How unskilled deliveries cost me my three newborns

In the quiet village of Emakhubari, Busia County, residents are busy in the farmlands preparing for the planting season. Oddly so, Ms Rodah Nadiri has chosen to stay at home. She has an appointment with a Community Health Promoter (CHP).

And as Ms Nadiri would later narrate to the Healthy Nation team, she takes the sessions seriously as they have been her lifeline.  The expectant mother of two rarely misses her appointments with the CHP, especially after losing three children to unskilled deliveries. When we walk in, she is upbeat having cleared her chores and ready for her routine check-ups. 

They quickly get down to it, with Ms Sophia Awinja, the CPH, asking about her health status and what she has been feeding on. The 35-year-old is eight months pregnant.

For the next couple of minutes, the CHP educates Ms Nadiri about the danger signs of pregnancy and why she needs to quickly visit a health facility in case she experiences any of the warning signs. 

Moments into their conversations, Ms Awinja whips-out from her bag, a Mid-Upper Arm Circumstance tape, one she uses to check if the pregnant mother’s nutrition is in check.  The two are clearly in sync, and the sessions seem enjoyable. Once in a while, the CPH pauses to allow Ms Nadiri to ask some questions. 

“I will be back in two weeks’ time, but remember my telephone line is always on. In case there is an emergency do not hesitate to call me,” says Ms Awinja as she announces her exit.

 Just a couple of years ago, Ms Nandiri had been struggling to have a child of her own, but the dreams would be cut short, thanks to unskilled deliveries. 

When she moved in with her husband in 2012, the couple had been eager to conceive. Unfortunately, they lost their first three newborn children in the hands of an unskilled traditional birth attendant (TBA). 

Ms Nandiri explains that after conceiving her first child in 2013, they did not see any need of visiting a health facility for the antenatal care clinics. 

Instead, she would always seek the services of a herbalist and a TBA until her delivery date.

“When labour pains kicked in, my husband quickly made arrangements and had a TBA brought to our house to monitor me until delivery,” says Ms Nadiri.

At first, all seemed well but after labouring for five hours, it became clear that something was amiss. “I lost the baby immediately after birth. The baby had been trapped in an amniotic sac and the TBA, who was partially blind, did not realise it until it was too late,” she offers.

In 2014, a few months after the child loss, the couple conceived their second child but yet again, they opted to stay away from a health facility fearing that she was likely to be mistreated by health workers.

Nine months later, Ms Nadiri once again lay on her kitchen floor awaiting to welcome her second child. This time, her husband had been ‘careful’ to bring in a different TBA for the safety of their child.

“My baby came, but he could not stop crying. He could not breastfeed and he succumbed to an unknown condition 48 hours after birth,” says Ms Nadiri. In 2016, Ms Nadiri once again delivered under the care of a TBA but the baby died a month later. Until his death, the mother had never visited a health facility. When the one-month old baby was being buried, the grieving mother had caught the attention of Ms Awinja, who had just been recruited as a CHP in the village.

While Ms Awinja visited the family to console them during the hard times, Ms Nadiri says her family was at the point of breaking up due to childlessness. 

Her husband was, however, willing to give it a fourth attempt. Luckily for the couple, the CHP has been around to take them through maternal child health education for the entire pregnancy journey.

The CHP ensured that she visited Matungu Sub-county hospital for her first antenatal visit and delivered in the same facility when she was due.

Ms Nadiri says her second born daughter was also delivered at the same hospital three years later. In a month’s time, the mother says she will be welcoming her third born child at the health facility.

“I owe the CHP gratitude for what she did to me, she gave me a chance to experience the joy of motherhood at a time I never thought I would ever carry my child,” says a happy Ms Nandiri. She is among the 42 per cent of Busia County residents who delivered out of health facilities, according to the 2014 Kenya Demographic Health Survey. 

According to the 2022 UNICEF report on maternal child health, ensuring all births are assisted by some skilled health personnel is critical in reducing maternal and newborn deaths across the globe.

The report explained that delivering under the care of a medical expert is key in ensuring the health worker recognises warning signs and refers mothers to emergency care in case of complications like haemorrhage, the leading cause of maternal deaths.

While 86 per cent of births across the world were assisted by a skilled health expert, the global body says facility deliveries have remained uneven.

“If current coverage of births by skilled health personnel stays the same, approximately 141 million births in sub-Saharan Africa will occur without the assistance of skilled health personnel between 2022 and 2030,” reads the report.

In an effort to reduce cases of child deaths, Busia Community Health Services focal person Emmanuel Luvai says the county has been working closely with the CHPs to conduct health education in an effort to increase facility deliveries.

Mr Luvai says they partnered with Living Goods , an NGO that  would offer training packages to pregnant women.

 “The partner focused on training the community health service providers on mapping out all the expectant women, building their understanding on why they need to see a service provider as soon as possible and tracking the women throughout the nine-month pregnancy journey,” says Mr Luvai.

With improved supervisions of the CHPs, the focal person says the facility deliveries have since improved to 83.3 per cent.

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