Eight months into her pregnancy Miracle’s mother started convulsing – a sign that undetected unchecked pre-eclampsia had advanced. She was taken to the region’s high risk maternity hospital and delivered a 3lb baby that same day. The pre-eclampsia had caused bleeding in her brain and though her life was saved, Miracle’s mother was now hemiplegic. Initially her milk came in but soon after her two week hospitalization ended her milk dried up and Miracle deteriorated quickly. Family members banded together to purchase a single tin of formula and tried to stretch the precious formula over the course of a month. Joyful Motherhood nurses were visiting an orphan in a neighboring community when they were told about Miracle. When they found her, she was severely malnourished and near death. Joyful Motherhood nurses immediately enrolled Miracle and worked to keep her on kangaroo care – wrapping her skin-to-skin on the chest of her mother or grandmother. They also attempted to restart lactation. Miracle is now six months old, she remains underweight at this time but nurses are continuing their visits and working to help Miracle close the growth and development gap between herself and her peers. Time is certainly of the essence as research shows that being underweight at 2 years predicts diminished development, productivity, and intellectual achievements over a lifetime. Joyful Motherhood will keep Miracle enrolled until 2yrs of age.
Archives for March 2019
During her pregnancy with her sixth baby, 35-year-old Tabalire suffered from severe headaches. She attended the recommended prenatal care and repeatedly told the midwives. She was admitted for a few days but discharged without any notable improvement in her condition. While admitted during her delivery, she again complained about the severe headache. Her delivery went well and her baby boy weighed almost 8lbs. At the time of discharge she continued to complain about a headache and backache. Nine days later her family arranged transportation to the hospital realizing that she was quickly deteriorating. Tabalire died on route to the hospital. When they reached the hospital nurses referred the family to Joyful Motherhood for continued support. Tabalire’s children are being raised by her sister.
Memory was born by c-section, she was small but healthy. After the surgery, her mother had severe anemia, she receive a single unit of blood but her body struggled to recover from the stress of the delivery. Her condition deteriorated and within a few weeks she died. Memory is now being raised by her grandmother in the village. She is pictured here in the arms of her older brother.
• 11 babies were enrolled including, three orphans, one baby with a mother in the ICU, one baby of a woman with severe psychosis, two sets of twins, and two babies whose mothers were not producing breast milk.
• 7 women were enrolled including, three for a ruptured uterus with subsequent hysterectomy and four for severe abdominal infections following their deliveries.
• Nurses visited 170 women and babies.
Mother Care Admission Story. At 18 Chimwemwe was pregnant for the second time. Her first child died as an infant and with that loss ever present in her mind she was praying for a healthy strong baby this time. She began laboring on December 22nd and reported to her health center. Two days later midwives determined that the baby was too big and sent her to the district hospital where a c-section would be possible. Chimwemwe delivered a healthy baby boy by c-section that same day. She was overjoyed with her baby but the pain from her surgery only increased over the following days. Clinicians at the district hospital noticed the deterioration of her health and sent her to the region’s high risk maternity hospital. There she underwent an exploratory laparotomy, they drained a half liter of pus, inserted a drain and started her on antibiotics. On January 12th she appeared greatly improved, the drain was removed and she was sent home. Joyful Motherhood nurses started their visits.
Baby Care Admission Story. 22 year old Monica had a normal healthy pregnancy, she delivered her baby boy in the hospital. After his birth she began to hemorrhage, the bleeding was not stopped in time and the requested blood products were not available. Monica died quickly. Her mother left the hospital with a grandson, one tin of formula and her 22 year-old daughter’s body. She was referred to Joyful Motherhood for continued support.
– 10 babies were enrolled in our program, including three orphaned newborns, one set of triplets, one baby with multiple congenital anomalies, one baby who was abandoned in a public space, one baby’s whose mother was not producing breast milk, and one baby whose mother was on chemotherapy.
