Bleeding after birth

Every year, Kenya loses more than 7,000 women to maternal deaths. Out of these deaths, 33 per cent are due to post-partum haemorrhage (PPH), the severe bleeding that occurs after childbirth. Recently, the Government released results of a pilot project that tested a drug that greatly reduces this life-threatening bleeding, writes NJOKI CHEGEBleeding is normal after any childbirth because it is the way through which the body disposes of excess mucus, placental tissue, and blood after giving birth. This condition, which is also known as lochia, is similar to the bleeding experienced during menstrual periods, albeit much heavier. It begins hours after birth and usually continues for two or three weeks.When this bleeding gets worse, however, it becomes post-partum haemorrhage (PPH), a fatal condition that leads to death, especially among women in the rural areas who give birth at home under the care of traditional birth attendants, far away from proper healthcare. In Kenya, the population of women who give birth at home simply cannot be ignored as they make up a worrying 56 per cent of total births in Kenya. The commonest cause of PPH is the retained products of conception. These are the parts of the placenta and membranes that remain inside the womb after childbirth. Due to their toxic nature if they stay in the womb for too long, these products of conception have to be disposed of through the bleeding.Another reason for the severe bleeding is uterine atomy or failure of the uterus to contract after childbirth. This usually occurs when the mother cannot access proper medication to counter the bleeding, hence leading to excessive bleeding. Other reasons for PPH include the perennial tears in the cervix and birth canal, which can be corrected through surgery, but this is often not available to women in the rural areas and informal settlements.So how does a woman who has just delivered know if she is bleeding excessively? Well, if she loses more than 500ml of blood after a vaginal birth or more than 1,000ml after a caesarean section birth, then she is suffering from post-partum haemorrhaging. Besides massive blood loss, which occurs in large clots, PPH is also characterised by light-headedness, weakness and dizziness. However, these are just the initial stages of PPH. The bleeding can turn into a real monster when the patient suffers shock, followed by kidney failure, after which she can fall into a deep coma and, finally, death. Dr John Ongech, the head of Obstetrics and Gynaecology at the Kenyatta National Hospital, confirms that PPH is the number one killer for women in Kenya, whether in rural or urban areas."This is not normal bleeding. In fact, no gynaecological bleeding is normal. Severe bleeding after childbirth should not be taken casually because of its fatality. Depending on how fast you are losing blood, you could die within hours of childbirth," he warns.According Dr Ongech, there are several ways of treating PPH."In the event where the uterus fails to contract after childbirth, we induce syntocinon injection that contains a synthetic version of the naturally-occurring hormone oxytocin, which causes the uterus to contract. The perennial tears in the cervix and birth canal can be treated through surgery, while the retained products of conception can be removed manually by hand. The bleeding can also be surgically stopped through either hysterectomy or sub-total hysterectomy that involves removing of the womb," Ongech says.Sadly, women who give birth at home and whose only antidote for PPH is a simple massage on the uterus, stand a higher risk of death since the treatments as indicated by Dr Ongech require assistance by a trained health care provider, who is often not present during the childbirth. It is, therefore, clear that not all women in Kenya benefit from the current approach to counter PPH. There are several reasons why many women in the rural areas choose to give birth at home. They include poor access to hospitals, limited access to dispensaries and health centres that do not operate 24 hours, and poor infrastructure.The negative attitude of the health workers in many health centres is also a great turn off. These health workers, on the other hand, are normally overwhelmed by the large numbers of patients and the lack of medical facilities, compounded by poor pay, lack of supplies and theatre facilities, and absence of drugs. Additional sources from Unicef and WHO.

Bleeding after birth

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