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Yoliswa Dube-Moyo

It started off with a little bit of nausea, sudden intolerance of dairy products and no relief from over-the-counter magnesium trisilicate. 

What seemed like a stomach bug of sorts turned out to be a positive pregnancy test reading. About 17 weeks on, Mrs Sindisiwe Ncube started feeling flutters in her tummy. More like butterflies. Confirmation that there was life growing on the inside of her. 

After the necessary blood tests were done at the onset of pregnancy to determine hemoglobin levels, blood type, HIV status and screen for sexually transmitted infections, Mrs Ncube knew she needed to consult a gynecologist/obstetrician who would monitor her pregnancy and eventually deliver her baby.

“I had been told I had polycystic ovaries which had resulted in a hormonal imbalance. The gynecologist I saw then told me I would need to see him if I ever wanted a baby. Fortunately, I conceived naturally and was looking forward to meeting my little one,” she said with a slight grin on her face.

Seeming unsure of how to narrate her story, she continued, “I knew about antenatal care so the search for the best gynecologist in town began. I went for my first visit which always culminated in the next as he checked my health and the baby’s health.”

It wasn’t until the anomaly and gender ultrasound scan at 20 weeks gestation that Mrs Ncube discovered there was a problem with her baby.

With tears slowly welling in her eyes, she said, “Talking about this still makes me nervous you know. The sonographer discovered my daughter had a large tumor in her abdomen. The excitement about the pregnancy, that the baby was a girl and the fact that the baby was generally healthy quickly wore off. It was a laborious 40 weeks of pregnancy as I wondered if my baby would be fine and what would happen to her after she was born. It wasn’t initially clear what this tumor was and whether or not it was communicating with other organs so more investigations had to be done as soon as the baby was born.”

Mrs Ncube, with much difficulty, explained that her pregnancy continued to develop normally under the watchful eye of her gynecologist but her mind would not let her rest as she kept wondering what would become of her baby.

“My baby was born and went under the care of a pediatrician. The tumor was palpable from the abdomen and an ultrasound scan on the baby revealed it was a duplication cyst of the duodenum. The only treatment option was surgery to remove the cyst. We sought the services of a pediatric surgeon and my daughter had to go under the knife at just seven days old. It was a very difficult time for us as a family but through the grace of God, everything went well; my baby made a full recovery and she’s a normal, happy toddler now,” she said slowly dabbing tears off her cheeks with a piece of facial tissue.

On the flip side. A mother recently died hours after giving birth to triplets at a remote rural hospital in Matabeleland North province. 

The 32-year-old woman from Binga was unaware she was carrying triplets until she went into labour at St Patrick’s Hospital in Hwange.

Expecting mothers in rural outposts do not undergo pregnancy ultrasound scans because the equipment is not available at most of the country’s poorly-resourced hospitals and clinics.

The woman naturally gave birth to the first baby, but had to undergo surgery to get the other two out, hospital officials said.

She was later transported by ambulance to Mpilo Central Hospital in Bulawayo, a distance of 400km, after her health deteriorated.

Mpilo Hospital Clinical Director Dr Solwayo Ngwenya said the woman had lost too much blood by the time she was brought to them on the night of September 24.

“We tried everything here, but it failed. She died on September 25. We had a highly competent medical team that operated on her when she got here. We had the doctors but there was not a lot they could do. She had bled too much and stabilisation efforts were in vain. She already had three children, now they are six but she’s no longer there to take care of them. It’s a very sad, sad, situation,” said Dr Ngwenya.

A significant number of women in rural areas either do not have access to antenatal care or undervalue its importance. Some live far from health institutions where they can be assisted while others have to contend with understaffed and poorly equipped health centres which cannot offer them much help.

Antenatal care, which is the care you get from professionals during pregnancy is important as health care practitioners check the health of the mother and the baby, give useful information to help mothers have a healthy pregnancy, including advice about healthy eating and exercise as well as discuss options for labour and delivery.

The World Health Organisation has since issued a series of recommendations to improve quality of antenatal care to reduce the risk of stillbirths and pregnancy complications and give women a positive pregnancy experience. By focusing on a positive pregnancy experience, these new guidelines seek to ensure not only a healthy pregnancy for mother and baby, but also an effective transition to positive labour and childbirth and ultimately to a positive experience of motherhood.

According to statistics, every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth, 94 percent of all maternal deaths occur in low and lower middle-income countries, young adolescents (aged between 10 and 14) face a higher risk of complications and death as a result of pregnancy than other women.

Maternal mortality is unacceptably high. About 295 000 women died during and following pregnancy and childbirth in 2017. The vast majority of these deaths, 94 percent, occurred in low-resource settings, and most could have been prevented. 

The high number of maternal deaths in some areas of the world reflects inequalities in access to quality health services and highlights the gap between rich and poor. 

Women in less developed countries have, on average, many more pregnancies than women in developed countries, and their lifetime risk of death due to pregnancy is higher. A woman’s lifetime risk of maternal death is the probability that a 15-year-old woman will eventually die from a maternal cause. In high income countries, this is 1 in 5 400, versus 1 in 45 in low income countries. 

“Women die as a result of complications during and following pregnancy and childbirth. Most of these complications develop during pregnancy and most are preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of the woman’s care,” read in part a WHO report on antenatal care. 

According to the report, the major complications that account for nearly 75 percent of all maternal deaths are severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia), complications from delivery and unsafe abortion.

The remainder are caused by or associated with infections such as malaria or related to chronic conditions like cardiac diseases or diabetes. 

“Most maternal deaths are preventable, as the health-care solutions to prevent or manage complications are well known. All women need access to high quality care in pregnancy, and during and after childbirth. Maternal health and newborn health are closely linked. It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death for the mother as well as for the baby,” reads the report. 

Health experts say severe bleeding after birth can kill a healthy woman within hours if she is unattended. 

Infection after childbirth can be eliminated if good hygiene is practiced and if early signs of infection are recognised and treated in a timely manner.

Pre-eclampsia should be detected and appropriately managed before the onset of convulsions (eclampsia) and other life-threatening complications. 

According to WHO recommendations, to avoid maternal deaths, it is also vital to prevent unwanted pregnancies. All women, including adolescents, need access to contraception, safe abortion services to the full extent of the law, and quality post-abortion care.

The latest available data suggests that in most high income and upper middle-income countries, more than 90 percent of all births benefit from the presence of a trained midwife, doctor or nurse. However, fewer than half of all births in several low income and lower-middle-income countries are assisted by such skilled health personnel.

To improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at both health system and societal levels.

In the context of the Sustainable Development Goals (SDG), countries have united behind a new target to accelerate the decline of maternal mortality by 2030. SDG 3 includes an ambitious target: “reducing the global MMR to less than 70 per 100 000 births, with no country having a maternal mortality rate of more than twice the global average”. 

Skilled care before, during and after childbirth can save the lives of women and newborns.