What you need to know:
- On her clinic card, the expected due date is marked as Saturday, February 6.
- By the end of Saturday, Tabitha has not gone into labour.
- On the eighth day post expected date of delivery, Tabitha prepares to go to the hospital.
- The scan reveals that the baby is overdue by one day, contradicting the expected date of delivery indicated on her ANC card.
- Due to the fact that the placenta has started to show signs of degeneration, the clinical officer orders induction of labour.
- The baby is born two days after admission and died a week later.
It is 9am and Festus Mwengea has just arrived on a motorbike to pick up Tabitha Justus and take her to hospital.
This Friday, February 5, they will ride from Tabitha’s home in Kitui’s Kisesini village to the hospital, 20km away. Tabitha is in her last trimester and is going for her fifth and last ante-natal clinic.
She has been Festus’ client for the past six months. Festus is always on standby in case the first-time mother requires his services. He sees it as his duty to ensure she gets to the hospital safely.
On her clinic card, the expected due date is marked as Saturday, February 6. “I am always at hand to help her. I have actually become a community health volunteer by default,” says Festus.
Before Tabitha leaves the house, Ndunge John, a community health volunteer, ensures she has everything she needs. In her handbag, are some essential items like a razorblade, clean strings and clothes, in case the baby comes before she gets to the hospital.
On this day, Festus has to carry Tabitha together with her neighbour, who is also going to the hospital for some checkups. They pick her up along the way.
Although it is neither comfortable nor safe to carry both women, Festus does not have a choice but to help them due to transport challenges in the area, the long distance and high fare. The rider charges Sh150 one way, from Kisesini to Ikutha town, where Tabitha has been attending clinics.
Tabitha tells HealthyNation Festus charges fairer than his counterparts, in addition to the fact that he is known to her.
Journeying on a hot morning through the thicket and on potholes is very uncomfortable for Tabitha. It takes an hour to cover the 20km, especially due to the bad state of the road.
“I get so tired and sick on returning home. Sometimes I feel like I was walking,” the 23-year-old tells HealthyNation.
It would be convenient to use a matatu to and from hospital and pay Sh50. But, the only vehicle in the area leaves at 7am and returns after 7pm. It would force her to leave home way too early and return too late for a heavily pregnant, young mother.
Also, walking to and from Kasaala shopping centre, where the vehicle stops to pick up passengers, would take her at least one hour.
“The motorbike is more convenient for me because the vehicle leaves too early and I would get home very late,” she says.
At Ikutha Faith Nursing Home, it takes 15 minutes for Tabitha to finish the checkups.
Matheka Ndeleva, a clinical officer, says her weight and pressure are okay, and the baby is doing well. Since the last clinic, Tabitha has added weight by one kilogramme to 57kg.
“If everything goes well, she should deliver tomorrow. If she goes into labour, she is supposed to come to the hospital immediately. If she does not go into labour in seven days, she should come to the hospital for an obstetric ultrasound, so that we can determine if there is a problem,” Matheka advises.
When we go back home, Tabitha tells HealthyNation when she got pregnant, Covid-19 cases had just started being reported in Kenya. She did not know she was pregnant until a strange rash appeared on her face, alarming her.
Like thousands of other mothers, she hesitated going the hospital for fear of contracting Covid-19. As days went by, she started suspecting she was pregnant.
“I also did not want to go to the hospital because I feared being given medication which could harm my baby. I would buy ointments and apply on my face and the allergy disappeared in a month,” she tells HealthyNation.
When she attended her first ante-natal clinic on Sept 3, last year, she was four months pregnant and weighed only 45kg. “I had some chest problems, fever and general body weakness last week, but I did not go to the hospital. I bought some menthol sweets and everything was okay afterwards,” she says.
Except for some headaches during the second trimester, Tabitha’s pregnancy was smooth, but not her journey.
Tabitha says she would be home alone most of the time. Her husband Justus Peter works far from home while her mother-in law sells groceries at Kasaala shopping centre to make ends meet.
As such, Tabitha had to be the one fetching water using a donkey - the commonest form of transport in this village. “I used to go for water even when I was seven months pregnant. One day, I felt so much pain. I feared losing the baby, so I stopped fetching water and doing other taxing chores,” says the mother, who would sometimes lack fare to go to the hospital.
And so, her mother-in-law had to undertake the heavy chores like fetching water. “I always feel tired. I cannot sit for a long time. But, I thank God that I have not been seriously sick during the pregnancy. Every time I go to the hospital, the doctor tells me that I am fine,” she adds.
Despite a health facility being nearby, at Kasaala, Tabitha does not want to risk going to deliver there especially because of long queues common in government health facilities, health workers strikes, lack of supplies and sometimes poor services.
