Thursday, October 13, 2011

Maternal Mortality

Sebsabe goes home after a nightmare end to her first pregnancy
It took two days, but Sebsabe got better and on the third day the family wanted to take her home. So we took the dressing off her caesarean wound and it had had healed perfectly. And her tummy was nice and soft and the pain had gone so I agreed. Her mother then put on a blue dress after peeling off the large grubby green dress she had on and  she gave  it to Sebsabe to squeeze into. A couple of quick pictures a few smiles and they were gone, but not before I made the midwives reinforce the absolute necessity for Sebsabe to come to hospital next time she is pregnant and especially as soon as the labour pains start. I think they got the message.

Meanwhile, we had two women with complications following successful births at home somewhere. One had an infection and needed antibiotics, and the other had sustained some bladder trauma and couldn’t pee. When a catheter was inserted nearly three litres of urine drained out –she must have been in awful pain. What was also  interesting about both these ladies was how pale they looked, and when we checked their blood counts, the results  even surprised the midwives. Back home the normal blood count  after birth would be above 100, and above 120 in a normal healthy adult woman; below 70 is severe anemia usually treated with a blood transfusion. Our two patients blood counts were 25 and 45g/L – testifying to what  must have been horrendous bleeding  and a terrifying scene at the time of the birth – they were both lucky to have survived! Bleeding at the time of birth is  the biggest single cause of maternal death world wide, accounting for about 25% of the 350,000 deaths a year – that’s about one woman bleeding to death somewhere in the world every 6 minutes. The second most common cause of maternal death worldwide is infection, and about as many die from complications of unsafe abortion.

Clearly these women would benefit from a blood transfusion but there is no blood bank in Motta. However, family members sometimes have compatible blood so we sent all available family for testing but unfortunately there were no matches. Our next option was to transfer them to Bahir Dar Hospital where there is a blood bank but the cost of transport was 800 birr – one family had enough but the other didn’t – hers was the higher of the two results so we just had to give her Iron tablets. I could perhaps have used some of the BMF money to help them out, but decided not to as I knew in time if she took the iron she would recover. If she had been septic like the other woman, or if her bleeding was continuing I probably would have, because recovery from sepsis is greatly impaired by anaemia.

At home these events are called Critical Incidents and each becomes the focus of  close investigation and review. They are infrequent even in big institutions. The  only time I ever saw a woman with such a low blood count up till now involved a Jehovahs Witness in New Zealand. She also had an infection and kept bleeding, till one night she decided to have a transfusion – I think the blood count by then was 18 - she said she could feel she was dying and suddenly she didn’t want to lose her children. Good on her! Damn stupid religion if you ask me – as usual in organized religion, it’s the poor women who suffer and the men parade piously round burdened by none of the  reproductive hazards that women have to put up with. I am so over organized religion!

The spooky thing is that these anemias and horrendous near deaths from bleeding only came to light because of other problems – I couldn’t help but wonder what other nightmares are happening out there unreported.

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