Still born babies: Who is to blame?

The pain of a woman. This is perhaps what would describe the agony and despair expressed by women who demonstrated what they considered “an unusual loss of babies” at Nairobi Women’s Hospital recently.

The women, some of them relatives of victim mothers, alleged several cases of lost pregnancies in “unclear circumstances” and laid blame on “medical negligence.”

Explanations by the hospital did little to quell the outrage of the women. The hospital would not discuss individual cases with Press, saying the records were bound by patient-doctor confidentiality.

“We cannot divulge details on individual patients. It would go against medical ethics. We acknowledge that problems occur during child-birth in every hospital. However, we have our own way of handling a patient if a death occurs,” says Dr Sam Thenya, the hospital’s chief executive.

That said, Dr Thenya says the hospital’s still birth death rate is one in about 2,000 births. “This is far much below the national rate. I can confidently say we have some of the best reproductive health services in the country,” he adds.

It is not only Nairobi Women Hospital that has been rattled by claims of negligence by some of its clients. Susan Wairimu Mureithi, 37, tells of her experience at Kenyatta National Hospital (KNH) last month, an ordeal that left her nine-month-old foetus dead.

July 12, 2012 remains the most traumatising day in Wairimu’s life. At 37, she had finally decided to have a child, if only to make her life more complete. Labour pains came on July 6, although she expected to birth on July 10.

She went to the hospital and was admitted. But the problem started only a day after admission when medical personnel declared her labour pains as “false” and recommended that she return home and come back later when in true labour.

She was uncomfortable leaving the hospital and literally refused to heed the doctor’s advice. “I told them I was feeling spontaneous pains. Soon my amniotic fluid started to leak. The nurses only told me to use a pad as it was “normal” to have the leakage. They were also a bit rough on me,” says Wairimu.

Too late

Defiantly, Wairimu stayed in the maternity ward for seven days, always refusing to go home. Then the worst happened. On July 13 at dawn, she told one of the doctors she had stopped feeling the movements of the baby.

Several tests were done and a few hours later, a doctor on duty delivered the bad news to one of the nurses. “It is too late. The baby is no more.”

Wairimu almost collapsed. She could not believe a pregnancy she had carefully carried for nine months had ended with the death of what she had declared, “the only life I will bring to earth.”

This week, Wairimu, who works at a beauty therapy establishment in Hurlingham, told of her despair. “You can imagine the years I have lived waiting for this baby. I am yet to reconcile myself with the loss,” she said.

She says she will take time before she tries her luck again. In the meantine, she believes her baby boy would have survived had she gotten a little more attention from the medical staff.

The hospital is investigating the circumstances of the loss. According to its spokesman Simon Ithai. “It was a sad case. We have spoken to the patient and soon we shall take action.”

The hospital’s deputy director and head of reproductive health, Dr John Ong’ech, further explains the circumstances surrounding this particular case, saying that because Wairimu was over 35 years of age, more care could, perhaps, have been taken by the staff on duty at the time. “The pains were indeed ‘false’, but we agree that someone should have treated the case more attentively due to her age,” says Dr Ong’ech, also a consultant obstetrician and gynaecologist.

Dr Ong’ech adds that a first pregnancy in a woman aged more than 35 years is termed “high risk”. “The best ages are between 24-26 years.”

Wairimu is not alone. Hundreds of Kenyan women are languishing in pain and despair after losing babies in their first pregnancies. Some of the affected mothers from various hospitals whom Saturday magazine spoke to believe that their babies would have been saved if medical personnel were more careful.

“It is psychologically draining to nurture a baby for seven or eight months and lose it only days before birth,” says Mary Wambaa, who lost a seven-month-old foetus at a Catholic mission hospital in Kasarani, Nairobi, last year.

Wambaa says her child’s death was the third at the hospital in the space of a fortnight, and believes it was not a mere medical accident. “We discussed the three cases with the affected mothers, and we think there was negligence at some point,” says Wambaa. She believes she got the wrong diagnosis when her amniotic fluid started to leak. “It was green in colour and nobody took notice,” she says.

Distressed foetus

According to Dr Ong’ech, green amniotic fluid is a very serious danger sign. “By this time, often the baby is dead or is almost dead and struggling to survive,” says the gynaecologist.

Staff at the mission hospital refused to respond to our queries and instead referred us to their matron, who could not be reached as she was in Italy at the time. “She is the only one who can respond,” said a nurse we spoke to at the hospital.

According to the World Health Organisations (WHO), the world loses 7 300 babies every day in form of still births. A half of these occur when the woman is in labour, according to WHO’s assistant director-general for family and community health, Dr Flavia Bustero.

“This means whether the foetus is mature or not, some skilled care often lacks at the critical time of birth for either the mother or the child.” WHO and different countries define a still born baby as one that dies after the 24th week of pregnancy (6 months) and which did not show any signs of life after being expelled from its mother.

