No woman should bleed to death while giving life

Pauline* checked into our maternity unit at five o’clock in the afternoon, apprehensive but hopeful.

She was having her first baby at the age of 25 and had enjoyed an uncomplicated pregnancy.

She was already in established labour and was admitted directly for monitoring in anticipation of a smooth delivery.
Three hours down the line, Pauline’s labour was nearing the end.

She was ready to meet her baby, and the midwife was gloved and waiting. Her 3,500-gramme baby checked into the world in top form, howling loudly, much to the pleasure of the mother and midwife. The umbilical cord was clamped and cut, and the baby was put in the warm resuscitaire while the midwife attended to Pauline in the third stage of labour (delivering the placenta).

PLACENTA CAME OUT WHOLE

Pauline’s placenta came out whole without any trouble and the midwife got onto the business of massaging her uterus and ensuring she had not suffered any injury to the birth canal.
However, in a space of five minutes, celebration turned into an emergency.

Pauline was bleeding like a broken dam. Her uterus just wouldn’t contract and the site where the placenta had come out of was draining life out of her.

The doctor on duty in the labour ward and four other nurses convened for emergency resuscitation measures.

The overall night nurse in-charge came running to the operating theatre to call for reinforcement.

Since we did not have a surgery going on, we quickly crossed over to the labour ward to help.

Within minutes, Pauline was on oxygen, her blood had been taken to the blood transfusion unit to prepare several units to give her.

She had three intravenous access lines in place, rapidly giving her lifesaving fluids as we awaited the blood for transfusion.

MANUAL COMPRESSION

Her uterus was under manual compression as we tried to stem the tide. Everyone was doing something to keep the new mother alive.

She had not even held her baby. She was awkwardly transferred to the operating room to institute surgical measures to control the bleeding, but she was rapidly losing consciousness.

Her last words have haunted me since. She simply said, “Thank you for your effort, but I know I am dying. Thanks for trying.”

She never made it onto the operating table. Twice her heart stopped and we had to resuscitate her.

Despite commencing transfusion of three units of blood simultaneously, we lost Pauline. The darkness that set in that night was palpable.

The hard and cruel reality hit us. We had just been left with a brand new orphan who was completely oblivious of his newly acquired status.
We had done everything humanly possibly but she still slipped through our fingers.

We had blood, staff, operating room, drugs and expertise but Pauline still left us. It sank home that sometimes, it is possible to do everything but it still won’t be enough.

NASTY SIDE OF MOTHER NATURE

That Mother Nature can lift the veil to her nasty side and we would not be able to stand up to the storm.

While Pauline was in the best possible set-up to survive this tsunami, several of her counterparts are not so lucky. They die in ambulances in a race against time and chaotic traffic.

They die in the hands of overwhelmed staff with inadequate resources to help. They die in the hands of unskilled birth attendants because they did not know better.

They die alone in their cattle sheds because it is normal (culturally) to deliver your third or fourth baby unassisted.
Maternal health advocacy is not a fad that we engage in when it is trending.

It is a consistent, sustained push to save mothers from the expected and the unexpected. It is the art of never slacking on the job when things go right for a long time.

It is the art of inculcating emergency preparedness drills periodically to keep the adrenaline flowing in the right direction to save lives.

It is the unending advocacy to ensure that maternal health remains top on the agenda in the midst of a multitude of health issues jostling for the top slot.
Pauline may have left us but the loss we felt has never subsided.

The loss is reinforced every time we see a death notification signed off as post-partum haemorrhage.

It gnaws deeply every time women in the village speak in hushed tones at a funeral, about how the deceased bled to death in childbirth.
There is a reason why haemorrhage has never been dislodged from the top slot in the list of causes of maternal death.

It is a wake-up call to all of us to rethink the efficiency of our interventions in its prevention.

The first step in facing a dreaded opponent is having a healthy respect for the havoc they can cause to spur us on to prepare better.

We may have done our best, but we must figure out how to make our best even better!