Childbirth is not just an excruciating experience; it also reveals the incredible strength of women, often feeling like a dance with mortality. Tragically, not all women emerge from this journey alive.
As an expectant mother prepares to enter the delivery room, one of the most significant threats she faces is postpartum hemorrhage (PPH), characterized by severe bleeding after giving birth. PPH is the foremost cause of maternal fatalities around the globe.
In October 2020, Alice Ojera’s daughter, Evelyne, who was 42, began labor with her seventh child. What should have been a routine delivery took a heartbreaking turn when she experienced heavy bleeding. Despite being quickly transported to the hospital, she tragically did not survive. “On our way to Kenyatta National Hospital, she passed away,” Ojera recalls with sorrow. Evelyne left behind seven children and a grieving family. “It has been incredibly difficult. I now care for seven grandchildren, and the loss of my husband and my daughter weighs heavily on me,” she shares. Evelyne’s situation is not an isolated incident.
The World Health Organization (WHO) reports that around 14 million women experience postpartum hemorrhage each year, leading to an estimated 70,000 maternal deaths. Even for those who endure this challenge, immediate surgical procedures may be necessary, and they may confront long-term reproductive health issues. In Kenya, the circumstances are particularly alarming, as the nation ranks among the top five in maternal mortality rates worldwide.
The Kenya Demographic and Health Survey 2022 reports a maternal mortality ratio of 355 deaths per 100,000 live births. This figure indicates that between 5,000 and 6,000 women lose their lives each year due to complications related to pregnancy, with postpartum hemorrhage (PPH) responsible for 40-50% of these fatalities.
Professor Moses Obimbo, the Secretary of the Kenya Obstetrics and Gynecological Society (KOGS) and an Associate Professor at the University of Nairobi, helps illuminate the gravity of this situation. He states, “This means that approximately 3,000 women die annually in our country from PPH alone. If we imagined 60 buses, each carrying 50 women, crashing simultaneously, it would make headlines worldwide for years. That’s the scale of loss we’re facing every year.”
Dr. Obimbo defines postpartum hemorrhage as a blood loss of 500 ml or more within the first 24 hours following childbirth. Various factors can lead to PPH, with uterine atony—the failure of the uterus to contract after delivery—being the most prevalent. Other contributing factors may include retained placental tissue, trauma to the genital tract, and disorders affecting blood coagulation.
Dr. Laura Oyiengo, a Health Specialist at UNICEF focusing on Maternal and Newborn Health, emphasizes that although Kenya has well-structured policies in place for the management of Postpartum Hemorrhage (PPH), effective implementation poses significant challenges. “We require adequately trained healthcare professionals, necessary equipment, medications, and blood products. This is where we experience difficulties,” she explains.
A cross-sectional study conducted in 2022 and published in BMC Pregnancy and Childbirth, involving 364 healthcare providers in Kenya, revealed a contrasting picture. While 89% of the participants recognized PPH management guidelines, only 62% reported consistently adhering to them. The research pinpointed critical obstacles such as a shortage of essential supplies, insufficient staffing, and lack of adequate training.
To tackle PPH, the University of Nairobi, in partnership with the Kenya Obstetric and Gynaecological Society (KOGS) and the Midwives Association of Kenya, has developed a comprehensive four-pillar strategy. This strategy encompasses advocacy and community involvement, research and reskilling, healthcare innovations, and strengthening the data ecosystem, along with various creative approaches to combat PPH in the region.
“Projects like walking blood banks are designed to establish a network of potential blood donors who can be mobilized in emergencies,” remarks Obimbo. He further mentions the implementation of the Non-pneumatic Anti-Shock Garment (NASG)—a pressure garment that can be applied to a bleeding mother to stabilize her condition while she is transferred to a facility with better resources. Additionally, they are utilizing Uterine Balloon Tamponade (UBT), a device that is inserted into the uterus and inflated with saline to exert pressure on bleeding vessels as an immediate emergency intervention.
A cluster-randomized trial published in The Lancet Global Health in 2019 showcased the efficacy of the NASG, demonstrating a 54% reduction in PPH-related mortality in low-resource settings. Beyond the imminent physical risks, PPH also has significant mental health repercussions for survivors, their families, and the wider community.
As highlighted by Obimbo, individuals who survive traumatic experiences may face a range of mental health challenges, including Post-Traumatic Stress Disorder (PTSD), anxiety, depression, sleep disturbances, and a heightened fear regarding future pregnancies. A systematic review published in BMC Pregnancy and Childbirth in 2021 revealed that women who endure severe postpartum hemorrhage (PPH) are three times more likely to suffer from postpartum depression compared to those who do not experience PPH.
The repercussions for families who lose a mother due to PPH are profoundly distressing. Research from The Lancet Global Health in 2020 indicated that children of mothers who die from PPH have a significantly diminished chance of reaching their fifth birthday—an increase in the risk of death for these young children of up to 50 percent. Dr. Obimbo mentions that husbands often face their own struggles with depression, attempting to uphold a facade of strength while navigating their grief and new responsibilities.
He also addresses a systemic concern: the inadequate recognition of maternal care within health insurance frameworks. “When you have insurance coverage, you’re told that your medical plan covers 5 million for in-patient care. However, what amount is allocated for maternity care for women? Approximately 100,000,” he points out. This imbalance frequently compels women to shoulder the financial burden of quality maternal care and any complications that arise during childbirth.
To effectively tackle the issue of PPH, Obimbo emphasizes the need for a comprehensive strategy that includes increased funding, specialized training, and ongoing education for healthcare professionals regarding the latest techniques for PPH management. The poignant call to action voiced by Alice Ojera underscores the gravity of the situation: “What I want to convey to everyone is that if you are caring for a pregnant woman in distress, do not delay. Take her to the hospital before the situation worsens.”
