24-hour care systems needed for mothers

Every pregnant woman expects a healthy pregnancy with no complications. However, unforeseen life-threatening complications can occur, requiring care by midwives, doctors and/or obstetricians in well-equipped facilities to save the mother, baby or both.

Severe bleeding during pregnancy or delivery is the leading cause of preventable maternal death. Other causes of death are high blood pressure, infections, difficult deliveries, birth injuries and foetal distress.

If the uterus doesn’t contract after delivery, the blood vessels where the placenta detached continue bleeding. This is the most common cause of postpartum haemorrhage (after birth bleeding). Other causes maybe a tear in the uterus, cervix or vagina.

High blood pressure is another leading cause of death during pregnancy. It could be pre-existing, or could develop after 20 weeks of gestation in what is called pre-eclampsia. The cause is still not understood, but if not addressed, it can progressively damage the mother’s liver, kidney and brain and lead to fatal complications for both mother and baby, including seizures.

Complications may also occur during induced labour or augmentation leading to distress in the baby. It is vital to keep track of the labour process and how both the mother and baby are coping. A cardiotocograph, acid-base check or ultrasound can be done to determine the level of distress.

While 80 per cent of women will have uncomplicated labour and delivery and will not require highly specialised care, 20 to 25 per cent of complications are unpredictable.

Therefore, pregnant women should select hospitals that are well-equipped, with a trained team including a consultant obstetrician/gynaecologist available round the clock to attend to emergencies. Low-risk pregnancies can be handled by midwives linked to a functional referral system in the event of complications.

Emergencies require timely decisions; therefore, 24-hour healthcare systems should be established in all county health facilities with nurses and midwives as the primary care attendants, and emergency back-up by a medical doctor or an obstetrician who is available within 10 to 15 minutes to handle any emergency.

Dr Musana is head of obstetrics, Aga Khan University Hospital, Nairobi