For someone whose gender is not of those that can conceive and give birth, many would say I know a bit too much about motherhood and they would be right. This is why they say that experience is the best teacher. Now to the real subject of the day.
Maternal mortality remains a major issue in developing nations, especially here in my country, Nigeria. Not a day goes by without the bad news of a woman dying before, during, or after the process of giving birth. I had my own fair share of this hydra-head health issue when I lost my first marriage due to the death of my wife during the process of giving birth (more about it later in this post).
According to statistics by the World Health Organization, the maternal mortality rate of Nigeria stands at a rate of 814 cases per 100,000 births. For those of us in Nigeria, these statistics look underwhelming considering the rate at which we get news of maternal mortality death around us. Everyone seems to know someone that has been a direct or indirect victim of maternal mortality.
Even though the high rate of maternal mortality has been attributed to three factors, the problem eats deeper than that. The three factors that have been fingered include delay in making the decision to seek medical attention during pregnancy, delay in getting the attention when the decision is eventually made, and delay in getting skilled health workers to attend to pregnant mothers while at the hospital for medical attention. While all these factors may play a part, they do not tell the complete story.
In my short time of existence (I am still quite young), I have witnessed the gestation and birth of 3 babies which are mine. The events that happened in each case were unique but can give an insight as to why we have a high maternal mortality rate in Nigeria beyond the 3 factors highlighted above.
My First Experience
I was newly married, living in the busy city of Lagos, Nigeria. Those living in Lagos can tell how difficult and expensive it is to get adequate healthcare. Hence, it was a huge race when my then-wife took in within the first few months after exchanging our marital vow. The distance between her office and our apartment was up to 10 km while traffic takes a large chunk of her time. Hence, she usually leaves home as early as 6:00 am and returns as late as 9:00 pm.
Considering all these factors, we opted for her to sign up for her antenatal care at a government hospital close to her office where she can easily hop in, get attended to, and hop out back to her office. It was a good arrangement and everything went smoothly until the 37th week when we a scan was recommended to know the status of the baby before the due date. Everything was fine with the baby except that the scan picked unknown water being present around the head of the baby. A second scan was recommended and the result was the same.
I followed her to the next antenatal appointment to assure her that everything is fine with the baby. It was right there and then that the consultant in charge convinced us to go for Caesarian Sectioning so as not to jeopardize the health of the baby as the nature of the strange water around the head is not known. She went straight into false labour due to anxiety, I guess. She was not wheeled into the theatre until about 24 hours after. The CS was successful and a healthy baby was brought out some moments after.
The mother was wheeled out of the theatre about an hour after, shaking heavily. I was told that the shaking is due to the effects of the anesthesia used during the CS and that it will wear away with time. To cut the long story short, she went into convulsion a few minutes after and gave up the ghost. Just like that!
My second experience
About five years after, I found the strength to marry again and after about a year of delay, my new wife took in. We registered for antenatal immediately and everything went smoothly. She fell into labour just a few days to the expected delivery date and the labour progressed normally, although I later got to know that the labour was induced with oxytocin. She gave birth successfully, cleaned up and returned to the maternal ward only to start bleeding heavily a few minutes after.
The bleeding was so much that she had to be rushed to the labour theatre again and it was there they discovered that she had cervical tears that went unnoticed by the midwives that took the delivery. She had to be anesthetized and stitched after which a pint of blood (personally donated) was transfused into her system because the RBC count was found to be underwhelming. She got fine and we were discharged a few days later.
My third experience
Two years after the first child, my wife took in again and we registered for antenatal as usual. This time, her blood pressure shot up towards the last stage of gestation, and was put on some antihypertensive drugs. At some points, the amniotic fluid was also found to have reduced significantly and she was admitted and placed on lactate buffer intravenous fluid. A week after the expected delivery date, she had some contractions and we thought it was time. It was in the middle of the night when we set out to the hospital.
On getting there, the doctor in charge of her case was not on duty, hence, another doctor had to attend to her. She was checked for cervical opening and we were told that she was not in labour. After about 45 minutes of documentation, the doctor announced that we might need to opt for Caesarian Sectioning due to the issue that has to do with my wife's high blood pressure and reduction in the amniotic fluid.
We accepted our fate and hoped for the best. She was admitted into the labour theatre right away and we started preparing for the CS right away. While at it, the doctor originally in charge of her case resumed duty and became furious upon finding out that CS had been recommended. She cancelled all the arrangements immediately, apologized and assured us that there is no need to recommend CS yet as she was just a week beyond her due date. We were discharged immediately without paying a dime. About 24 hours after, my wife fell into genuine labour and within 6 hours, gave birth to a bouncy baby boy.
I made sure she was checked very well before being discharged from the labour theatre to prevent the reoccurrence of the bleeding event (we used the same hospital, by the way).
Takeaways from my experiences
Up till today, I still do not know what went wrong that could have led to the death of my first wife after the CS. Even though the death certificate stated that it was due to eclampsia, she never had any history of high blood pressure or pre-eclampsia and I suspect that they just wrote it to give an alibi. Many people encouraged me to take legal steps against the hospital but I was not in the right mental state to even ask any questions. The only step I would have been opened to taking would anyone that can bring my wife back to life, and there was none. Could her death be due to negligence/mistake?
In my second experience, had it been that the bleeding was not discovered on time, it could have led to a more dire circumstance, perhaps even death. I had to pay extra medical bills due to the anaesthesia she was given before the cervical tears were stitched. One would have expected the management to bear the brunt and even tender some apologies to us. Their negligence could have added to the maternal mortality rate statistics.
The third case also depicted the state of the hospitals in Nigeria and the gap between personnel when it comes to the knowledge of their fields. If not that the doctor in charge resumed on time, she could have been opened up (and, who knows what could have happened!) without any need for it. In Nigeria, CS remains a less preferable option for pregnant women due to the risk and cost involved.
In addition to the three factors that have been pointed out to be the reason for the high maternal mortality rate in Nigeria, the following factors can also be added from my own experience:
- Negligence by medical personnel
- Poorly trained personnel
- Poor medical facilities
I will like to know what you think in the comment section.
Thank you for making it down here.