The eerie silence of stillbirths

Raquel Otieno, 24, is heavily pregnant. Thirty-four weeks pregnant to be exact, she tells me. Just three weeks to go. Like most expectant mothers, she can’t wait to hold her baby in her arms. But this isn’t her first rodeo- and she is afraid. Nay, she is scared...that this pregnancy, like three others before will leave her heart, womb, and arms empty and aching. A stillbirth.

“The first time was in 2013. They were twins- a boy and a girl. For a twin pregnancy, it was quite uneventful. But on the date of delivery, my babies drank amniotic fluid. They were born green and were dead minutes afterwards,” Raquel says, balancing tears in her eyes.

The twins were buried at Langata Cemetery, while Raquel was still recuperating in a hospital bed.

Raquel had two more stillbirths in 2014 and 2016 respectively.

Strangled by the cord

“The one in 2014 was a boy. Like with the twins, I had had a relatively easy, healthy pregnancy. During delivery, the umbilical cord wrapped around his neck and strangled him to death,” she says as she dabs away tears from her eyes with a napkin.

“He was also born breech, which further complicated the situation. I was dilating rapidly and the doctors decided against a caesarean section. He was dead by the time he came out of the womb,” she says.

When she got pregnant again soon afterwards, Raquel and her husband were elated. Surely, God would let her keep this one, she thought. But it wasn’t to be.

In 2016, she checked into a hospital to have her baby delivered. She was anxious but optimistic. It was two weeks to her expected date of delivery but she had requested a caesarean section. That morning, she had counted her baby’s kicks and assured herself everything was fine. If all went well, she would have her baby, already named Chrisette, in her arms that same day.

 Dried up amniotic fluid

After a scan to ascertain the baby’s position, doctors told her that the baby was dead. Raquel’s amniotic fluid had drastically dried up, killing her unborn baby.

“I couldn’t believe it. I had done everything right. I had been checked just the week before and told that everything was fine. I had felt her play within me that morning. How could things have gone wrong so quickly?” Raquel wonders, the pain still fresh in her voice.

Hope reigns

Torn by grief, Raquel decided that she wouldn’t get pregnant again. So it came as a surprise when she discovered that she was pregnant in early 2017.

“I was on contraceptive pills. It looks like they failed. I was happy that God had decided to give me another baby. But I’m exhausted. If anything goes wrong now, with this one, I don’t know...I don’t know...” she says in a near-whisper.

Definition of ‘still birth’ varies

A stillbirth is when a baby is born dead but had reached a gestational age in which they can be viable outside the womb. “In Kenya,” explains Nelly Bosire, a gynaecologist and obstetrician, “we consider it a miscarriage when a pregnancy is lost at 28 weeks and below. Anything after that is a stillbirth. But in the developed world, the cut-off gestational age to consider it a stillbirth is as low as 20 weeks because of access to advanced technology.”

According to The World Health Organisation (WHO), in Kenya, the rate of stillbirths is almost eight times that of developed countries. A report published in the medical journal, The Lancet, found that there are 96 stillbirths in Kenya every day. There are 23 stillbirths for every 1,000 births in Kenya. In 2015 alone there were 35,000 stillbirths in Kenya, an increase from almost 32,000 in the year 2000.

Although these figures are dismaying, the report showed that in the last 15 years, the rate of stillbirths in Kenya has been on the decline. However, health experts worry that even with significant progress in reducing maternal, neonatal, and under-five deaths- stillbirths remain stubbornly high.

Induction gone wrong?

In May 2016, Lulu Kimbio was looking forward to being a first-time mother. She had already picked a name for her son: Jabari John Gitau, fondly abbreviated to JJ. Like Raquel Otieno, she had had a healthy pregnancy.

At 38 weeks, she had labour pains. After labouring overnight, with advice from her doctor, she went to the hospital where she was given tablets to hasten the process. She believes that the events that took place afterwards might have led to her son’s death in the womb.

“At some point, a nurse came and added something to my drip. I don’t know what it was and if my doctor had authorised it. When the baby was crowning, his heartbeat wasn’t in sync with the contractions — which is usually a sign that the baby is in distress,” she says.

