Stillbirth: The pain of mothers leaving maternity without their babies

Liz Nduta suffered two stillbirths and a miscarriage. She is now a mother of three. [Rosa Agutu, Standard] Picture this: you are expectant and almost due, you have chosen a name for your baby. You have even bought baby clothes and are prepared to meet the little person that has been growing inside you for months; in fact, you cannot wait to see those tiny feet as the due date approaches. But then at the hospital, you are informed that things are not okay, and there is a big chance that you might not see your baby alive. It is a matter of life and death, doctors say. They have to remove the baby urgently by Caesarean Section. Fearing the worst, you agree to the surgery, hoping that it will save your little one's life. However, the baby is born, but you do not get to go home with them. You left your house knowing well you would go back with a baby. Now you are going back empty-handed, healing a Caesarean Section wound with nothing to show for it. You blame yourself, asking questions like "Did I do something wrong? Why me? Why my baby?" You blame your maker; you even blame your body for failing you. Sadly, this is the story of most women who have experienced stillbirths (foetal demise) and miscarriages. In 1999, Liz Nduta had her first baby, everything went well and after a while, she was ready for a second baby. Heartbreaking words We met Nduta at her home in Nairobi. The bubbly mother of three boys welcomed us for her first-ever interview. She has talked about her loss with family and close friends but not in front of a camera. In 2002 Nduta conceived again and carried the baby to full term. Then one morning she woke up and she could not feel the baby playing in her womb. She rushed to the hospital where they confirmed their biggest fear and the doctor uttered the most heartbreaking words: "There is no heartbeat". The umbilical cord had gone around the baby's neck and they had to remove the baby. Nduta could not push so she had to go through a Caesarian operation. After a week in recovery, she went back home albeit empty-handed. "So you can imagine the pain, you are back home, you are healing a wound and there is no baby," she said. "At that point, everyone knew you were expectant and were excited for the new baby. When they see you without the baby bump, they ask how the baby is doing. The pain was too much it reached a point where I wanted the ground to swallow me." Not only that; Nduta admits that she could not look at baby clothes. "I would imagine my child in those clothes, I would imagine seeing him in the baby cot, it was difficult," she said. During the mourning period, she could not sleep with the lights off as it was too scary. Her husband had to seek counselling for her. In 2003 she conceived again but after 20 weeks, she lost the pregnancy. In 2004 she conceived again, it was smooth until 24 weeks. 24-hour life "I was getting a watery discharge, I went to the doctor and he said the amniotic fluid was leaking. I stayed in the hospital for seven days. "While there I woke up in intense pain, I called the nurse, then the doctor came and said they have to remove the baby and chances of survival were slim," she said. The baby died after 24 hours. Sadly, Nduta did not get a chance to hold her newborn. "I felt like bad luck was following me. I held my baby when she was dead. We had named her Zawadi, but I did not get a chance to hold her when she was still breathing. We did a funeral and gave her a good send-off. For the other losses we told the hospital to handle the burials," she said. During that period one of her friends took her for a spiritual seminar. While there the priest told them to pray on their own, and that is when she had an intimate conversation with God. In 2008 she delivered her last born. It was not an easy pregnancy, she was on bed rest, due to bleeding. She was admitted and the baby was delivered successfully at 37 weeks. The story is the same for Bibian Takaa, who had to seek counselling on her own after losing multiple pregnancies. After delivering her first-born daughter in 2011, Bibian wanted more children, however, the journey would be one of the most difficult experiences of her life. Four times she conceived and four times she lost the pregnancy. "I would conceive then I would go to the hospital and they would say the womb is empty so they would clean me and I would try again," she says. In 2016, she was told that her fallopian tubes were blocked. She and her husband went to India to seek further treatment. While there, they opted for In vitro fertilisation (IVF). It was successful and she was informed that she was carrying twins. "I had fibroids which were growing with the twins, so at three months I lost one twin. I was scared so I kept asking the doctors to keep checking if the other baby was still alive," she says. The pregnancy was delicate and she was put on complete bed rest. One evening at around 7pm she went to the bathroom to take a shower. Her husband walked in and saw trails of blood from the bed to the bathroom. They rushed to the hospital, while there the bleeding had stopped but she had to be admitted. "I was there talking to my husband then I tried to get up. Then I saw my husband's panicked face, he called the nurse. I was bleeding, there was blood all over the bed, my back and my hair. They had to perform an emergency CS. The baby was so weak, they had to take him to the Intensive Care Unit," she says. During an earlier interview with The Standard, Bibian's husband, Sylvester Ouma said that he was excited to have a baby boy. "We named him Mihaly; the boy I spent all my savings to have, he was 2.1kgs, so they put him in an incubator. I called everyone and told them the son we had been waiting for was finally here. I