Failed by the system: Mothers we lost inside maternity wards

Bringing forth a new life into the world is a joyful moment for a mother and her family. The cry of a newborn marks a new beginning and signals hope for an exciting life ahead. 

But when the mother dies during childbirth, this joy and hope is cut short, casting a long shadow of tragedy, grief and uncertainty on her family. 

This trend has been growing in Kenya in recent years, leaving newborns without mothers to care for them and thrusting partners into confusion of immeasurable proportions. 

With each death, profound loss ripples through families and communities.

The Kenya Demographic and Health Survey of 2022 estimates that 362 maternal deaths occur per 100,000 live births in the country. At the current estimated annual births, this translates to more 5,000 women and girls dying of pregnancy or birth-related complications every year. 

In what raises concerns, about 70 per cent of the cases are reported in referral hospitals during weekends and public holidays, the survey reveals.

Meanwhile, data from the Kenya Medical Practitioners and Dentists Council (KMPDC) lifts the lid off negligence by health workers as reported by expectant mothers. 

Three out of 10 medical negligence cases lodged last year were related to pregnancy, accounting for 27 per cent of the 1,301 complaints the council received since its inception.

Gynaecologists, however, attribute the shocking numbers to inadequate personnel and equipment in health facilities, both which inhibit access to proper healthcare. But the United Nations Population Fund (UNFPA) 2021 says that in the absence of doctors during childbirth, providing midwives could prevent eight out of 10 such deaths.

In the last few weeks, the Healthy Nation has been interrogating the cases of five women who lost their lives while or after giving birth in various maternity wards across the country, to establish what happened and why they died.

What went wrong? Could these lives have been saved?

The interviews from kin read like a script off a horror movie. Others point to missed opportunities that could have saved the mothers’ lives.

These five women represent thousands of Kenyan women who were failed by the country’s healthcare system. 

We found out that a wide range of reasons are to blame for the premature deaths. From inadequate healthcare worker skills to haemorrhage, insufficient drug administration and inadequate medical supplies. Further, visiting some health facilities is to walk the valley of death. 

These reasons are complicated by pre-existing medical conditions, lack of blood and platelets and even lack of reliable transport between health facilities.

Even more heartrending, most of such deaths in rural counties are not recorded and, therefore, not tracked by hospitals.

 This means the deaths could overshoot the Ministry of Health’s records.  

 EVERLYNE AKINYI

Alice Okwach’s heart was shattered when she lost her daughter, Everlyne Akinyi, on the seventh month of her pregnancy in 2021. The place of happiness for her growing family was quickly taken over by sorrow and despair. 

When Healthy Nation visited Alice in Mathare North in Nairobi, we found her clutching at a worn photo of her daughter – taken during happier times.

She explains that Everlyne was rushed to Selina clinic when she started bleeding. At the clinic, she gave birth to a bouncing baby boy. Her bleeding, though, persisted. 

When she was stretchered to the emergency unit, it was discovered that her blood pressure was higher than usual. An urgent referral to Kenyatta National Teaching and Referral Hospital (KNH) was required to save her life.

“She was weak. She could not even open her eyes,’’ the grieving mother narrates. But the hospital did not have an ambulance to transfer the patient to KNH. ‘‘We were told to find our own means for the transfer.’’ 

Everlyne passed on before reaching KNH. ‘‘I wish hospitals were better equipped to take care of such cases. My daughter would still be here to take care of her children,” weeps the grandmother of Baby Testimony Michael, now three.

 ABIGAEL CHERUTO

The family of Lily Chesang from Kaptama in Mount Elgon lost their only daughter, Abigael Cheruto, during delivery earlier this year. Abigael was 24 and enthusiastic about life. 

She had laboured for nearly 72 hours before giving birth to her baby. Six hours later, Abigael’s baby died due to complications arising from what doctors termed prolonged labour.

Lily rushed home to bury the newborn only to return to the hospital to find her daughter bleeding profusely. She says doctors asked her to buy medicine at a nearby pharmacy for Abigael’s treatment. 

The family would buy the drugs and wait for doctors to administer them on their patient. Hours went by before they were asked to take Abigael to another facility in the county. 

Lily says health workers at the hospital dragged their feet with approval for a referral even as the woman’s bleeding worsened. When the referral finally happened, doctors assured Abigael that all would be well. This was never to be. Her daughter bled to death. Worse, under the watch of doctors, she says. 

Lily is livid about the doctors’ attitude. She believes they mishandled her only daughter. ‘‘Their negligence killed my daughter and grandchild.’’ To her, Abigael would still be alive had the doctors ‘‘attended to her on time’’. 

 BEVILE SHAU

The month of April brings grief to Hudson Shau. Losing his wife and son at a health facility in 2016 on the day that was meant to be the happiest in the family is a sore memory to him to date. 

Bevile went to labour and was rushed to Mount Elgon Sub-county Hospital. By the time they arrived after 10pm, she was in numbing pain. The man was asked to wait on the queue with his wife, who was evidently in pain. As she writhed in the bench, services at the facility moved at a snail’s pace. 

