By Mactilda Mbenywe
Elizabeth Akinyi, 28, holds her six months old twins with a lot of pride every minute with them brighten her and ends memory of pain she underwent after giving birth.
During pregnancy, she had no complication but always advised by medics to take long bed rests she recalls a nurse telling her that there was nothing major to worry about.
She delivered twins well at Migori county referral hospital and immediately she passed out, but before she heard nurses shouting voices fading PPH PPH!
The twins had six kilograms between them, which overstretched her womb hence failing to contract and when the placenta was removed she started bleeding excessively.
According to a nurse Mary Juma who attended to her, Akinyi passed out for 30 minutes as medics tried to control her bleeding which was in excess.
“She was losing a lot of blood medics were afraid they would lose her,” said nurse Juma.
In return, medics administered drugs to stop bleeding but nothing was working. Her blood pressure was steadily dropping. She had lost 1,300Ml of blood and was going into a shock.
She was very exhausted and her pulse weakened. She was fast getting cold and something had to be done to save her life.
Postpartum hemorrhage is heavy bleeding after giving birth to a baby. Excessive bleeding can cause a severe drop in blood pressure.
Postpartum hemorrhage is ranked as number one killer in maternity wards claiming about 130,000 women every year, with a bigger number in sub-Saharan Africa according to World Health Organization (WHO).
More than half of these deaths occur within 24 hours after childbirth.
WHO further reports that the bleeding is caused by either a placenta that is not expelled after birth or when the uterus fails to contract after delivery.
Postpartum hemorrhage is defined as blood loss of 500ml or more within 24 hours after giving birth. Blood loss above 1,000ml within the same timeframe is considered to be more severe.
Health experts warn that each pregnancy magnifies a mother’s risk especially if she does not have access to healthcare.
In Kenya, an estimated 6,300 women die each year during pregnancy and childbirth. According to the World Health Organization, Kenya is among the 10 countries that comprised 58 percent of the global maternal deaths in 2013, contributing two percent of these deaths.
The Confidential Enquiry into Maternal Deaths in 2019 by Ministry of health department of Family health, showed that postpartum hemorrhage accounts for 34% of maternal mortality in Kenya, followed by pre-eclampsia/eclampsia 19% and unsafe abortion at 9%.
The inquiry into maternal deaths done between June 2015 and June 2016, found that nine out of 10 women who died of obstetric bleeding had received substandard care and that different management of the condition would have saved their lives.
Delays in starting treatment, incorrect diagnosis, and lack of adherence to treatment protocols are some of the factors that lead to death of mothers from excessive bleeding after birth.
To save Akinyi’s life a nurse at the hospital rushed in to the ward with a uterine balloon tamponade (UBT), a water-filled condom balloon.
The UBT was inserted into Akinyi’s uterus and water pumped inside. Ten minutes later, the bleeding stopped.
The balloon was left in the uterus for an hour as the nurses monitored the bleeding. It worked. Two days later, Akinyi was discharged from hospital with her healthy twins.
According to a gynecologist at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), Dr. Josephine Ojigo, if UBT had not worked Akinyi’s womb would have been removed in a procedure called hysterectomy to stop bleeding.
Without the UTB Akinyi could have died, Dr Ojigo said.
“Akinyi is one of five women whose lives have been saved by the uterine balloon tamponade, which comes in handy in saving lives of mothers giving birth in rural health centers that are resource-constrained”, the medic testified.
The UBT is made of two condoms, two cotton strings, one Foley catheter and a 60ml syringe. The condom attached to a catheter is inserted into the uterus and filled with water slowly to inflate it. As it swells and takes the shape of the womb, it applies pressure on the uterine wall to stop excessive bleeding. If it works, bleeding stops within 15 minutes. The low-cost catheter is disposed of after use.
Data from the Ministry of Health (MOH) published on its website indicates that by the first quarter of 2019, the UBT innovation had been rolled out to over 1,300 facilities in 20 counties, including 15 counties considered as the counties with the highest burden of maternal mortality
The Data further states as at January 2021 over 6,600 health workers in the county have been trained on the UBT technique 1,300 facilities provided with PPH management manuals, wall charts and UBT kits.
As of now, 9,000 kits of UBT have been supplied locally across the country mainly in parts of Western and Nyanza regions with 629 documented lives saved using the -UBT innovation.
According to the Reproductive health coordinator Ms Beatrice Oloo, in Migori County department of health and sanitation the county which is ranked among counties with high mortality rate in the country and the innovation has been a success in 16 health facilities within the county.
“Every time we have Post-Partum Hemorrhage case in these facilities we do not worry, we have the UBT at our disposal and I know a mother will not die,” Ms Oloo says.
Jane Amondi holds her six months old baby tightly as she remembers how UBT saved her life at the county hospital.
“Things were happening too fast, I am lucky to be alive,” she said in smiles.
Calling for the urgent need to upscale it across all medical facilities in the country, Dr. Monica Ogutu, the executive director of the Kisumu Medical and Educational Trust (KMET) says, it is an innovation that can save lives.
“It might be one of the world’s most economical lifesaving devices but in return it does much,” Dr Ogutu said.
According to Dr Ogutu the government’s pledge to review National Post-partum Haemorrhage Protocol should include UBT kits on the list of essential commodities.
KMET is the sole assembler and distributor of the kits in Kenya is meant to supply the hospitals at Sh1,000 a piece.