*This blog contains upsetting/triggering themes and information related to stillbirths.
The day of birth is the most dangerous for babies and their mothers: nearly half of maternal and newborn deaths occur during this period. But many of these deaths are preventable.
Last week I spent the whole of Wednesday revising our reproductive, maternal and child health advocacy strategy, which contributes to ending preventable newborn deaths, especially in developing countries. Then the following evening my mum called to tell me that my nephew died at birth. He was full term; and his mum attended all her antenatal check-ups at two renowned, private obstetrics and gynaecology clinics in a middle-class community in Monrovia, the capital of Liberia. My mum had taken her in when she got pregnant, cared for her, and reported that it was a great pregnancy throughout. The baby’s parents (first timers) and the rest of the family were so excited to receive him.
Blood, they say, is thicker than water. The death of a baby I never got to meet has hit me unexpectedly hard. I don’t want to see the word ‘newborn’ anywhere. I don’t want to see pictures of living newborn babies and I can’t stop crying randomly in public. I keep getting flashes of his beautiful face. Ending newborn deaths is something I have spent much of my 12-year global health career working on – but the newborn death I am now confronted with is that of my nephew.
So why did my nephew die?
Our angel baby died of birth asphyxia (lack of oxygen), though I was initially told that he was stillborn and had died in utero at least 48 hours before delivery – it was supposed to keep me from grieving due to the superstitions and myths around stillbirths in my culture.
The next day I received pictures of my nephew. He looked nothing like a baby who had died in the womb. He appeared so fresh and healthy and could pass for a toddler. I instantly felt there must be more to the story, so I demanded a detailed explanation of the entire labour and delivery process.
I was told that the midwife reported that the mum was being “lazy to push the baby” and he got stuck long in passage (the vaginal canal) before he was finally pulled out. But he had suffocated and died. I could not believe what I was hearing. The clinic blaming the mum – a petite 18-year-old, pregnant for the first time – for the death of her child?
A look at my nephew will indicate to even a non-medical person that there was no way a safe vaginal delivery would have been possible. “We have too many questions but no answer”, my mum said, choking on tears.
My questions are: how is it that the antenatal visits, measurements and scans did not suggest that the mum would need a caesarean section (CS) when she went into labour? Why there was no referral for CS when the “mom was being lazy to push”? The realisation that a healthy baby suffocated and died because the attending midwife overlooked the signs of a possible prolonged and obstructed labour – an indication for emergency CS – and did not refer, sent me into a rage.
We are all at risk
This devastating experience shows that when health systems are weak, the whole population is at risk, whether poor, middle-class or rich, accessing public or private facilities. My nephew is just one case. According to the World Health Organization, half of the 2.6 million stillbirths that occur during labour and birth every year are easily avoided with simple, timely interventions. In our case it was poor service delivery.
I started my career working on health system strengthening in post-conflict Liberia and was proud when the country achieved one of the key Millennium Development Goals in 2015 by slashing under-five mortality by two-thirds. This was made possible by progressive systemic changes from Madame Sirleaf’s government, donors and health professionals (especially midwives) across the country.
The current government has failed to renew the roadmap for accelerating progress towards ending preventable maternal and child deaths in Liberia. We could afford for my nephew to be born in a private specialist health facility, supposedly with a skilled midwife – yet this is what happened to him. Think of the number of babies in Liberia who die every year due to lack of access to skilled birth attendants and/or quality care.
Yes, we can
Ending preventable newborn deaths and stillbirths in Liberia and other countries is possible – but it requires systemic changes (legislation, budgets, administrative structures, etc) from governments, as articulated in Save the Children’s report Ending Newborn Deaths.
In Liberia, with the 2019/20 budget submission fast approaching, the government should:
- Remove user fees at the point of service to improve more equitable health access, particularly for the most disadvantaged communities.
- Develop a health financing policy which will support improved investment in the health system and an adequate package of services, with a focus on the poorest people.
- Increase public spending on health from the current 1% of gross domestic product to 5%, towards UHC and in line with calls from UHC2030.
- Strengthen primary health care and facility-based paediatric services by investing in infrastructure, equipment, essential drugs antibiotics and oxygen, and skilled health personnel, and address supply-chain gaps.
- Strengthen procurement and supply of life-saving commodities, such as antibiotics and oxygen, at the community and facility levels.
Photo: Newborn baby Maraga holds his mum’s hand at a clinic in Busia County, Kenya (Allan Gichigi/Save the Children).