Monday, June 11, 2018

Agony of late-term pregnancy loss

 

By Dr NELLY BOSIRE

Nothing makes an obstetrician go cold like a panicky call from a pregnant woman saying the dreaded: “I can’t feel my baby moving!”

I got that call from Sophia* a patient who was 34 weeks along, one morning before I had even woken up. She was frantic and hysterical.

I directed her to have an ultrasound at a radiologist’s at 8am because she was too anxious to wait for me to get to the practice for review. By the time I saw her, she was a mess. Her eyes were red and puffy and the tears flowed freely.

We had to induce labour to deliver the little one. Watching her brave the pain knowing that there would be nothing to show for it at the end of it all is more than anyone should have to bear. The baby died of a cord accident; the umbilical cord was tied up in a knot that tightened and cut off blood supply to the baby, resulting in death.

I wondered if the little one felt the oxygen supply being snuffed out. Did she struggle like a person drowning, just to get a lungful of air, or in this case, a placenta-full of oxygen from mummy?

Did her dark warm pool of amniotic fluid turn darker as she faded in and out of consciousness, before being enveloped in the deceptively warm cloud of death? Was she in pain? We shall never know as foetuses haven’t managed to communicate with us yet.

Last week I sat in the house reading a message about a colleague who had just lost his newborn twins. I stared at the screen of my phone, devastated, wondering how the mum was feeling.

The excitement of nurturing not one, but two lives, cut short. Having borne the discomforts of pregnancy with dignity and grace, knowing that she had a higher calling greater than her comfort. Delivering the tiny beings and watching them fight for dear life, but holding on and not giving up. Spending every living moment saying a prayer for them, having nothing else left to do.

Crushing blow

to not have the pleasure of holding them to your breast and nourishing them as is every mother’s dream because they are too tiny to suckle. The crushing blow to your heart after the horribly harsh journey when you are told that they are no more. That their journey has ended before yours as their mother even began. That they never got home to the nursery you had lovingly decorated. Never got to lie in the cot you had carefully selected. Never got to wear the clothes you spent hours shopping for.

Who consoles such mothers? Where do they go to lay down the pain in their heart? What do they ask for when they get down on their knees to pray? They asked in earnest that their little angels may live and God said NO! So what next? The price to pay for the loss of the little ones is hefty.

The physical wounds resulting from surgery, the staggering hospital bills as no expense has been spared to give the little angels a fighting chance and the emotional toll on the family is no mean feat. But nothing compares to the mother’s heartbreak that will never fully heal.

Did you know that there are online sites fully dedicated to poetry from parents who have lost their loved angels expressing their pain? Neither did I. When I found one, I read a few of the poems and they brought tears to my eyes.

Perinatal death is a dragon whose fire we have not succeeded in putting out in our country. We focus on maternal death because it makes us feel guilty to lose an adult people have known for years when we could have prevented it. Yet despite being so vocal about it, our maternal mortality rate is still at an unacceptable 362 (deaths) for every 100,000 live births.

Callous attitude

However, our attitudes to the loss of babies in the period just before delivery, during birth and in the first 28 days after, are a little callous. We quickly want to brush the loss aside and move on. Because we did not know this little person. We did not get to call them by name or learn their personality. The neonatal mortality rate in 2017 stood at 22 deaths for every 1,000 live births. We are not hearing enough noise about this.

A lot of these babies could be saved with functional healthcare systems. But when the country boasts a handful of neonatologists and most newborn units across the country are poorly equipped and lack neonatal nurses to care for the babies in need, we are surely condemning them to a quick exit.

For the mum going through such a deep sense of loss, if you are not sure what to say to them, don’t say anything. They are going through unimaginable pain. They are blaming themselves yet they crossed unimaginable territory in the fight to keep their babies alive. Have they lost faith in God? Let them be; they will come around when it is time. If they do not want to see a newborn, it is in order; don’t flaunt yours. Do not do any more harm.

Our psychologists and psychiatrists must take to the frontline in supporting these mums.

As their caregivers, obstetricians and neonatologists need extra sensitivity training and counselling skills to effectively deal with the shell of a woman the loss leaves behind.

You cannot claim to provide care when you are terrified at the sight of tears. The mother will cry a river in your office. If it makes you sweat instead of drawing out your humane side, you are in the wrong profession!

The author is an obstetric/gynaecologist practising privately in Nairobi.

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