Born blue and breathless: An infant's fight for survival, a mother's descent into depression

It's every mother's joy to receive a newborn, especially when it's the firstborn, but sometimes that joy can take an unexpected turn. For 38-year-old Rael Awuor from Kisumu County, what began as a smooth pregnancy filled with hope and careful preparation quickly turned into a nightmare she never imagined. Living in Lolwe Estate, she had never missed an antenatal clinic, trusted her gynecologist at a Private Hospital in Kisumu, and was eagerly waiting to hold her baby in August 2021. "I was looking forward to being a mother," Awuor recalls. "My pregnancy was easy, with no complications. I had proper guidance, and I never missed a clinic appointment. But nothing really prepares you for childbirth. Nobody tells you about the other side, the possibility of losing your child, or your own life." Her story is about 24 hours of excruciating labor, delayed Cesarian section, and her newborn's fight for survival in a Neonatal Intensive Care Unit (NICU). Awuor describes her pregnancy journey as calm and joyful. She was counting down the days to August 2021, the month she was due to give birth. On August 19th, she began experiencing mild contractions. Following her gynecologist's instructions, she checked into Kisumu Specialist Hospital. She was the only patient in the ward that day, a situation she describes as "strangely calm." But her calmness soon turned to distress as the hours dragged on and labor failed to progress. Unbearable pain "I labored for 24 hours. I later learned from another gynecologist that good practice requires that if you are not dilating, the doctor should decide much earlier to operate. In my case, nothing was done until later. By then, my baby had passed meconium inside the womb, and the pain was unbearable," she says. At midnight, Awuor's screams echoed through the hospital halls. Yet, no gynecologist was available to perform the urgent cesarean section. Nurses on duty appeared unresponsive, forcing her relatives to call her doctor. He promised to come the following morning, leaving her in a dangerous situation. "I survived only by the mercy of God," she says. "How I endured that night, I still don't know." At dawn on August 21, Awuor was wheeled into the operating theatre. The anesthetist administered spinal anesthesia, and she could hear and feel everything happening from the waist down. When she asked if her baby had been delivered, she sensed panic in the gynecologist's response. Her daughter was born not with the healthy pink skin of a newborn, but blue-black, a sign of oxygen deprivation. She had ingested meconium, her first stool, which blocked her tiny lungs. She did not cry at birth. Instead, she was rushed to the corner of the theatre, where a pediatrician fought to resuscitate her. "My heart sank. I held my baby for the first time while she was still on oxygen. I had no experience handling a newborn, and here I was with a child fighting for her life. My brain just started shutting down slowly," Awuor remembers. Though the newborn eventually turned pink and began to cry, the danger was far from over. Doctors advised transferring her to a facility with a machine that would clear her lungs. This forced the new mother to move just hours after her Cesarean. The journey to Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) was harrowing. The newborn convulsed in the arms of Awuor's cousin while still on oxygen. The nurse traveling with them downplayed her concerns, but his worried glances betrayed the seriousness of the situation. Upon arrival, the NICU team at JOOTRH rushed the baby in. For Awuor, the sight of the intensive care unit was overwhelming. "I had never seen anything like it. Rows of incubators, wires, machines-everything looked surreal. My knees gave way, and I broke down outside the corridor. I had heard horror stories about public hospitals, and now I was being left alone in this strange environment," she says. The following days tested Awuor's resilience. She could not walk properly because of her stitches, yet she had to wake up every three hours to feed the baby. At first, she could not produce breast milk, a situation that deepened her despair. Nurses encouraged her to try food like porridge enriched with millet and beef broth to stimulate lactation. Slowly, her supply improved. But the emotional strain was heavier. The NICU corridors were cold and eerie, especially at night. She remembers shivering at 3am, hearing wails from other wards, and fearing that every scream meant another child had died. "I was sinking into postpartum depression without knowing it," She says. "I developed high blood pressure, panic attacks, and anxiety. I was constantly afraid of losing my baby. Sometimes, I would ask other mothers to check if she was still alive because I could not bear to look myself." Despite her struggles, she praises the staff for their professionalism and compassion. Pediatricians conducted daily rounds, explaining each child's progress openly. Nurses encouraged mothers, maintained spotless wards, and offered emotional support. "What blew me away was the kindness of the nurses. They treated us like family. Despite stereotypes about public hospitals, this was a place of hope for many of us," she recalls. After 10 days, her newborn had made significant progress. Tests showed her vitals were clear, and she no longer required oxygen. Mother and daughter were discharged. Although relieved to go home, Awuor carried emotional scars. Panic attacks followed her into motherhood. At night, she would wake up crying, convinced that her baby would die. Family members noticed her distress, and a sister connected her with a counselor who worked with mothers battling postpartum depression. "That counselor saved me," she says. "She reassured me that my child would be fine. She helped me accept that what I went through was trauma, not weakness which was really affecting me. That's when I truly understood that postpartum depression is real. It can affect anyone, no matter how well-prepared you are." Her child has since grown into a healthy, bubbly four-year-old, meeting all her developmental milestones. But Awuor admits she is still occupied by fear. "I am not planning to have another child soon. The trauma still lingers," she says. Her experience has turned her into an advocate for NICU awareness and maternal mental health. She urges mothers to ask questions, demand explanations, and never shy away from seeking help. She also calls on hospitals, especially private ones, to better equip their facilities to avoid unnecessary referrals. "Many mothers suffer postpartum depression in silence. We must walk with them, not stigmatize them," she says. September, which is observed annually as NICU Awareness Month, is a time to honor premature and sick babies, their families, and the healthcare professionals who care for them. It shines a spotlight on the challenges parents face while navigating NICU journeys-fear, stigma, financial strain, and emotional trauma. The awareness month also elaborates the importance of community support. As Awuor notes, many young mothers she met in the NICU were abandoned by their families, left to face motherhood alone. Others were trapped in hospital because they could not clear bills. "My message to mothers is simple: always ask questions, seek support, and never carry the burden alone," she says. Her testimony is a call to action: to equip hospitals, train healthcare workers, support families, and break the silence around maternal mental health. Birth asphyxia, which is the failure to establish breathing at birth, remains a major contributor of infant deaths. WHO estimates it accounts for about 900,000 deaths each year globally. This condition typically results from complications during childbirth and is one of the leading causes of early neonatal mortality. When oxygen deprivation is severe, it can cause lasting brain injury, disability, or even death. In severe cases, it first damages the brain before spreading to other organs such as the lungs, heart, and kidneys. The Kenya Vital Statistics Report 2024 by the Kenya National Bureau of Statistics reveals that prematurity and birth asphyxia are the leading causes of death among children under five, with pneumonia ranking second. In 2024 alone, these conditions were responsible for 4,112 out of 20,156 under-five deaths recorded in health facilities across the country.

Born blue and breathless: An infant's fight for survival, a mother's descent into depression

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