Mothers' stories of hope in the face of maternal health risks

Mary Wanjiru, cuddles her one-day-old baby at Pumwani Maternity Hospital. [Mercy Kahenda, Standard] Agnes Mutinda did not know she had a multiple pregnancy. At 28 weeks, she went for a normal ante-natal check-up at Makadara health centre, but suddenly developed acute abdominal pain. A nurse at the clinic referred her to Pumwani Maternity Hospital for emergency care. The first time mother was scared and confused. At the facility, she was wheeled to the maternity ward where she delivered her firstborn daughter, Baby Shine, a preterm who weighed only one kilogramme. Her joy of cuddling her first bundle of joy was, however, short-lived as she was quickly rushed to theatre to deliver her second-born through a Caesarean section procedure. "My labour pain intensified. I panicked after I learnt I was carrying twins, and that I required to undergo C-Section to deliver the second one," Mutinda narrated her ordeal at Pumwani Maternity Hospital. She adds, "As I was wheeled into the theatre, I was traumatised to leave my preterm baby behind. I was ready for any eventuality. I anticipated the worst." Unfortunately, her second delivery was declared a stillbirth. Mutinda emerged safe from the procedure and her surviving daughter was later discharged from the newborn unit at 1.7 kilogrammes. Mutinda acknowledges that seeking maternal care on time saved her life and that of her baby. "Health professionals truly struggled to save my life and my baby. Maybe had I arrived here on time, I would be holding my twins. But it is not all lost. Here I am, with my daughter," adds Mutinda. "When I saw my wife wrapped in white bedsheets, I cried because she was bleeding excessively. I thought she was dead, until I was re-assured of her safety by a doctor," recalls Mutinda's husband, Eric Onyambu. "I also feared for the life of my baby, having been a preterm. I had never seen such a tiny baby" Onyambu's psychological support was key in his wife's recovery process, after a difficult birth. Mary Wanjiru, was also going about her chores when she got into labour at 35 weeks. The 25-year-old from Githurai rushed to Dandora Health Centre for care, but was referred to Pumwani Maternity Hospital since the pregnancy was risky. On arrival, she was injected with corticosteroid injections to help the baby's lungs to function. Wanjiru panicked, but would safely deliver her second born. "I got scared after I learnt my baby wasn't able to breathe. I expected the worst, only to deliver a healthy baby," says the mother. "I am thankful to my husband for taking me to hospital for care. Had I delayed, the baby would have died." Mutinda's and Wanjiru's cases are not in isolation. Their survival and that of their babies is attributed to quality healthcare at birth, despite having had high risk pregnancies. As Kenya joins the globe to commemorate World Health Day themed 'My health, my right', health experts note the importance of access to quality and timely maternal and healthcare to avert deaths. According to a recent report by the Ministry of Health titled 'Saving Mothers' Lives: Confidential Enquiry into Maternal Death' between 6,000 and 8,000 women are estimated to die every year in Kenya. Dr Laura Oyiengo, a maternal and child health specialist at UNICEF Kenya, says quality healthcare results into better outcomes for both mother and child at birth. Quality care, she explains, is having pregnant mothers, newborns and post-natal mothers receive care that enables them to have the best outcomes. The care includes antenatal care services, patient education, hospital delivery, and post-natal follow-ups. Babies should be examined to ensure they are healthy - including being able to breastfeed - and have any concern addressed before discharge. "Quality care will simply have mother attended to by a professional health provider and be able to get C-Section services, if required, or assisted delivery services," says Dr Laura. A recent study by the ministry in partnership with UNICEF also revealed that four out of five mothers who died, were due to poor quality services. Three top reasons for deaths were found to be post-partum hemorrhage, infections and hypertension. To improve maternal and child health, UNICEF is working with the Ministry of Health to develop guidelines on quality healthcare and how to offer these services to mothers. Pumwani Maternity Hospital is among facilities implementing quality healthcare practices because of its high volume of deliveries. Under the programme, healthcare workers are trained and equipped with skills and knowledge on management of pregnancy, post-natal and newborn health. Delivery technologies like birthing stools, and Kangaroo mother care have also been adopted at the hospital to ease delivery. "Instead of spreading resources, we focus on the three causes of maternal deaths by looking at health systems and health workers, to have resources targeted to improve health systems and healthcare worker capacity to address the three top challenges," added Laura. Pumwani Maternity Hospital CEO, Christine Kiteshuo, said ANC visit is key in improving maternal and child health. At ANC, women with pregnancy risks are identified for close monitoring to guarantee their safe delivery. Pregnant women also learn the best pregnancy care, nutrition and hygiene at the clinics. "At Pumwani, the journey for quality care begins at ANC, where health providers work hand-in-hand with Community Health Promoters (CHPs) to identify expectant women at community level and enroll them for clinics," says Kiteshuo. ANC visits at the hospital have increased from 400 in 2022, to 745 in 2023. "CHPs have been a game changer in maternal and child health. They liaise with community and register pregnant women, whom they follow up to ensure they enroll to ANC clinics," says the CEO. After completing ANC visits, women go through labour, with help of gynaecologists, who work alongside midwives. There are 11 obstetric gynaecologists at the hospital, 63 Medical officers, and 119 nurses handling labour and theatre. Deliveries at the hospital average at 60 every day, with at least 18, 377 deliveries having been recorded in 2023. The hospital has a capacity of 354 beds and 242 neonatal beds. Plans are in place to set up neonatal ICUs. The newborn unit, with a capacity of 120 beds, has also improved health of preterm babies and those born with complications. At least seven babies are admitted to the unit, with common conditions being preterm, respiratory defects and jaundice. "I am encouraging pregnant women to come to hospital, where they can be seen, screened, prioritised, given health education and when they proceed to labour, it is easy for them to have a good outcome," says the CEO.

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