Upmarket hospital silence

Many countries declare that a still-born baby should also weigh about 400 grammes at the time of expulsion from its mother. Reproductive health experts say the pain of losing a baby is “too much for the mother such that everything must be done to ensure all conceptions lead to birth.”

Significantly, upmarket hospitals were not willing to discuss or divulge their still birth data. Nairobi Hospital, for example, did not participate in this feature story even after numerous requests.

Dr Lazarus Omondi, the superintendent at Pumwani Maternity Hospital, was more forthcoming, saying that data shows that 308 babies were still born in 2009, representing 1.7 per cent of the 18,069 deliveries recorded.

In 2010, this number reduced by a 100 cases out of the 17,557 (or 1.18 per cent) deliveries at the hospital. Last year, 253 still-births were recorded out of the 18,490 deliveries, representing 1.37 per cent. At KNH, where 12,000 deliveries take place in a year, 2 per cent of the pregnancies lead to still birth.

Lifestyle risk factors

“The challenge is that most of our patients (52 per cent) are referrals from lower hospitals and are already mismanaged and sometimes too late to help,” says Dr Ong’ech. Larger, more expensive private hospitals might present even lower percentages due to modern services.

Prof William Stones, the head of obstetrics and gynaecology at the Aga Khan University Hospital, says still births can be related to the mother, the child or the nurse/medical staff.

“Diseases such as diabetes, hypertension, anaemia and poor nutrition (on the part of the mother) are major causes of still births,” says Prof Stones.

These are problems that can be managed if the mother attends her antenatal clinic sessions regularly. Dr Thenya adds that chromosomal abnormalities and congenital malformations of the foetus are also to blame. According to the doctors, women who get pregnant at a very early age or later in life are at more risk of still births.

“Mothers aged 20-29 years have the lowest rates of maternal and infant morbidity and mortality. Younger and older women have higher rates,’ says Dr Omondi. He adds that obesity, drug abuse, smoking and blood group incompatibilities may also be contributory factors.

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Smear campaign against Nairobi Women’s Hospital?

Nairobi Women’s Hospital has recently been in the spotlight for what many women have termed the negligence of its staff members. Numerous reports have turned up on social media sites accusing the management of not listening to patients.

The management of Nairobi Women’s Hospital believes there is a smear campaign against them. “Investigations are going on and so far … we are reading business rivalry,” says Dr Sam Thenya, the hospital’s chief executive. The hospital is today the biggest private, for-profit hospital in Kenya.

Dr Thenya says the hospital’s investigation process in the event of a death is clear. “We classify it as avoidable or unavoidable. Then we hold emergency mortality review meetings with all those who attended to the patient,” says the doctor.

According to him, the hospital always has, on duty, at least four professionals: “Entry nurses (fresh graduates), a staff nurse, senior staff and a consultant, who is normally a senior and experienced doctor,” he explains.

Dr Thenya defends the hospital’s use of fresh graduates in several departments. “Where do we expect our graduates to get experience? We must give them a chance to work together with their seniors. (But) they are not allowed to work on their own,” he says.

Prof Stone of Aga Khan University Hospital says emergencies can occur in any birth, but what matters is how it is handled by the medical staff. “The … expertise of the nurse or midwife in charge when the emergency occurs is crucial,” explains Prof Stones.

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How to reduce chances of still born births

An expectant mother must make at least four antenatal visits to her doctor during a pregnancy, reproductive health experts say.

Dr John Ong’ech, a consultant gynaecologist at Kenyatta National Hospital, says only 40 per cent of expectant mothers make the four visits, and therefore lack the information necessary to tell whether their pregnancy might be headed towards danger.

In addition, he says that a pregnant woman should have “a health care provider to advise on nutrition and exercises, a counselor, to help with social or relationship problems, a nurse or trained midwife, and a doctor.”

Women who lack proper nutrition may be causing their babies untold health problems. In addition, women who have relationship, financial or job-related problems may also be subjected to stress that may be detrimental to the development of the child.

Caroline Kisiangani, a Lamaze-certified child birth educator says that antenatal visits are key, as they help detect problems early. “You get to discuss your needs, worries and fears in every stage of pregnancy,” she says.

Many still births are lifestyle related meaning the illnesses that arise from them can be avoided. Other natural reasons such as congenital malformations, if detected, can be managed medically

Any pregnant woman must check her stress levels and learn birth planning skills. It is crucial that during labour, a woman’s relaxed state is facilitated so that she can push effectively.

If she is thinking about how she will pay the hospital bills or whether the nurses and midwives are paying attention to her needs, then she is entering dangerous territory. Women who do not have supportive partners to hold their hand during labour should always call on the help of a good friend, or a mother or aunt who they trust to be on their side.

Childbirth classes will also help quell a pregnant woman’s anxieties. “Modern women nowadays attend birth classes together with their spouses. This helps learn about each other’s emotional and physical needs,” says Kisiangani.