That is why she has settled on a private health facility. “You can go there (public hospital) and they tell you that they do not have vaccines or other services and refer you to Ikutha. Instead of that, I felt that it was better for me to seek services in Ikutha,” she says.
On Saturday, her expected due date, she feels some abdominal pain, which she hopes signals the beginning of labour. The pain subsides after 20 minutes and she goes back to sleep. By the end of Saturday, Tabitha has not gone into labour.
But she has nothing to worry about because the clinical officer gave her seven days. “I believe I will go into labour soon. I am not worried. I am psychologically prepared for either a normal delivery or a caesarean section,” she says, a day past the due date.
The next six days are marked by an anxious, long wait. Every day after that is tiring and the joy of becoming a mother turns into a longing to hold her baby. The days come and go without any sign of labour.
The following Friday she receives a phone call from the hospital. “The doctor says I should go back to the hospital tomorrow because I am overdue by a week. He has to examine me to establish if there is a problem,” she tells the HealthyNation team.
On the eighth day past the expected date of delivery, Tabitha gets up early and prepares to go to the hospital.
As usual Festus picks her up and takes her to the hospital. Matheka examines her and ascertains that everything is fine. He refers her to Ikutha Sub-County Hospital for an obstetric scan.
It is Saturday morning when Tabitha arrives at Ikutha Sub-County Hospital for her scan. In a public hospital like this one, an obstetric ultrasound is not considered an emergency procedure, so the receptionist advises her to return the following week on Monday, February 15.
However, something akin to a miracle happens. Just as she is about to leave, Dr Nicholas Ouma, the hospital’s sonographer, drops by the facility to collect something.
He is kind enough to perform the procedure despite being off duty. The scan reveals that the baby is overdue by one day, contradicting the expected date of delivery indicated on her ANC card.
The conflicting dates could mean two things: the expected due date was overstated or probably the first time mother gave the wrong date of her last menstrual period.
“That is a why the scan is very important. In this case, the scan report indicates that the heart rate is fine and there is no foetal abnormality. The baby’s position is also fine, but it is overdue by one day,” says Matheka on the day he is given the scan report.
Although Tabitha is overdue by only one day, Matheka is not taking chances.
Due to the fact that the placenta has started to show signs of degeneration, the clinical officer orders induction of labour.
“The report shows the placenta has degenerated, which may affect nutrient supply to the baby. Usually, if the date of delivery has passed, it is possible that a baby may stop getting enough nutrients which may result in intra-uterine retardation. So, the best thing to do is to have Tabitha induced,” he says. “If that fails, then she has to undergo an emergency caesarean section.”
Ikutha Faith Nursing Home does not have a theatre and, therefore, cannot conduct an induction. Tabitha is referred to the nearest hospital, which has the services.
A baby who is overdue may also suffer foetal stress while there are risks of infections and unexpected complications, explains Matheka.
It takes Tabitha five hours to get to Our Lady of Lourdes Mutomo Mission Hospital, some 27km away.
Although she is finally admitted and induced at the mission hospital, the baby is not coming as soon she expects.
Baby Moses Mumo Peter comes two days after his mother is admitted to hospital. Weighing four kilogrammes, he arrives at 4pm on Monday, February 15.
Tabitha can finally breathe. She is excited that the journey has ended well and her bundle of joy is home.
But the joy is short-lived. Baby Moses died early Sunday, February 21.
The baby had died at night, Tabitha tells HealthyNation on phone.
With a heavy heart, she struggles to explain the previous day’s happenings. When they went to bed, everything seemed fine. She woke up to feed him, but noticed he was still sleeping and did not want to wake him up.
In the morning, wondering why the baby had overslept, she had decided to wake him up. Baby Moses was not responding. “I called my mother-in-law to the house. That is when we realised that he was not breathing. The baby is gone,” she says.
No BCG mark
When Elizabeth Kamene, a community health volunteer, had gone to check on them on Saturday, baby and mother were fine. “The baby was fine, he was suckling well and was behaving normally except that he had a cold which was not serious,” she says.
“He also had colic and I advised the mother to buy him some gripe water.”
If a cold does not prevent a baby from suckling, it cannot be termed as a danger sign, she tells HealthyNation. “I advised her to take him to hospital should she notice that the blockage was preventing him from suckling. However, I also noticed that he had not received the BCG vaccine,” she adds.
BCG vaccine is primarily used against tuberculosis. She says she told Tabitha of the danger signs she should watch out for to tell if the baby needed medical help.
Elizabeth also tells HealthyNation that because the baby had stayed in the womb past the due date, it might have caused him to develop a weakness. Unfortunately, the mother and healthcare professionals at the hospital where he was born might have missed this, adds Elizabeth.
For now, a devastated Tabitha only has her baby’s photos and clothes to remember him by. Baby Moses’ father never got to meet him.