So understaffed was the health centre that throughout the night, only one health officer attended to expectant mothers and other patients. For eight hours, no one attended to the couple. Hudson recalls pacing the corridors of the maternity wing in jitters the whole night. For the father of three daughters, the birth of his son was a milestone. 

After a torturous night, his wife delivered a baby boy. But Hudson could not celebrate yet. The wife was held in the labour room with stomach pains. It is then that Hudson learnt that his wife’s attendant had fled. She could not be reached on phone. 

Moments later, his son died. Meanwhile, his wife’s situation went from serious to grave. A referral to Bungoma County Hospital for emergency care was recommended. Before she could be referred, Bevile developed breathing complications. She needed to be placed on oxygen. But the oxygen machine was not working. She died an hour later. 

Doctors attributed her death to internal bleeding.  Eight years later, the man is sore from the twin loss. 

“I still believe my wife would have made it out of the ward safely had there been a specialist and functional equipment at the facility,’’ Hudson says with a crushing heaviness of heart.  

He blames the ‘‘embarrassing’’ situation at the health facility for robbing him the pride of a son. “Isn’t it the right thing to do to separate the maternity wing from the section for general medical services to avoid disruption of services?’’ He wonders, his voice trailing off. 

BENTA ATIENO

In one instance, the burden of Lilian Adhiambo’s sorrows becomes too much to bear. Tears flow down her face without restraint. She is recounting the moment a few years ago when nurses at Korogocho Hospital asked her to take back home her sister, Benta Atieno,  whose condition was deteriorating during labour.

"They said her situation was not good and they could not handle it. We took her to Mama Lucy Hospital, where she was admitted,’’ she adds. 

The next day, Benta delivered her baby. The following morning, her body started turning yellow as she grew weaker. ‘‘I was told my sister did not have enough blood in her body. She needed nourishment.They said she needed to be fed well and given lots of fruits to regain her energy.”

On the third day, Benta was discharged. “When I enquired why she was being discharged in that state, the doctors promised she would regain her strength. They said: “Just go home and give her food.” Two days later, she died.

Lilian lives in agonising rue. “I wish I had money. I would have taken my sister to a better hospital.”  

HELLEN ASIKO

Had it not been for the 2017 doctors’ strike that lasted 100 days, Rose Juma says she would still be sharing happy moments with her daughter-in-law, Hellen Asiko.

Hellen succumbed to excessive bleeding after she was left under the care of a traditional birth attendant (TBA).

Their daughter’s excruciating abdominal pains that coincided with the health workers’ strike is the tragedy that befell this family. 

Hellen had given birth to a baby boy, assisted by a TBA. But as Rosa celebrated the arrival of her grandson, she would be informed that the placenta was stuck in her daughter-in-law’s uterus. It could not contract. Hellen bled as the TBA looked on shell-shocked and helpless.

With no money and depending on  neighbours for support, Hellen was taken to a nearby private facility. She was declared dead on arrival, six hours after giving birth, her body a hue of yellow owing to massive blood loss. 

“My daughter would have been attended to free of charge at a public health facility,” reflects Rosa, carried away by thoughts. 

Hellen’s husband is yet to come to terms with his loss. ‘‘If only we had been attended to by health workers at the local public health facility, my wife would still be alive. We would be a happy family of four,’’ he says.

Distressing condition of maternity wards in counties

A 2024 report by the Health ministry and Amref Health Africa reveals that half of Kenyan mothers die of haemorrhage. Postpartum haemorrhage is the loss of at least 500ml of blood within 24 hours of childbirth. It affects about five per cent of mothers worldwide, according to the United Nations Fund for Population Activities.

Two out ten die of pre/eclampsia and 11 per cent die of sepsis. Shockingly, seven out of 10 women die at night, on weekends and public holidays, the report highlights.

In terms of distribution across the country, Tana River, Garissa, West Pokot, Elgeyo Marakwet and Machakos recorded the highest number of maternal deaths. Others are Homa Bay, Siaya, Wajir, Kilifi, Murang’a, Makueni, Migori and Turkana. 

Dr Janet Karimi says 24 health facilities across these counties are notorious for maternal deaths. “We have to safeguard the lives of our expectant mothers and newborns at all costs,’’ says the head of Newborn and Child Health at the Ministry of Health.

An ideal maternity unit should have a separate labour ward, delivery room, postnatal vaginal delivery ward, post-caesarean section ward and an antenatal ward

A report by the Auditor General reveals the distressing condition of maternal health in counties, especially in public hospitals. Many of them lack basic equipment, thus endangering the lives of mothers and babies. Many were congested, with some mothers sharing a bed. Unsurprisingly, maternal mortality in Kenya was in an upward trend between 2017 and 2022.

The audit further revealed that seven Level Four hospitals do not have maternity theatres. These instead use general surgical theatres for delivery. This results in delays during emergency maternity cases, often resulting in death of mothers. In most cases, facilities that do not have theatres refer caesarean section cases to other centres.

The Healthy Nation is looking to expand the gallery of women who have died during childbirth. We would appreciate hearing from families and loved ones who have lost relatives in this way. Please write to us at [email protected]. Next week, we will feature stories of mothers who have lost their children in maternity wards.