African Mothers Health Initiative

Providing care for critically ill mothers and vulnerable infants in Malawi.

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postpartum hemorrhage

June 2022

In June nurses enrolled six babies (including 5 orphans and 1 baby without access to breast milk) and two women. Nurses conducted 169 visits to infants and critically ill postpartum women.

Baby Admission Story. Edess was living in a rural part of Mozambique close to the border of Malawi. She was pregnant with her fifth child and the labor started hard and strong. There was no time to make the trip to a hospital, so a traditional midwife in the village was with her during the birth. The delivery happened smoothly and quickly but the placenta did not follow and so Edess was forced to travel to the hospital.

At the end of a pregnancy the placenta receives approximately 500ml of blood every minute. Normally within minutes after a baby is born, the body will release the placenta and blood vessels feeding the placenta will shut down by a combination of the contracting uterus and clotting factors. When the placenta does not deliver within 30mins of a birth, the risk of hemorrhage increases exponentially.

Traveling from a rural community to a hospital in an emergent situation never happens quickly in Malawi or Mozambique. There is no functioning EMS system. In the majority of communities like Edess’ the only transportation vehicles are bicycles or ox carts. Roads are unpaved and rough. And, once a woman reaches the main road, she will need to wait for a passing bus or car to pick her up and take her to the hospital. Edess finally reached a rural hospital in Malawi, but tragically, she died on the same day. After her death, clinicians at the hospital referred her mother and baby to our local partner, Joyful Motherhood. If you would like to ensure that nurses visit Edess’ baby on a monthly basis in her village and provide formula and later porridge, please DONATE. Thank you.

November 2021

  • 8 babies were enrolled (6 orphans and 2 babies with mothers hospitalized in critical care).  Nurses visited 162 babies and discharged 12.  We are currently following 248 babies (newborns – 24mo).
  • 3 women were enrolled. Two of the three had stillborns and two of the three had total hysterectomies.

Baby Care Story.  Dalitso’s mom attended prenatal care throughout her pregnancy.  She wasn’t exactly certain how far along she was, and on 24th October Dalitso was born, weighing less than 5lbs.  His mom lost a lot of blood during the delivery and was transferred to the District Hospital for a blood transfusion.  Within the relatively short period of three hours after the birth, she arrived at the referral hospital and received the first unit of blood.  It took another seven hours for her to receive a second unit and by that time her condition had deteriorated significantly.  She died during the transfusion.

Postpartum hemorrhage is one of the most common causes of maternal death in Malawi.  The contributing factors include: pre-existing severe chronic anemia (malnutrition), poor management of obstetric hemorrhage, a poor emergency transportation system, poor access to emergency obstetric care, inadequate supply of blood products, and difficulty in accessing available blood products.  It is unlikely that midwives attending her at the referral hospital had an accurate estimate of the blood she lost during the birth.  The midwives were most likely assessing her need for blood by her vital signs and unfortunately a woman can lose 25% of her blood volume before she becomes symptomatic.  Even if she had received the two pints immediately following the hemorrhage, it is unlikely that this intervention alone would have saved her life.  She was 21 years old.   After the funeral, Dalitso’s grandmother brought him to Joyful Motherhood to enroll him in our program.  Our nurses will visit Dalitso and his grandmother monthly to provide formula and ensure that he remains healthy over his first two years of life.   DONATE

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