The midwife who refuses to let women bleed to death during childbirth
Sylvia Lanya, a nurse and reproductive health coordinator in Makueni County, during the interview on April 24.
What you need to know:
- The nurse explains that the death of a mother during childbirth touches every strand of a family.
- The newborn baby is left behind. The other children have no one to call mum. The husband starts learning to do things without his spouse.
If there is one thing Sylvia Lanya carries with deep passion, it is the mothers, babies, and pregnant women she interacts with daily.
Sylvia is a nurse midwife at Kibwezi Sub-County Hospital, where she also serves as the sub-county reproductive health coordinator.
Back in 2014 when she was a young nurse fresh out of school, one of her first assignments was to help deliver a baby. She had done it before and was confident she would do it with ease. Her training had been thorough, and never in her mind did she imagine she would make a fatal flub.
She was the night-nurse on duty.
After taking reports from the day-nurse, she physically went to check on the clients in the wards. She came to a woman who had delivered her seventh child earlier that day.
Sylvia assessed her and even talked to her, asking whether she would consider using a form of contraception.
“I politely told her to take a break from giving birth because her uterus might refuse to contract the next time she tries to get a baby,” she tells Nation.
She moved on from the woman's bed, went to see other clients, and returned to her nursing station to get the treatment trolley so she could start administering drugs to patients.
She had not even finished preparing the drugs when a client came to her, saying that the lady who had given birth to her seventh child that day was bleeding abnormally.
Sylvia rushed to check on the patient.
"There was a pool of blood under her bed and it had moved to the next bed. It was so much that I had to get gumboots to attend to her," she remembers.
She could not handle the woman alone. She called out to her colleagues for help.
"When the other team members came, we secured IV lines, took blood samples, administered a drug called misoprostol, and I massaged her uterus. It refused to contract completely, even after emptying the bladder," she narrates.
All that effort did not bear any fruit. At that point, their facility was not offering theatre services and they did not have a consultant. They decided to refer her to another hospital. Sylvia accompanied her into the ambulance and to the next facility, which was about 30 kilometres away.
"She kept telling me that she was thirsty. She was also drowsy and wanted to sleep. I tried to keep her awake. I engaged her. I wanted her to talk so we could get to the next facility," she says.
At that point, Sylvia did not know how much blood her client had lost. She had no calibrated drapes (a tool used for measuring blood loss during surgery). She used her eyes to gauge the blood loss. At the back of her mind, she knew the lady had lost so much blood and would urgently need a transfusion as soon as they reached the next facility.
They got there while the woman was still alive, and she was taken straight to the theatre.
"Blood kept dripping from the ambulance to the stretcher, all along that path. When the midwife saw her, she shouted to call a doctor, and I remember her saying that it was a bad postpartum haemorrhage (PPH) case," she says.
PPH occurs when a mother bleeds excessively during childbirth or in the moments immediately after. The latest threshold from the World Health Organisation (WHO) classifies blood loss of about 300 milliliters or more as PPH.
The woman received a blood transfusion while undergoing surgery to remove her uterus. But the bleeding did not stop, even after the uterus was removed and she had received five units of blood.
Sylvia says the woman had developed a condition called disseminated intravascular coagulation, meaning her blood's clotting factor had stopped working.
Sylvia had to return to her other clients, but she kept checking on the woman through a colleague at the receiving facility.
"I was traumatised by what I had seen," she says.
At 6am, the receiving facility called her. They said they had tried everything, but they had lost the mother.
"It really broke my heart. I needed to enter a room and scream. In our facility, we have someone we can talk to for debriefing. That feeling is not easy. Anytime you think about it, you just start crying," Sylvia says.
She explains that the death of a mother during childbirth touches every strand of a family. The newborn baby is left behind. The other children have no one to call mum. The husband starts learning to do things without his spouse. Sylvia says the impact is enormous and deep.
While that situation devastated her, it also inspired a change. She strived to learn how to handle postpartum haemorrhage cases in order to save women who bleed excessively during childbirth.
Makueni County, where she is stationed, got an opportunity to train its healthcare workers through the Accelerating Measurable Progress and Leveraging Investment for Postpartum Hemorrhage Impact project. Through it,
Sylvia learned new skills and gained access to innovations that help her handle PPH cases better.
The project, which ends in July, introduced the country's first ever PPH prevention drug called heat-stable carbetocin along with calibrated drapes for measuring blood loss during delivery. The project also equipped them with tranexamic acid, used to treat excessive bleeding.
"This has really built my confidence. When I get into the maternity ward, I usually tell my colleagues that there is nothing that I cannot handle. Let it come in red. Let it come in white," she says.
Sylvia keeps empowering younger colleagues through training. Over time, she says, she receives fewer emergency calls. Her junior colleagues are now able to handle PPH cases on their own.
In her capacity as sub-county reproductive health coordinator, she is sometimes tasked with visiting families that have lost a loved one during childbirth. Recently, she visited a family that had received a set of twins, but their mother was no more.
"Seeing that mound of soil broke me. The older son was crying when he saw us. I couldn't hold it. I went to the back of the house and cried. I remember having such a long drive back home that day and had to play loud music to distract myself," she says.
Sylvia notes that she has seen significant changes in her facility since the PPH training. The number of PPH cases has dropped sharply.
Blood transfusion rates have gone down, she says. She also notices that non-pharmaceutical supplies such as gauzes, cotton wool, and intravenous fluids used to resuscitate patients are rarely needed.
"This means that the measures we have put in place to prevent PPH also help us to save resources," she tells Nation.
She advises that preparedness for PPH in any maternity ward is essential. She adds that having a workforce with the knowledge and skill to attend to a woman with PPH is critical, and it builds their confidence.
"Nowadays if there is a PPH case, I just smile because I know that my teammates can handle it. Teamwork really builds our confidence and it saves lives," she adds.
Sylvia says that even though PPH prevention happens during labour, there is a need to prevent it earlier. She advises women to attend preconception clinics so that healthcare workers can identify those at risk of developing PPH.
"Preconception care will help us start treating cases like anaemia before they even give birth. If people prepare for their farms before they plant, they should also be able to prepare for their child and have a product that is befitting and highly intellectual," she explains.
"Your body has to be ready."
