife," Victor tells The Standard. He and Zipporah had known each other since primary school, began dating in campus, and moved in together in 2013. That same year, they welcomed their first child, followed by their second, and later baby Jannelle, the little girl who heartbreakingly lost her mother at birth. All three deliveries were by Caesarean section. Victor vividly remembers Zipporah's longing for a daughter, a dream that would ultimately cost her life. "After our second boy, I felt we were done with childbirth," Victor recalls. "But Zipporah always longed for a baby girl. She wanted one before she turned 35. When she conceived again, she was so excited, we all were. The children would even pray for a baby sister," Victor recalls. The pregnancy progressed smoothly, though doctors warned of a complication, placenta accreta, where the placenta grows too deeply into the uterus. World shattered Knowing she would need another C-section, Zipporah booked an elective surgery at a private hospital for October 25, 2023. On October 24, she was admitted for final checks in a Kitengela hospital. "Her blood pressure was normal. She was full of life. We even joked about whether the gender might surprise us," Victor says. That night, Victor went home to care for their two elder children. The next morning, they eagerly set out to meet their new baby and welcome their mother back. At the hospital, a nurse approached him, cradling a newborn. Beside her stood Zipporah's bed. It was empty. "We met a nurse holding our newborn whom she handed to me. Our boys were so happy. They finally had a baby sister. But Zipporah wasn't there. We waited, but she didn't come out. Something felt wrong." Victor's anxiety deepened. His wife was still in theatre. He peered into the theatre and was horrified to see his wife lying in a pool of blood. His world was shattered. But a doctor reassured him, saying they were working around the clock to save Zipporah's life. It was, however, clear, Zipporah had died. She suffered massive bleeding (PPH), caused by the placenta accreta. Doctors tried to stop the bleeding but could not save her. "That was the darkest day of my life," Victor says, his voice breaking. I saw my wife lying in a pool of blood. They told me she bled too much. Her organs shut down." The family received the sad news with a heavy heart. "Seeing my children cry was the hardest thing I have ever faced," he says. Victor, a taxi driver, suddenly became both mum and dad to three children, including baby Jannelle, a newborn just hours old. Question of breastfeeding the baby was the hardest to answer, in the grieving moments. "Look, a baby at hand, no breast to breastfeed, yet so tender to eat any meal," he recalls. Exclusive feeding With guidance from healthcare providers, Victor put baby Jannelle on exclusive feeding - no water, no porridge, only formula - for six months. A 1-kilogramme tin of formula cost Sh2,000 and lasted barely a week. "I exclusively fed her for six months before introducing complementary foods. Though the cost was exorbitant, it was for my baby's survival. I had to ensure she got all the nutrients to boost her immunity," says Victor. Determined to provide the best care, he asked his mother to stay with him and help raise Jannelle. With family support, the little girl is now one year and nine months old, bubbly and full of life. Initially, Victor hired house helps but was unhappy with their care. He then sent Jannelle to live temporarily with his mother, visiting regularly to bond, while staying with his two older children. His day starts at 5am. He prepares breakfast for the children, ready for school. "Zipporah used to wake up early, even when she was pregnant, to prepare the boys. One day, our firstborn told me, "Dad, Mum looks tired. You should be the one waking up." The next day, I did - and since then, I have been the one waking up," he says. Victor works his taxi shifts during the day, making his last trip by 6 pm so he can be home by 7pm. "My biggest concern is raising them well," he says. "I want them to have everything they need. In my own way, I make it happen." Yet beneath his daily hustle, the pain of losing Zipporah weighs heavily. Reflecting on her death, he is angry, not only at fate, but at a system he believes failed her. "They told me she had placenta accreta and bled too much. But if you know you cannot handle such a case, refer the patient," he says bitterly. "Do not admit patients just to make money. Do not gamble with lives if you don't have enough blood, an ICU, or the right specialists." Placenta accreta spectrum Zipporah's dream was to give their family the daughter she had longed for, and she did. But fate claimed her life in the process, leaving Victor to piece theirs back together. "I am doing my best for my children," he says, adding "...but no one should have to lose a wife this way. No child should cry for a mother who went in to bring life, only to lose her own." Prof Moses Obimbo, a scientist and obstetric gynaecologist at the University of Nairobi, explains that placenta accreta spectrum is a condition where the placenta grows into the muscles of the womb. Obimbo explains that though women die of many complications at birth, one of the most dangerous is involvement of placenta. Placenta is a vital organ that connects a mother and her baby during pregnancy. The placenta forms as the baby develops. It has two parts, one from the baby and one from the mother, which meet to allow transfer of oxygen, food, nutrients and waste to pass between them, he says. Normally, the placenta, he explains, attaches to the upper part of the uterus, either on the back or front. But sometimes it does not attach properly. It may settle at