Are our women safe anymore?

Last week we celebrated International Women’s Day with a horribly bitter taste in our mouths. Just a day before the big day, we witnessed a woman get assaulted by a mob of boda boda riders in Nairobi. 

As the distressing video did the rounds on social media, I couldn’t help but wonder what kind of a society we have become. The poor woman was screaming helplessly while menacing men banged on her car, physically assaulted her, and ripped off her clothes. 

Even before we could breathe, the head of the Royal College of Midwives, Ms Gill Walton, issued a public apology on behalf of the College, for lives lost to the “normal birth” drive. Heartbreakingly, this is a tad too late!

In the animal kingdom, there is an unspoken rule that pregnant females are accorded special consideration for the duration. Maternity care has remained a sacred space all across the world. We judge the effectiveness of our health systems based on our performance indices in maternity; the maternal mortality and perinatal mortality ratios. 

It is with respect to the importance attached to the maternity period that dozens of policies, guidelines and standard operating procedures have been developed to ensure safety for both mother and baby throughout the process. 

Advocating for safe delivery is at the fore of every care provider, hospital, or organisation that supports safe motherhood. Unfortunately, over the years, vaginal birth has been equated to safe delivery. The strong messaging went on to distort the perception that a caesarian delivery is not a safe delivery! Herein lies the problem! 

Take Bertha* for instance, a nurse by profession and a first-time mum, admitted to labour a week after her due date. She had postdatism, a condition where a baby comes after the due date. Though she expressed concerns about the size of her baby, she was firmly reassured by her obstetrician and her midwife not to underestimate herself and aim for a “natural birth”. Bertha laboured for 16 hours before her baby came. The baby’s shoulders got stuck in the birth canal and after emergency manoeuvres, she delivered a 4,300g baby. 

While everyone congratulated Bertha for her heroic delivery, she lay in her bed psychologically traumatised, nursing painful stitches in her perineum resulting from the extensive episiotomies she was given on both sides. She felt that no one understood her pain and was unable to talk about the trauma for years. All she knew was that she would never ever get pregnant again. She did not have the strength to undergo such abuse a second time.

The story is no better for Miriam*. She laboured for 14 hours, begging for a caesarian section with every painful contraction. The midwife and her family members joined forces in encouraging a “normal” birth. This ended in a chaotic delivery of a 4,000g baby, with an extensive third-degree tear in the perineum, ripping part of her anal sphincter. 

The doctor who repaired it initially failed to recognise the sphincter injury and Miriam ended up with stool incontinence. She eventually had to go for surgery to repair the injury. So much for a quest to avoid surgery and anesthesia! 

For decades, we have acknowledged that delays in providing emergency caesarian sections have resulted in poor outcomes for babies, with birth asphyxia causing cerebral palsy, convulsions, and perinatal death. However, with technological advances in the monitoring of the unborn baby, we are able to delay the caesarian section a little longer where vaginal delivery is imminent.

What we fail to acknowledge is that the mother is not just a baby-carrying vessel and passage. She is a human being in her own right, whose outcome also matters. We pride ourselves when the number of maternal deaths goes down but fail to question the quality of life of the mothers after the pregnancy and delivery experience. 

We need to put in place monitoring indices for the morbidities that mothers suffer from after delivery. It is the only way we can begin to pay attention to the impact of maternal morbidity. Chronic pain, urinary incontinence, stool incontinence, difficulties in walking, and psychological trauma are in no way insignificant. 

A mother should not have to give up her life to create one!

Dr. Bosire is an obstetrician/gynaecologist