– 7 women were enrolled including five with ruptured uteruses and subsequent hysterectomies, and two with severe infections following c-sections and subsequent.
– Nurses visited 138 women and babies
Baby Care Admission Story.
Mary was pregnant with her fifth child when she tested positive for HIV. She attended prenatal clinic and was able to receive anti-retrovirals to lower her viral load and decrease the risk of transmitted the disease to her baby. She went into labor a bit earlier than expected but delivered a healthy five and a half pound baby boy. Mary’s health seemed stable but she had developed a sore on her leg which, despite herself care, only seemed to get worse. The midwives who attended her delivery determined that the wound was severe enough to refer her to the regional hospital. There clinicians biopsied the wound and diagnosed her with cancer. Mary soon began chemotherapy but was forced to stop breastfeeding. At this point Mary and her baby boy were referred to Joyful Motherhood.
The World Health Organization recommends that HIV positive women exclusively breastfeed their babies to six months. WHO recommends anti-retrovirals during pregnancy and breastfeeding to decrease the risk of transmission. The risk of death from malnutrition or diarrheal illness for a young baby in Malawi outweighs the risk of HIV transmission from his mother. Formula is used as an absolute last resort, for babies who do not have access to the breast milk their need to sustain their lives.
Joyful Motherhood nurses are visiting Mary and her baby, providing formula, monitoring his health, growth and development and providing health education to Mary.
Mother Care Admission Story.
Sakina felt some early painful contractions on October 15th. She was a healthy 17 years old, expecting her first baby. Her mother accompanied her that day to the nearby health center to ensure that she labored under that watchful eyes of trained midwives. Soon after their arrival Sakina began seizing. She had developed eclampsia. Sakina was transferred to the district maternity hospital for high risk management.
Pre-eclampsia is a life-threatening disease of pregnancy. Even in 2019 our knowledge of pre-eclampsia is incompleted. We know risk factors but cannot predict who will be affected. When a woman suddenly develops high blood pressures and has protein in her urine she is diagnosed with pre-eclampsia. Delivery is the only cure. In the US a woman with pre-eclampsia is monitored carefully and delivered as soon as possible. In Malawi these early signs are often missed. There is often not much time between their onset and the quick acceleration of the disease. Pre-eclampsia may affect all the major organ systems and ultimately lead to death. Seizures indicate an advanced disease process (eclampsia).
On October 30th Sakina finally delivered a six pound baby boy. She was critically ill but clinicians believed she was well enough to go home and discharged her on November 4th. Sakina’s body was struggling to heal from the eclampsia and the c-section and she did not produce any breast milk. Her mother anxiously and loving tended Sakina and the baby, she saw them both struggling, but how could she leave Sakina to seek help for her grandson? She feared Sakina would deteriorate if left alone and where would she even go to get milk. Within one week Sakina’s baby boy wasted away and died. On November 11th Sakina’s mother could wait no more, she decided that to save Sakina, they would go to a mission hospital. She would have to pay for care but she would worry about that later. At the mission hospital doctors diagnosed Sakina with a severe infection and referred her to the region’s high risk maternity hospital. There Sakina was diagnosed with severe peritonitis and a necrotic uterus. On November 12th 17-year-old Sakina was taken to the operating room and underwent a total hysterectomy. Weak and critically ill Sakina stayed in the hospital for over a week. On November 20th when it was noted that her condition was not improving, she returned to surgery. Her wound was reopened more purulent material was washed from her abdomen, four drains were placed. For the next month she stayed in the hospital, her wound slowly healing. On January 4th Sakina complained of leaking urine and a fistula was noted. She was referred to the fistula center where she was taught about dressing changes and discharged home on January 6th. She was still leaking urine but would have to wait until her body was strong and healthy enough to undergo the first repair surgery.
Joyful Motherhood nurses first met Sakina while at the high risk maternity hospital. They followed her after discharge and will continue to visit her, monitoring her health and offering emotional support to her family until she returns for her fistula surgery.