What you need to know:
- It is inevitable that there are babies we will lose in this period immediately after birth as a result of unpreventable complications such as congenital abnormalities that are incompatible with life, extreme prematurity and genetic abnormalities.
- However, the larger proportion of deaths is preventable and we must strive to avoid them. The race to save a life already compromised is one we do not easily win and one that costs thousands of shillings.
Lena* lay on her back, spent. She was barely conscious but she kept mumbling about her baby. She wanted to know why she could not hear her baby cry. However, she was so tired, her voice was barely audible. No one gave her an answer. They were focused on the baby.
The midwife finally cleaned Lena up and transferred her to the postnatal ward. Lena was exhausted. She gratefully sank into a deep sleep. She had been in labour for over 24 hours, with neither sleep nor nourishment.
With the introduction of the free maternity care under the Linda Mama benefits scheme in Kenya, many small private facilities signed up with the National Hospital Insurance Fund, now renamed National Health Insurance Fund, as service providers. However, the manner in which the fund was structured did not address certain important aspects.
For facilities to claim reimbursement for services rendered, they had to present evidence of the actual delivery. This means that if the facility monitored the patient for seven hours and the patient developed complications that required that the patient be referred for more specialised delivery services, the referring facility was not reimbursed for costs thus far.
This unfortunate oversight resulted in patients being held in facilities with the hope that they will deliver, causing unwarranted delays and unfortunate outcomes for the mother and baby. This was the case for Lena. She was kept at a level three private maternity home for 24 hours before she was referred to the level four public facility. Eventually, the prolonged labour resulted in severe consequences for her baby. Lena was dehydrated and exhausted by the time she arrived at the public hospital. The maternity team quickly initiated resuscitation and prepared Lena for caesarian section. She was transferred to the operating room but before surgery commenced, she was able to deliver vaginally, with assistance, using special equipment. But the baby was not so lucky.
The little one was unable to breathe well after delivery, having suffered birth asphyxia. During this prolonged duration of labour, baby was not able to get sufficient oxygen through the placenta and umbilical cord. This resulted in injury to the baby’s brain cells due to insufficient oxygenation.
Lena’s baby had to be transferred to a neonatal intensive care unit at the national referral facility. It means that Lena’s sleep had to be interrupted and she joined her baby in the ambulance.
It was tough 10 days while Lena watched her baby on a ventilator. Baby fought hard for her life but it wasn’t easy. The dominos began to fall. First it was the convulsions that would not let up, further aggravating her brain injury. She had to be put on anticonvulsants. Just when the neonatologists thought they had things under control, next came infection. Her antibiotics had to be switched to stronger ones. This was quickly followed by kidney failure. At a measly 3200g, she had to start on dialysis. Her body was struggling to balance the salt levels.
Lena cried so long, she had no more tears left. She would sit for hours at her baby’s bedside. Her mother sat with her all day and left in the evening. She tried to convince Lena to eat but it was in vain. She would take a few sips of uji throughout the day as her daily sustenance. She was ready to be a single mother after her partner succumbed to Covid-19 before Lena even knew she was pregnant, but she did not envisage starting out this way. On the fifth day, the doctors thought the baby was looking better. Her blood tests showed that the infection was coming under control and the convulsions were few and far apart. She had even started making a few drops of urine. This great progress lasted all of three days before things truly fell apart. The convulsions increased in frequency despite treatment and a new wave of infection (neonatal sepsis) set in. For the next 48 hours, it was all touch and go. Lena was besides herself with anguish. Her mother camped at the hospital all night with Lena until morning when t
he doctors concluded that there wasn’t anything else that could be done for her.
After a spirited fight for 10 days, baby finally let go. Lena only got to hold her daughter for the first time in death. She never suckled her baby, never changed a diaper, never gave her a bath, never got to dress her in the cute little clothes she had bought.
Her baby joined painful statistic of 21 deaths per 1,000 babies born alive, who lose their lives within the first 28 days of being born. This figure remains way too high despite having come down by a third over the past two decades. Even worse is that out of all children losing their lives before their fifth birthday, half of these deaths happen before they see their first month of life.
It is inevitable that there are babies we will lose in this period immediately after birth as a result of unpreventable complications such as congenital abnormalities that are incompatible with life, extreme prematurity and genetic abnormalities. However, the larger proportion of deaths is preventable and we must strive to avoid them. The race to save a life already compromised is one we do not easily win and one that costs thousands of shillings.
It is not enough that maternity and perinatal care is free to the mother. We must ensure that the care provided is of good quality and that the entire system of service delivery works properly. Financing maternity and perinatal care must be thought through to ensure appropriate, safe and efficient delivery of care without gaps that compromise these tenets and become a threat to life.
It is time we dried Lena’s tears; no newborn baby should die of preventable death!
Step up efforts to end preventable deaths of newborns.
Dr Bosire is an obstetrician/ gynaecologist