Takindwa’s mom started her labor at the District Hospital in Malawi. She had had a previous cesarean section so it was important that she labor at a hospital with an operating room. Many women in Malawi labor in rural area which are far from any health facility. And even when there is a clinic nearby, many times they lack an operating room and staff capable of performing a C-section. The national C-section rate in Malawi is about 6% this compares with a US C-section rate of about 32% (WHO 2013). According to the World Health Organization, the percentage of women who will require a C-section in order to birth safely is about 15%. This means many Malawian women are not receiving necessary C-sections, which as a result jeopardizes their lives and the lives of their babies.
Takindwa’s mom was in the right place to access emergency obstetric care and after many hours it became apparent that she would again require a C-section in order to deliver safely. Takindwa was born on April 13th by what initially seemed to be an uneventful C-section. However, within a few hours her mother became short of breath, collapsed suddenly and was pronounced dead. There is no capacity to perform an autopsy, so the cause of her death will never be know with certainty. However, considering that her mother was a healthy 19 year-old woman, it is likely that her death was related to a surgical error. Tragically in Malawi, both poor access to care and poor quality of accessibly care threaten the lives of many women.
Takindwa’s family was immediately referred to Joyful Motherhood and our nurses have been following her ever since. Today she is a health 7 month-old.
Niya is only 16 years old, but several weeks after the birth of her first baby she had surgery for a total hysterectomy. Niya took care of herself during her pregnancy and grew a 8lb 9oz baby. Unfortunately her baby was too big for her to birth naturally and she ended up with a C-section. C-sections, though common in the US, carry significant risks in Malawi and increase the risk of serious life-threatening infections. Days after giving birth, Niya became increasing ill, her abdomen swelled and she returned to the hospital. Clinicians there did a laparoscopic surgery to determine the cause of her swollen abdomen and found that her uterus was necrotic. The infection was so severe and had continued unchecked for so long that her uterine muscle had completely died as was beginning to decompose inside of her. She had an emergency hysterectomy. Soon after the second surgery she experienced severe nausea and vomiting and was diagnosed with a bowel obstruction. She underwent additional treatment for the bowel obstruction. It was a traumatic and life changing birth experience. She would need to learn to care for her new baby, care for her wounds, and strive to accept the loss of her fertility. Joyful Motherhood nurses have been following her, supporting her as a new teen mom, counseling her about her hysterectomy and encouraging her. Her baby is growing well and she is planning to return to school soon.
Faith was born January 28, 2018. Her birth was uneventful and the next day her 23-year-old mother, Salimba, took her home to meet the rest of the family. On February 14th Salimba became ill. Her family says her face and feet were swollen and she started vomiting. On February 18th they took her to the closest health center. She died there before she was ever evaluated by a clinician. Faith’s grandmother was then directed to Joyful Motherhood. Overwhelmed and grief stricken she told the nurses she didn’t think she would manage. She had five other children at home to raise. With support from Joyful Motherhood nurses, Faith’s grandmother has done a wonderful job; today she glows when talking about her granddaughter.
In the face of this beautiful woman you can see lines of grief, determination, and quiet joy. She is holding her grandson Precious who was born on the day her daughter died. Her daughter delivered Precious and then as she lay back to embrace her new son she began to bleed. The bleeding continued despite efforts of those with her to slow it down. Her life washed away in a sea of red. Her mother clung to her newborn grandson and gave him a name from her heart. She worried about her ability to keep him alive and well, without breast milk and without money for formula. Within the week after telling countless people her story, she was directed to Joyful Motherhood for support. Precious is now 8 months old.
Nineteen year-old Juliet was nearing the end of her pregnancy. She had gone for her prenatal visits at the Mitudu health center, she had taken the antimalarial medications as instructed by the midwife, had the necessary blood work, and regular blood pressure checks. Everything seemed to be going well until the day she collapsed and started seizing.
Pre-eclampsia is one of the most dangerous diseases of pregnancy. Even as our knowledge about it continues to grow, our ability to predict who it will effect remains limited. The onset is often sudden and occurs towards the end of pregnancy. One of the warning signs is a rising blood pressure. Pre-eclampsia can affect all the major organ systems, damaging the liver and kidneys, resulting in bleeding in the brain, seizures and death.
Those around her took Juliet immediately to the health center and from there she was transferred to Bwaila, the district maternity hospital. Without a well organized EMS this process of just getting her to a place where she could be helped took several hours. When she arrived at Bwaila, Juliet was unconscious and still seizing. The midwives – familiar with this presentation – quickly administered magnesium sulfate, the only medication shown to help control and prevent eclamptic seizures. Even with the medication, the only cure for eclampsia is delivery. Once a woman reaches the point of seizing her life is in grave danger and if she is not delivered within a relatively short period, both she and her baby will die. Unfortunately even delivery does not guarantee that the mother’s life will be saved. The clinician at Bwaila delivered her 5lb baby by C-section and Juliet was sent to the ICU, where she remained unconscious for 4 days.
This is where our nurses found Juliet. After talking with her family, she was enrolled in our Mother Care program. Juliet regained consciousness and after a short period she was discharged from the hospital. The nurses planned to visit her six times in her village. During their first visit, nurses found Juliet still swollen and convalescing, still struggling to care for her baby. This picture is from their second visit. As part of her home based care, nurses will counsel her on the disease and help her community members create an emergency plan for such events in the future. They will also provide some education on the care of her baby and help set up an income generating project.
Triplets Stella, Eunice and Joseph each weighed about 2lbs at birth. Their parents were already struggling at the edge of survival and now suddenly there were three additional children to feed. It was not uncommon that an entire day would pass with no food. Life -which involved fetching water, washing clothes by hand, and farming with hand tools – demanded great daily physical exertion regardless of the fuel or lack there of in their bellies.
As a midwife in the US, I often have patients tell me they struggle to produce enough milk for their babies. Here, with well nourished patients, we talk about reducing stress, increasing the frequency of feeds and/or breast stimulation; and we talk about specific foods that may help increase supply. Here this support and advice works at times, and at times women start slowly supplementing with formula and eventually stop breastfeeding all together. Women may experience anxiety, guilt or frustration at times, but there is always a way to sustain the life of the baby. In the case of Elizabeth, her body was being pushed to its physical limits on a daily basis in multiple ways. Though the milk any woman produces is always beneficial for her children, the volume Elizabeth produced could not adequately sustain her triplets. Without Joyful Motherhood, she would not be able to purchase the formula needed to supplement her babies.
Joyful Motherhood enrolled the babies bringing supplemental formula and encouraging Elizabeth as she continued to nurse. And yet, for months their weights hovered below 5lbs. At six months of age they added the enriched porridge brought by Joyful Motherhood to their diet and finally they began to gain weight steadily. They are now 13months old, two of the three are walking. Stella weighs 15lbs, Eunice weighs 15.5lbs and Joseph weighs 19lbs.
Chisomo weighed less than 5lbs at birth and his mother died just moments after his first cry. His low birth weight and his status as an orphan meant that from day one, Chisomo was much more likely to die in early childhood than his peers. Thankfully, his grandmother was directed to Joyful Motherhood and has been receiving home based support from our nurses. He is now 3 months old and his chubby cheeks are a sign of good loving good care. Evenso, it is important to remember that he still has a long road ahead of him. Malaria, diarrheal illnesses and household food insecurity will continue to threaten his well being. With your help we can ensure that AMHI and Joyful Motherhood will stand by his family until his second birthday.