If only she had gone out
If only she had said no
If only she kept it closed
If only they used protection
If only she did not get pregnant
If only they had planned
If only they had the drug
If only she had money
If only there was blood
If only there was time
Perhaps she’d be alive today
But you are, so come on this journey!
Far too many women have died and are dying during pregnancy and childbirth. Hopefully, we will be able to prevent some more deaths after you have read this article.
We lost a woman on the operating table a few years ago. She had delivered a baby and bled to death because her womb would not stop bleeding. This was an unplanned pregnancy. It so happened that the last pregnancy was just as risky and doctors had warned her not to attempt another.
Sadly, she and her husband failed to use protection and she got pregnant again. They also refused to consider termination of the pregnancy. A pastor may have been involved but that is another story.
Pregnancy is a big deal which needs better planning and strategy. Preparedness for pregnancy is important and massive preparedness for the delivery is also critical. Antenatal care is vitally important and these days, early assessment in the clinic and ultrasound scans of the abdomen should be performed.
The special one
There are special circumstances like a first pregnancy especially in a woman above 35 years of age, a woman with multiple pregnancies, previous caesarean section, women with medical problems like hypertension and those with previous difficult deliveries. These special conditions make pregnancy and delivery risky and can lead to death. Women in such categories must be under the care of a qualified doctor.
It is necessary to stress for women in Nigeria, that visits to the herbalist and listening to pastors can only do harm. Pastors are not medically trained and should not give medical advice. These people should not compel you to go against the advice of your doctor. So relying on them could end up being life-threatening!
Cause of death
The most common causes of maternal deaths are bleeding after the delivery (25%), complications from unsafe abortion (15%), hypertensive disorders of pregnancy (10%), infections (8%), and obstructed labour (6%). Indirect causes are malaria, anaemia, HIV/AIDS, and cardiovascular disease, all of which may complicate pregnancy or be aggravated by it.
Okay, one of the biggest killers is bleeding following child birth (postpartum haemorrhage). There are two options in the management. One is to use drugs to contract the womb and second, to remove the womb altogether in a safe environment. Perhaps we should talk more about the two options and solutions.
For decades, oxytocin and ergometrine have been the treatments of choice for postpartum haemorrhage. Although both drugs are effective, oxytocin is more widely used because it has fewer side effects and can be used safely in women with hypertension and pre-eclampsia. However, in their usual form both drugs can be given only by injection, and both require refrigeration. They are therefore of limited availability and benefit in low resource settings, especially in rural areas.
There is a drug called Misoprostol that everyone should know about. Misoprostol, an orally active and heat stable prostaglandin E1 analogue, has emerged as a popular alternative to oxytocin and ergometrine. This drug is important in preventing maternal deaths following child birth. The drug helps to contract the womb and stop bleeding from the raw surface following the removal of the placenta.
Now, this drug is cheap and should be in the delivery pack of all pregnant women. It is far more important than sanitary pads or baby clothes. However, not many women know about it and certainly not many women in rural areas, rural clinics and maternity homes. Will you tell them for me?
You see, this patient did not have the drug in her bag and the hospital did not have any effective drug in their cupboard. For instance, many of the drugs we use are temperature controlled which is pretty difficult in our environment. These drugs should travel from one fridge straight to another without being exposed to the hot sun in Nigeria. These are drugs that should not be left at customs overnight! The drug the hospital had in the fridge had actually expired since the last time NEPA took light.
The only other option in the situation is an operation to remove the womb and stop the bleeding. You may also need to transfuse the patient with blood. So blood must be available for every woman having a delivery, just in case. Blood must be readily available in the hospital. It should not be the relatives that go around town looking to ‘buy’ blood!
What have you learnt so far?
The key aspect of this story is that she carried the pregnancy to term, delivered the baby and died from massive bleeding. Drugs to stop the bleeding had expired. There was also no blood immediately available for a transfusion. Finally, the husband delayed consent for her womb to be removed, till it was too late.
The other lesson is that waiting for untrained people; relatives and pastors, to make decisions on these kinds of issues could be extremely dangerous.