the cervix or grow too deeply into the uterus, a condition referred to as placenta accreta spectrum - where the placenta burrows too far into the womb. In a normal pregnancy, the placenta attaches to the lining of the uterus, but in placenta accreta, it goes deeper into the muscles. This is placenta condition that killed Victor's wife. "Women who have had CS or surgery to remove fibroids are at higher risk of placenta accreta spectrum, as scar tissue can draw the placenta to implant more deeply, that results into bleeding," explains the scientist. Buried deep The real danger with the condition, Obimbo explains, comes after birth, during the third stage of labour when the placenta is supposed to detach. "If placenta is buried deep, it won't come out easily," he says. "Pulling it out by force can cause catastrophic bleeding because pieces can be left inside the womb. That's how many cases of post-partum haemorrhage start."According to Ombimbo, managing placenta accreta requires skill and preparation. "We train students on how to handle it carefully. In some countries, there are centres of excellence to manage these cases because they are so delicate. If the bleeding cannot be controlled, sometime the only way to save the mother is to remove her uterus," he explains. The condition is, however rare, affecting between one and three percent of pregnancies. But Prof Obimbo warns that in poorly prepared facilities, the risks are higher. "If a doctor is not trained or a hospital is not equipped, chances of losing a uterus or even a life are much greater," he says. He emphasises that PPH is still the leading killer of mothers in Kenya, causing up to 59 per cent of deaths. First line interventions of PPH includes uterine massage, administering additional uterotonics, manual removal of placenta. Other advanced measure is use of IV fluids, tranexamic acid, bi-manual compression and collaboration with obstetricians for surgical interventions. Other major causes include high blood pressure in pregnancy, unsafe abortions, obstructed labour and infections. He says some women are at higher risk than others. "Mothers who give birth when they are very young, below 20, or when they are older, above 36, face more complications. And women who have many pregnancies - the sixth or seventh child - are also more likely to experience heavy bleeding or blood pressure problems," explains the scientist. Further, he stresses that delays are costing lives. "There are three delays - women delay in seeking care, there is delay in reaching the hospital, and delay in getting treatment once they arrive," he says. "Unless we fix these delays from the community to the hospital, we will keep losing mothers to preventable causes." To tackle these dangers, the Kenya Obstetrics and Gynaecological Society, the University of Nairobi and the Midwives Association of Kenya have joined forces on advocacy, training and research. One of their campaigns, Run for Her, raises awareness and resources to save mothers' lives. The initiative also help sensitise donation of blood for transfusion to save mothers at birth, following excessive bleeding. Victor's experience mirrors that of hundreds of men who have lost their wives at birth, due to excessive bleeding and other maternal related complications. Kenya Obstetrical and Gynaecological Society (KOGS) President Dr Kireki Omanwa condemns how Zipporah was handled, noting her life, and that of many women can be saved with proper management. "I did not attend the patient, but got theatre notes on what they did about it. It was sad because it showed there were gaps in understanding and identifying the problem," says Omanwa. Early signs According to the fertility expert, every expectant mother should be seen by doctors and professional health workers to avoid deaths and complications related to pregnancies and births. For instance, blood count should be done, to determine blood group and haemoglobin level. Ultrasound scan should be done, to show location of the fetus, amount of fluid, where placenta is and if the baby is doing well. "If what was required to be done was done, they would have caught early signs of excessive bleeding and referred Zipporah to Kenyatta National Hospital (KNH) where we have all consultants, and we could have planned what to do with the placenta, or a good way to handle it, or even remove it, but picking placenta piece-meal was wrong," observes Omanwa. Kenya is also faced with shortage of obstetric gynaecologists, with only about 700, patchy in distribution, as majority are in Nairobi. Counties of Isiolo, Samburu, Wajir and Mandera have one or none at all, says Omanwa, while Turkana has one. "We have issues with manpower. We need midwives, clinicians, nurses, nutritionists because in any delivery, we work as a team," he says. Ministry of Health in support with UNICEF has also developed a policy and developed a curriculum on what should be done to manage maternal health. In the policy, UNICEF supports training and buying commodities and follow-up on healthcare provision. Dr Laura Oyiengo says the move aimed at ensuring policies trickle down to facilities that provide care."Government has trained health workers, but you go to facilities, they do not have commodities," said Oyiengo. Prof Anne Beatrice Kihara, president of the International Federation of Obstetricians and Gynaecologists notes the need to look into excessive bleeding at birth locally and globally. She says excessive bleeding in some women is because of low blood through the pregnancy. Prof Kihara emphasised the need to intertwine mother and baby care during pregnancy, and golden one hour (immediately after birth).

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