bonded with my son as my wife was recuperating," he said. "I had to make trips to the nursery to see him. He was my boy, my Mihaly, my first son. I could now walk with my head high. My wife was discharged three days later. That very night I got a call from the hospital. I was told my Mihaly was gone". That was on April 4, 2017. Ouma went to the hospital and the sight of his boy, lifeless in an incubator, pained him. "They didn't even cover his eyes. He was naked. I have never experienced that kind of pain. My Mihaly was gone," Ouma said. Bibian says that while at home she had compressed milk so that her baby would have something to feed on when the husband went to visit him. But her baby never got a chance to feed on the milk. "I was broken. I was not able to hold or touch my baby. He was a fighter though, he really tried to live. The following day we took him to the morgue and organised a trip to our rural home for the burial," she says. After the burial, it was a healing period for the whole family. "It was painful, I was healing a CS wound without a baby. I could not go to the toilet. I had physical and emotional pain," Bibian says. Approximately 10 to 15 per cent of pregnancies globally end in miscarriage, or before 28 weeks. Annually, 2.6 million babies are stillborn, leading to an increased number of babies dying during pregnancy or childbirth. Between January and July 2018, at least 594 out of 1,758 newborns did not make it out of Kenyatta National Hospital's newborn unit alive. According to the World Health Organisation (WHO), Kenya's stillbirth rate is at 22 per 1,000 births. Almost half of them happen during labour. Dr Saudah Farooqui, Head of the Obstetrician and Gynecology department at Nairobi West Hospital says if the miscarriage happens during the first trimester, it could be because of chromosomal abnormalities. "If it is the second trimester and after 20 weeks it could be a number of causes, the most common is infection. Maybe E. coli, or if the mother has diabetes, or high blood pressure and it is not controlled or caught on time. It could also happen if there is premature rupture of the membranes, or if the placenta detaches," she says. Membranes rapture Another reason is if the woman has an infection of the vagina colonising up into the uterus, that is mostly after premature rupture of the membranes. Also if there are any congenital abnormalities, or the mother is rhesus - and the baby is rhesus positive. "Another risk of foetal demise is if you have multiple pregnancies. It could be because of the space. There are a number of reasons that can cause foetal demise but infection is common, especially during the second trimester," she says. Dr Saudah says that after a miscarriage or foetal demise, the mother's uterus is cleaned using medication, or physically through a procedure in the theatre. Dr Saudah notes that the mother is often really affected psychologically, therefore she always calls a psychologist to see her patients before they are discharged. "Mothers always ask what they did wrong, so I try to give them closure by explaining what happened and then call a psychologist," she says. Midwife Nerea Mlale Ojanga also speaks a lot about counselling and encouraging families not to leave their foetus in the hospital, and instead give them a decent burial. "They were people; they had faces. I used to have clothes that I would give mothers to bury their babies in. It gave them closure, I would walk with them through that period," she says. Mlale adds that one of the most common causes of stillbirths is the umbilical cord tying around the baby's neck. In such a case death can be prevented if the mother monitors the movement of the baby. "Monitor the routine; if the playing stops, seek medical attention, because the cord goes around the neck of the foetus and they choke," she says. When that happens, an emergency Caesarean procedure is recommended. Mlale urges organisations to give women who have had miscarriages and stillbirths time to heal. A human resource director who chose anonymity says that in her organisation if a woman suffers a miscarriage or stillbirth, she is given compassionate leave which is only 14 days. Supporting mothers Annita Munyiva Musyoki, a clinical psychologist at Nairobi West Hospital says that grief cannot be detected. "We give them time; we go with the pace of the mother. I let them know that I am here to support them. You never force therapy, so if I come in and you are not ready to talk, I will give you space until you are ready," she says. Munyiva says that therapy is not just for the mother, but the spouse and the older children. "Different clients have different number of sessions. We do determine with how you respond," she says. According to Luo Council of Elders Chairman Odungi Randa, when a mother has a miscarriage or a stillbirth, older women in the community come together to support her. "It is strictly a female affair, the burial of the foetus will be handled by women only, and the burial will be behind the main house," he says. After that, the woman will be given traditional medicine to clean her womb. Sheikh Abubakar Bini, Chairman of the Council of Imams and Preachers of Kenya for Uasin Gishu County says matters of life and death lie in the hands of God. "What we do is pray for the mother so that Allah can console them during this traumatic period, because at this point the mother might wonder what she did wrong." Pastor Walter Bulimi also echoes the same sentiments and adds that they reach out to the whole family for counselling and prayer. "We encourage them to go through therapy, and advise them to bury the foetus. It should be treated as a child who passed on, we encourage the family to go through mourning," he says.

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