Overbleeding
Medza says the profuse bleeding came after she delivered. Luckily, doctors quickly rushed her to the theatre; her uterus had ruptured. She explains that the experience was traumatic, but eventually her life was saved.
The trauma she experienced after staying in the theatre for two hours created fear in her, and she says she will rethink giving birth again.
“I don’t like remembering the experience. I feel a lot of pain now that we’re talking about it,” she sadly says during our interview.
The story was different for Florence Cherry, a mother of three from Kilifi County.
Cherry was compelled to deliver through caesarean section in all her three pregnancies due to high blood pressure complications during pregnancy, also known as preeclampsia, as well as the inability of her pelvic muscles to expand.
“I had no history of blood pressure until the last weeks of the first pregnancy,” she says.
She further explains that at some point she went through a lot of pain, thinking it was labour pain, but when she was examined, it wasn’t time yet.
“My body started swelling. I felt like I was suffocating,” she narrates.
The pressure levels were stabilised and then doctors decided to induce her, but she didn’t experience any labour pain. After waiting for some time and a check-up was done, the baby’s heartbeat couldn’t be felt; therefore, they rushed her for a caesarean section to save the baby.
The story was the same for her second pregnancy, but this time not as bad as the first one. She had to be closely monitored since she conceived less than a year after her firstborn. CS was the only option for her.
“I didn’t insist on giving birth normally since they had already told me that my pelvic muscles can’t expand,” she notes.
Cherry says the situation was worse in the third pregnancy. At six months, high blood pressure was again detected and she had to be admitted for it to be stabilised. That wasn’t the end, for the HBP issues were on and off.
“I felt like pushing at seven months,” she explains.
A few days to the delivery, a check-up revealed that the baby’s heartbeat couldn’t be felt. She went for the third caesarean section.
“I don’t know how it feels to have labour pains,” she states.
Due to the difficult journey she has had with every pregnancy, she decided to do a tubal ligation, a safe permanent form of female sterilisation where the tubes are tied, blocking them permanently.
“I thank God for the three children but I couldn’t continue risking my life,” Cherry says.
The decision was consented to by her husband after the doctor’s advice. Cherry says that although she desired to give birth normally, she couldn’t have continuously risked her life, especially after the doctor warned her.
“My gynaecologist said I could continue to the fourth, fifth and even sixth pregnancy, but it’s risky,” she adds.
She noted that some friends had been saying CS isn’t the best because it limits the number of children one can give birth to; however, this didn’t change her mind.
Gynaecologist Dennis Miskellah says postpartum haemorrhage, bleeding after childbirth, is the leading cause of maternal deaths in Kenya.
He says the bleeding happens regardless of whether the delivery was through caesarean section or normal childbirth when the uterus fails to contract or tears during injury after delivery.
In a situation where one has a bleeding disorder or the placenta remains inside, making it unable for the uterus to contract, the mother is likely to bleed after childbirth.
He advises against women insisting on giving birth normally, especially if the labour has prolonged without much progress, for this could cause the uterus to rupture, putting the mother at risk.
He says the prolonged contraction of the uterus, especially if there has been a previous CS conducted, puts the mother’s life in danger.
“We advise women at such a time to go for caesarean section to save their lives; this is the best intervention,” he explains.
Miskellah says it’s not advisable for a pregnant mother to insist on normal childbirth if she’s already had two previous caesarean sections. However, for women who’ve had one CS previously, it’s possible to give birth normally only if the cause for the first CS is non-recurrent.
He says maternal deaths can be prevented if pregnant mothers start antenatal clinics early, where blood levels are checked to rule out any possibility of anaemia.
He explains that for those carrying twins, or if the child is big, as well as those with a history of bleeding disorder, it’s advisable to ensure they’re properly examined and placed close to a facility with proper equipment, including transfusion services, due to the high risk of bleeding after delivery that they have.
Miskellah says it’s safer if doctors start the haemorrhage protocol for any mother who loses more than 300 ml of blood after childbirth.
On her part, Head of Obstetrics and Gynaecology at KUTRRH Janet Githinji says complications of high blood pressure after delivery, bad infections resulting in sepsis, and bleeding due to unsafe abortion also contribute to maternal deaths.
She notes that prevention of the deaths requires not only the efforts of the government but also the mothers and society at large. She emphasises the need for pregnant mothers to start antenatal clinics early and deliver in health facilities where they can be handled by skilled birth attendants.
This will help capture any form of complication or danger sign early and intervene, adding that the follow-up should go on for 42 days after delivery.
“Mothers shouldn’t think that they’re pros since they have already delivered several children before at home,” she warns.
In cases where the mother keeps bleeding even after interventions, she says removal of the womb will be necessary to save the mother’s life. She adds that in a routine case, monitoring for bleeding is done for between 24 to 48 hours, hence the need to deliver in a healthcare facility. For those who’ve undergone caesarean section, one can be discharged after between 48 to 72 hours unless there are complications.
“You should be discharged if you’ve given birth normally within 24 to 48 hours if all is well,” she says.
Misconceptions
On misconceptions about giving birth through caesarean section, which is one of the interventions, Doctor Miskela says the narrative that women who give birth through CS are weak is a myth.
He also warns against the perception among Gen Zs that giving birth normally destroys their bodies, saying this isn’t true since the birth canal has the capacity to contract back to normal after giving birth.
“Caesarean section is recommended after a doctor’s assessment; it’s not done for fun or money,” he explains.
In Kenya, 5,000 maternal deaths are reported every year, with postpartum haemorrhage, which is bleeding after childbirth leading, followed by high blood pressure complications during pregnancy, also known as preeclampsia. According to the 2019 statistics, bleeding contributes up to 50 per cent of the maternal deaths.
The cases are more common in underdeveloped counties like North Eastern Kenya as well as in some cities, despite the existence of infrastructure.
Doctor Githinji, however, says that although the goal is to reduce maternal death cases to a ratio of 70 deaths per 100,000 live births by 2030, this will require proper health financing and ensuring that health facilities are functional in terms of availability of blood in case of transfusion and other products.
“This is apart from mothers and society developing a good health-seeking habit,” she insists.
Currently, the government has rolled out a rapid response initiative to accelerate the efforts required to reduce maternal deaths. She notes that the availability of the Maternal Deaths Surveillance and Response tool in health facilities could help analyse the situation and identify where interventions are needed.
According to a WHO report, globally, over seven hundred women die daily from preventable pregnancy-related cases.