Her passage was too narrow for the baby and she had to have an emergency caesarean section. With only a local anaesthesia, Lulu could feel the moment the baby was removed from her womb. She waited to hear his cries. Nothing.

“I was panicking because he wasn’t crying. I was asking ‘Why isn’t he crying? Why isn’t my baby crying?’ They said that they had lost the baby. Then I passed out.”

The hours and days afterwards went by in a blur for Lulu. Due to postpartum haemorrhage and high blood pressure, she was in and out of consciousness. She was placed in the hospital’s high dependency unit.

The first time she saw her son’s face was from a picture her husband had taken. It broke her down.

“I had been somehow numb with the physical and emotional pain. Seeing his face, so handsome and innocent, opened the floodgates,” Lulu says with a small, bitter laugh that brings tears to her eyes. The next time she saw him, he was in a tiny casket in Chiromo Funeral Home.

She and her husband decided to have their stillborn baby cremated. They would spread his ashes in Diani — their favourite holiday destination.

“I was scared that if we had him buried, I would be constantly tempted to go to his grave. We got a certificate from Chiromo to spread the ashes in Diani. When you have a still born baby, you get a death certificate not a birth certificate. On the certificate, they don’t even write the baby’s name, they list it under the mother’s name,” she says.

Bewitched?

“Some people believe that I’ve been bewitched and should consult a witchdoctor. A friend once told me to leave my husband and let him marry someone who could give him babies. I have to cut out the negative people from my life and focus on my own healing,” Raquel says.

Although her husband and extended family is supportive, Lulu has also had to deal with hurtful comments.

“People don’t understand the grief of a stillbirth mother and some expect you to move on like nothing happened. Some say things like ‘God will give you another one’ or ‘At least he died at that stage, before you got to know him’. These comments, although well-meaning are extremely hurtful and insensitive,” Lulu says.

However, the two mothers have found an understanding community in Facebook groups. “In Kenya, one of the leading groups is ‘Still a Mum,’ headed by Wanjiru Kihusa. Through these groups, I have made friends who going through the same journey. They have made the weight a little easier to carry,” Lulu says.

Still a mother

After a stillbirth, especially if she doesn’t have other children, many women are left confused over whether they can still claim the motherhood tag.

“When people ask, I tell them that I’m a mother but my baby is in heaven. Although JJ isn’t here, I’m still his mother. I kept the baby stuff that people had gifted me and will probably use them if I have another baby. But I also gave away some of the things in honour of JJ’s memory. This year, we even celebrated his birthday with a cake— something I plan on doing each year.” Raquel says that she still finds it hard to be with other mothers. “I have lost four children to stillbirth and not many mothers can relate to that. I can’t afford to go for therapy, but I share my story whenever I get a chance. That helps with my healing,” she says.

“I discarded everything that reminded me of my babies...seeing reminders every day was too painful. But I will never forget them, even if I never got to look in their eyes.”

Lulu remains positive that she will have another baby. “This year, I miscarried another pregnancy at 10 weeks. My husband and I were hit hard by that loss. But we’re keeping our hope and faith up,” she says.

Tips to other mums like her

“I would like them to connect and network with others like them, because you will find comfort, encouragement and wisdom from those mums who have been there before you. You are not an outcast and you will realise that you belong in a group of women who, like you, are still learning to grieve the child they never knew. Your child will for ever be in your heart.

Raquel sighs heavily as and rubs her protruding belly. “I’m all ears on my tummy. I talked to my doctors about having an early caesarean section but they discouraged it because of the risks it poses to the baby’s immunity. I hope this one is here to stay. I can’t take the pain of another stillbirth.”

Dr Bosire says the lack of access to advanced antenatal care is responsible for the high rate of stillbirths in Kenya.

“Some of the complications and conditions which lead to stillbirth would be easily picked by ultra sound machines and other advanced technology but in rural and low income areas especially, many mothers don’t have access to such services. The truth is that our country’s antenatal care is very basic. The truth is that 90 per cent of antenatal care is given by nurses and midwives,” she expounds.