Anyone can be victim of maternal mortality

With the recent postpartum experience of tennis star, Serena Williams and close shave with death, it just might seem like every woman, irrespective of education or financial wherewithal can fall victim to maternal mortality. Medinat Kanabe reports.

A few weeks ago, the news broke of how tennis superstar, Serena Williams almost died after child birth. Williams, who was delivered of her baby through a Caesarian Section, CS, fell ill a day after the operation and doctors found several little clots in her lungs.

Not long after, she suffered another terrifying scare, when her C-section scar burst open and doctors found that a large haematoma (a solid swelling of clotted blood within the tissues) had flooded her abdomen.

The tennis star had to undergo several surgeries and was unable to get out of bed for six weeks.

Recounting her ordeal, Williams said she almost died if not for the prompt intervention of the doctors.

Without doubt, Serena Williams is one lucky woman; as many others have died due to such careless oversight.

Grace Thompson (not real name), a graduate of Business Administration from one of Nigeria’s prestigious universities is one of the unlucky ones. She died a few weeks after child birth. According to family source, she died from high blood pressure while some others said she bled to death.

She had given birth and was undergoing the normal postpartum bleeding period; having an elaborate naming ceremony was therefore understandable as the bleeding was not supposed to make her handicapped. Unfortunately, the bleeding never stopped and she died of excessive blood loss.

Another case is that of Nollywood actress, Modupe Oyekunle who died after given birth to her third child. She had been delivered of the baby, even held the child in her hands before she passed on.

Another popular Yoruba actress who died after childbirth is 42-year-old Moji Olaiya, who passed on in Canada two months after bringing forth her baby. While it was never confirmed that her death was due to complications from childbirth, many drew their conclusion based on the time span.

Emmanuella Harrison is another such victim. In March, 2017, she left her husband and children for the hospital to deliver her baby but never returned home.

Mrs. Harrison, who was already a few days overdue, was driven to the hospital by her husband. She finally gave birth to a healthy child after laboring for hours but died from postpartum hemorrhage.

According to Doctor Rufus Olawale Adewuyi of the Ilogbo Central Hospital, Ijanikin, maternal mortality is the death of a woman while pregnant or within 42 days of delivery or termination of pregnancy irrespective of the duration of the pregnancy, which may be caused by things related to the pregnancy or the management of the pregnancy.

“If a woman aborts a pregnancy, no matter how old the pregnancy is, and dies within 6 weeks after the termination, it is maternal mortality.”

Adewuyi hinted that maternal mortality is a big issue in the world, saying one can assess the state of health of every country based on their maternal mortality rate. “A country with a good health condition translates to a very low maternal mortality rate. It is unfortunate that Nigeria is one of the five countries in the world with high maternal mortality rate. This shows the state of our public health and the standard of living of the people.”

The doctor said things that are responsible for maternal mortality includes socio economic status of the people; socio cultural status of the people, their beliefs, the health consciousness of the people, how affordable their health services are, and how effective the regulatory agencies are.

Other reasons responsible for maternal mortality according to the doctor include the fact that a sizable number of deliveries are either taken at home or handled by non trained personnel.

Although not trying to hold brief for abortion, he said because abortion is illegal, people cannot come out to do it, hence it is being handled and managed by quacks.

“For the socio economic status, we understand that many people cannot access good health care because of lack of money. Because of some beliefs, many people prefer to deliver at home, thereby patronising TBAs. This has remained this way because of the lack of PHCs in many rural communities, making them worst hit.

“People in these places fall into labour and cannot get into a secondary health care facility, if urgently required. Usually, it takes so much time, which may lead to death,” he said.

One of the ways to reduce maternal mortality, according to Adewuyi is to educate the girl child. “This will keep them in school all through childhood to about 20 years of their lives; this helps them to escape teenage pregnancy. Teenage pregnancy is known as a high risk pregnancy because when a teenager is pregnant, there is a high risk of Vesicovagina Fistula, VVF, turbulent delivery and many other issues that can lead to maternal mortality.

“They are more informed when educated, they are placed in a better socio economic class, they know when to go to the hospital, where to go, and can plan their lives better, which in turn helps the society. They are also aware of family planning and know that the more they get pregnant and go through labour, the higher they are exposed to risks.

“Hypertension, diabetes and hemorrhage are other major causes of maternal mortality and they require special and professional management, which is not available in many parts of our country.”

Using the hospital where he works as an example, Adewuyi said antenatal is very important to have a healthy child and a happy mother. During this period, the women are counseled and checked on a regular basis to know those who require special care and close monitoring during pregnancy and after delivery.

 “Some are placed on classical ANC while others are placed on close monitoring. We may see some only four times throughout the pregnancy while we see some almost every week all through the pregnancy. Every pregnant woman that comes to the hospital here must see the doctor.

“We always have an obstetrics gaenocologists on ground every time the women come; that is why our maternal mortality rate is 0 in 10. We don’t have any here except when the pregnancy was not managed by us and poorly managed or before the patient gets here the baby or the mother is already dead. Once a woman is discharged, we advise her to do exclusive breastfeeding, which we start telling them from the beginning of the pregnancy, so they are very much enlightened about the benefits.

“We also have a congratulatory message, which we hand over to every mother and it contains things that we expect them to do when they get home and what we don’t want them to do. After we discharge them, we give them 48-hour appointment, a 72 hour appointment, an eight day and some other appointments to monitor them.”

Asked if women that deliver through CS have higher risks than those who go through vagina delivery, Adewuyi said “For every surgery, the risks are there but CS is a surgery that can be performed by a junior doctor; so it is a very simple one but it cannot be compared to vagina delivery.

Noting that sometimes people who deliver through the vagina have complications and those that deliver through CS don’t have any form of complications, he said “For CS, the risk is usually postpartum hemorrhage.”

Postpartum hemorrhage, according to him, can be primary or secondary. “It is primary when it reduces after 24 hours but becomes secondary when it continues for more than one week and is heavy. After delivery, we expect the womb to contract to help contain the amount of blood loss but when the womb is not contracting, which we call lack of uterus contraction, the blood vessels, especially from the placenta bed continues to bleed.

“Another cause is when part of the placenta is retained in the womb. The first thing she should do is to come back to the hospital. After you deliver, if you notice anything strange, don’t listen to people around you; come to the hospital and let the doctor tell you that it is nothing. Don’t wait until it gets out of hand because it will increase from one stage to another and may make it difficult for the health practitioners to handle.

“When a woman delivers, we administer some treatment so that after the first day, the blood begins to reduce until after 6 weeks when it would have changed to spotting.

“If after 24 hours of delivery a woman discovers that her bed is soaked with blood even with the use of pads, then she should raise alarm. She should also raise alarm if the bleeding comes with weakness.”

In his final analysis, Dr Olawuyi concluded that child spacing does not only reduce maternal mortality but also improves the health status of the mother. “It goes a long way to help the economic status of the family. It allows the family to be able to cater for the ones they have and for the woman to be able to recover very well from the last delivery. It also helps the society, as the woman is able to stay at work, as against observing maternal leave every time.”

April 21, 2018