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When you are about to die, you can feel life draining out of you. Your eyes lose focus and your limbs can barely move.
It is almost useless to even try fighting it — that damn dying feeling. And when everything becomes all hazy, there is a certain zeal that kicks in; the urgent desire to live, and for about a minuscule minute it helps you to fight that floating and drifting feeling.
And when no help arrives, your mind takes over and resolves to accept the inevitable. It’s a horrible feeling and all the things you haven’t done or haven’t said to the people you love become so evident that you want to cry.
You want to shout out loud and say, “I am not done with living damn it!”
But you cannot, because you can feel the blood leaving your body at an alarming rate....it actually gushes out and the first place to feel the cold is the head, and then all consciousness is lost.
That was me. Four months ago. I walked into hospital ready to have my third child and I almost didn’t walk out alive. At 3am, in the recovery room post-delivery, I was fighting to reach the nurse’s buzzer button, which lay on the bed right next to my head. But I couldn’t. I had woken up feeling weak and wet. I knew what all that wetness meant and I knew I had to call for help, but I couldn’t lift a finger and for the first time in my life, my big mouth failed me.
And so on that bed, feeling my life draining out of me, and with no one by my side, since I sent them all home to sleep, I told God that I wanted to see my people and my children again, then lost conciousness. I was lucky a nurse found me soon afterwards. But a couple of months later, a friend would not be as lucky.
It was on the day the Beyond Zero Campaign, headed by the First Lady Margaret Kenyatta, kicked off their maiden Half-Marathon to help reduce and even curb maternal deaths in the country. A sunny and promising day it was, and as the athletes took to their heels on the hot tarmac, an old friend was fighting for her life and that of her unborn child in hospital.
Did you know that about 5,500 women die each year in Kenya due to pregnancy-related complications? (source World Health Organisation, WHO). That day, my dear friend became a statistic.
And in the two weeks that followed her sudden death, about four other cases were reported on various social media forums where other women and mothers had lost friends or relatives during childbirth. These were, however, not women who did not have proper access to medical facilities.
They are not the ones captured within the WHO spectra of statistics where they clearly state that their data is mainly drawn from rural areas and people living in poverty. These were middle-class women, with insurance covers or enough money to pay a bill at any high-end hospital in the city.
Currently, the number one cause of the death amongst the middle and upper spectra of the society during childbirth is Post-Partum Hemorrhage or PPH otherwise known as severe bleeding after childbirth. It is more prevalent in women who have undergone Vaginal delivery (VD) and often occurs during the period doctors refer to as “the Golden Hour.”
During this period, according to Dr Njoki Fernandes, a gynecologist from AAR says, “a woman who has had VD, should be under the ever watchful eye of the nurse and checked on vitals (blood pressure, pulse and bleeding) at least every 15 minutes.
It is in this window period that if an abnormal bleeding should occur, the nurse on duty should catch it early enough for the doctor to be able to save the patient’s life. It is also during this period, however, that most mums (especially second time mothers) will find themselves alone and not attended to because being a seasoned mom, everyone believes the worst is over and the mother should be left to rest. This should not be the case.”
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According to the WHO, women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy. Other complications may exist before pregnancy but are worsened during pregnancy.
The major complications that account for nearly 75 per cent of all maternal deaths are:
1. Severe bleeding mostly after childbirth
2. High blood pressure during pregnancy – pre-eclampisa and eclampsia
3. Infections usually after childbirth
4. Complications from delivery
5. Unsafe abortions
And while all women are at risk of any of the above, it is the women in developing countries who are recorded to be at higher risk mainly due to the fact that they have higher chances of actually being pregnant.
The lifetime risk of maternal death in Kenya is 1 in 160 women will die from maternal cause. Most of these deaths can be prevented, says Dr Fernandes. Changes have to be made where maternal health is
concerned. Even though it starts with visiting a health facility as soon as you find out you are pregnant, the medical fraternity too, need to re-learn tips and tricks to curbing the menace that is maternal mortality. From good labour management to keen follow-ups post delivery, everyone needs to be on board to ensure that another woman doesn’t die when giving life.
But as Dr Godfrey Ngayu, a consultant gynaecologist at The Women’s Clinic in Nairobi insists, even these measures won’t be enough unless under-staffing of medical personnel, even in the private sector, is addressed.
“Millenium development goals as per maternal health have not been reached,” he says. “By 2015, the rates should have come down to 100 deaths in 100,000 births but the numbers are at 488. There is not enough personnel and infrastructure is still wanting even within the city.”
Elizabeth Makheti’s sister-in-law would be alive today had the doctors taken serious her complaints on severe headache right after child birth. “When she visited the doctor days after delivery, they affirmed that her BP was normal at 150/86, they even did a scan on her feet and confirmed that there were no blood clots.
She was put on intravenous drip painkillers for two hours then told to go back home. She was given more painkillers to manage the headache at home,” the doctors found nothing odd and did not see the need to keep her for further observation or investigation. “She said the doctor said she was okay and the headache was just the theatre anaesthesia still wearing out in her system.”
However, when she woke up with the splitting headache the next day, she knew better than to stay and wait for it to get worse. She left the house accompanied by the nanny and made her way to a nearby clinic. On her arrival, she fell unconscious and was rushed to the main hospital.
“I got to Aga Khan just as they were wheeling in my sister-in-law. My husband was also there. They rushed her to the Emergency Room and the doctors there tried to stabilise her. After sometime, the doctors suggested a CT scan to see what caused her to collapse, we immediately sought approval from her mum and off they went to try and save her life.
Her baby was taken to the nursery at the hospital as we waited for what seemed like hours. Later, the CT scan results came and a panel of doctors explained to us the report - a vein had ruptured in her brain due to high blood pressure, which turned out to be what was causing the headaches. The rupture was severe and had left her in a comma.”
From then on, the doctors did everything they could medically think of to try and reverse the effects of the rupture, but as fate would have it, it was the case of too little, too late. Her sister-in-law succumbed to eclampsia that had crept in after the birth of her child.
Elizabeth still walks around wondering, if she had not done enough at the onset of her sister’s complaints with the headaches. She wonders if things would have been different had she taken the time to ask the doctors more questions before her sister-in-law’s discharge and on follow up visits.
According to Dr Njoki Fernandes, “doctors should take more time with their patients, and do thorough follow ups to prevent the preventable. And I say it often starts with the mismanagement of labour. Following childbirth, we should prepare for the worst always; maybe only then can we be adequately able to save a mother from a future condition such as eclampsia or PPH.”
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