Medics call for good care of a pregnant woman, to reduce maternal deaths

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Ms Eileen Mulaa (right) together with expectant mothers in a training exercise. She says exercise helps in building endurance ready for labour by improving a woman’s muscle tone and strength which may make it easier for her to adapt to the changes that pregnancy brings -Photo/Andrew Ombuni/CGN

Kakamega

By Andrew Ombuni

John Otieno, who hails from Mayoni area in Kakamega County is yet to come to terms following the demise of his wife and their child a month ago.

When time came for his wife to go and deliver their first born child, she went to a nearby health facility in Eldoret town where they were staying.

She was admitted in the maternity ward and had complications when giving birth, something that forced medics to operate on her after two days of labour pain.

After performing the caesarian section to save her life, she delivered a baby boy but had already died while still in the womb as a result of prolonged labour pain, after an hour, she started experiencing breathing difficulties and then taken to the Intensive Care Unit (ICU) where she died two days later.

It was later discovered that she had never attended clinic for checkup during the nine months of pregnancy. She was anemic and diabetic.

This is the case for many women in the rural areas and in urban areas who belong to the low and middle class.

According to the data on the District Health Information Systems (DHIS), Kakamega County alone for the last two years has recorded at least 2,500 maternal and neonatal deaths.

In 2017, maternal deaths for women aged 20 years and above was 34, maternal deaths audited 27, fresh still birth 401, macerated still birth 383 and neonatal deaths 230 which totals to 1,075.

Maternal deaths audited is the number of women who die during pregnancy or within 42 days of the after delivery.

In 2018, maternal deaths for women aged 20 years and above was 40, maternal deaths audited 43 women, fresh still birth 434, macerated still birth 460 and neonatal deaths 484 totaling to 1,025.

In Kenya, an estimated 6,300 women die annually during pregnancy and at child birth according to the National Council for Population and Development report of 2015, which translates to 17 women losing their lives daily.

World Health Organization (WHO) report of 2018 shows that at least 99 per cent of all maternal deaths in the world occur in developing countries where half of the deaths occur in Sub –Saharan Africa.

In an interview, Caleb Wanambisi, a Senior Medical Officer in Maternal and Child Health Department at Kimilili Sub County hospital said excess bleeding, high blood pressure during pregnancy and complications from delivery area leading causes of maternal deaths in Kenya.

Dr Wanambisi said infections usually after childbirth, unsafe abortions, hypertensive disorders and pre-existing conditions such as HIV and anaemia also contributes to maternal deaths.

He said a pregnant woman in the first trimester after conceiving experiences life threatening complications and that she must be monitored closely, saying she must start attending ante-natal clinic.

Dr Wanambisi who has over 8 years’ experience as a midwife said during the first three months of pregnancy, women experience excess vomiting (Hyperemesis Gravidarum), which is occasioned by the imbalance of hormones.

He said this stage is dangerous since the patient loses a lot of fluids and can die. “If she is not managed well, she can have spontaneous abortions courtesy of minor illness if she is not attending ante-natal clinic,”

“They are affected by mild anaemia due to inadequate irons and other essential nutrients in the body and is associated with low birth weight, premature births and causes death,” said Wanambisi.

Wanambisi said Hypertension in pregnancy (preeclampsia) leads to high blood pressure, protein in the urine and swelling of legs (edema), adding that some get candidiasis (urinary tract infections) and if left can cause spontaneous abortions.

He said pregnant women who have never gone to clinic must ensure they start attending ante-natal clinic at week 20 of pregnancy for examination to correct such anomalies.

“Sometime the pregnancy can occur outside the fallopian tube (ectopic pregnancy) over failure to attend clinic. Blood flows to the abdomen leading vaginal bleeding. Such a patient if not managed early, will die and that pregnancy must be terminated to save her life,” said Wanambisi.

Godfrey Mutanda, a medical officer at Bungoma County Referral Hospital said during the second and third trimester, the conditions are almost the same but it’s the most dangerous stage during pregnancy.

“A pregnant woman can get eclampsia (hypertensive disorder) leading to convulsions, swelling of legs and high blood at 28-40 of pregnancy leading to preterm labour and vaginal bleeding and preeclampsia,” said Mutanda.

He added: “Vaginal bleeding may be a sign of a placental problem such as a placenta previa and placenta abruption which if unmanaged can cause death,”

Mutanda said when placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery thus depriving the baby of oxygen and nutrients leading to vaginal bleeding.

Mutanda said the complications occurs in the last 12 weeks of pregnancy. “Women who are 35 years and above and have undergone surgeries before such as C –section experience a bright red vaginal bleeding and can die if not managed early,”

Eileen Mulaa, a Exercise and Sports Scientist,from the department of Exercise Science and Recreation Sports at Kenyatta University said even after a woman giving birth, she can still die.

Ms. Eileen who is also a personal trainer said some of the life threatening conditions that can lead to death after giving birth include blood clots, infections, postpartum depression and postpartum haemorrhage.

She said some of the early signs include chest pain, difficulties in breathing, heavy bleeding, severe headache and extreme pain such complications can be avoided if expectant women do physical exercise at least 2-3 three times a week for 30 minutes.

“Exercise keeps you fit during pregnancy. It helps build endurance ready for labour by improving a woman’s muscle tone, strength and endurance which may make it easier for her to adapt to the changes that pregnancy brings,” said Ms Mulaa.

Ms Mulaa said regular exercise in pregnancy improves the pumping of the heart, noting that swimming is the safest form of exercise to a pregnant woman since the entire body is taken care of. Others are cycling, walking, dancing (aerobics), breathing exercises, postural education and back care.

“Don’t do physical exercise in the event of medical or obstetric complication during pregnancy unless after a medical assessment. Exercise should not be performed in case of arterial hypertension induced by pregnancy, premature rapture of membrane, premature labour and cervical incompetence,” said Ms Mulaa.

Other conditions are vaginal haemorrhage, morbid obesity, history of premature birth.

Mulaa said physical exercise should be suspended if a pregnant woman suffers from constant dizziness, low blood pressure, breathing difficulty, Cardiac diseases, Chronic vascular and chronic pulmonary diseases.

Purity Kamande, a nutritionist, from the department of Health Promotion and Sports Science at Masinde Muliro University of Science and Technology (MMUST) said a pregnant woman should observe a balanced diet.

Ms Kamande said Protein and energy requirements for a pregnant woman are highly increased in the second and third trimester of pregnancy since there is rapid growth of the foetus, saying she should have a weight gain of between 10-14kg during pregnancy for women with a normal Body Mass Index (BMI).

Kamande said during pregnancy, a woman should add one extra meal in addition to 3 meals per day to cater for the increased energy needs and must be a diversified diet.

“Increased intake of fluids is recommended. Small frequent meals are advised to reduce the occurrence of heartburn. The intake of coffee and tea should be reduced as they inhibit iron absorption which is an important nutrient during pregnancy,” Kamande said.

She said pregnant mothers should also increase intake of vegetables and fruits, calcium especially in the third trimester where there is increased development of the foetal skeleton, saying sources of calcium are dairy products and omena. Other nutrients are Vitamin C zinc, magnesium, phosphorus and vitamin D.

Ends