Mother delivers triplets by her own

By Tom Gwebayanga

Nakaibale with her triplets at home in Bukwaya-Inuula, Bugyenda district

Annet Nakaibale, a mother of eight, knew she was carrying more than one baby, but did not expect triplets. As fate would have it, labour pains struck when she was by herself in a grass-thatched hut.

The 35-year-old narrowly survived death. She recently successfully delivered triplets without anyone’s help.

The resident of Bukwaya-Inuula in Bugaya subcounty, Buyende district, says the labour pains began at about 7:50am when all her children had gone to school and the neighbours to their gardens.

“The pains started abruptly but I did not have the energy to walk to my neighbours, who were tending to their gardens,” she says.

Nakaibale delivered the first child, but hardly had she reached for the razor blade to cut the umbilical cord, when the second baby came. “After cutting the second cord, I thought it was over, but fresh pains erupted and the third baby came.”

As Nakaibale lay in a pool of blood wondering what to do, she heard someone walking past her hut and she made an alarm.

“Help, I have delivered triplets, but I am desperate,” Medi Kabolu, the passerby, narrates. “The triplets were crying helplessly, lying bare on the ground.” He did not know what to do, so he also raised an alarm. Sympathisers gathered around her and mobilised a motorcycle that transported her to Bugaya Health Centre III, 15km away.

The babies’ weight had not been established, but they were healthy, according to medical workers at the health centre. Unfortunately, Nakaibale’s husband, David Kaduku, left four months ago to burn charcoal in Kiboga Forest, so he was not at home to welcome the bundles of joy.

“I am happy that I survived because I would have bled to death. I thank my fellow residents for their support” Nakaibale, says.

She says four months ago, the attendants of a nearby drug shop had examined Nakaibale and revealed that she was carrying more than one baby, but did not divulge more details.

On why she did not consult the experts, Nakaibale says she could not afford sh10,000 to hire a boda boda to Bugaya Health Centre III.

Challenge of health facilities in Bugaya

Charles Musasizi, the district health inspector for Buyende, says Inuula parish comprises 14 villages with only one health facility, Bugaya Health Centre III.

He adds most maternal deaths result from failure of mothers to make it to the health centre because they cannot afford the transport costs. Musasizi says there is also shortage of medical workers. The people manning the drug shops usually double as midwives.

According to Dr. Thomas Suubi of Suubi Medical Clinic-Mateete, Sembabule district, an expectant mother must be put under surveillance to minimise pre-and post-delivery complications.

Recently, Sarah Naigaga, a resident of Buseete, Buyende district in eastern Uganda, also delivered a baby in Buyende livestock market.  Such occurrences are common, since the Melinda Gates Foundation that used to transport pregnant mothers in Buyende and Pallisa districts phased out the project in 2010.

Understanding the risks involved

Any pregnancy is challenging, but for a multiple pregnancy, the experience is more demanding and the risks, high

If you are expecting more than one child, you are at a greater risk of pre-eclampsia, a life-threatening condition that occurs during pregnancy and/or immediately after giving birth.

The condition is characterised by a rapid rise in blood pressure that can lead to seizures, stroke, multiple organ failure and death of the mother and/or baby. One, therefore, has to understand and appropriately respond to the warning signs of preeclampsia before the condition gets out of hand.

Multiple pregnancies are high risk and an obstetrician must watch the pregnancy closely because it can result in pre-term birth. A pre-term birth is when a baby arrives before 37 weeks of pregnancy.

The further on into your pregnancy you are, the more likely it is that your baby will do well. This is because his organs will be more mature, his lungs will be better prepared for breathing and he will have more strength for sucking and feeding.

You may face physical complications from the added strain of carrying additional weight for a longer period of time, and you might feel some extra psychological stress over wondering how you will feed and care the babies

Sometimes one baby will get more than its share of oxygen and nutrition at the expense of the other. This puts both in grave danger, as the overload on the larger twin can be just as lethal as the deprivation to the smaller one.

Regular ultrasounds are, therefore, needed to make sure the babies are growing at roughly the same rate.

Delivery poses dangers as well. Breech babies are frequent. This is where the baby’s buttocks and/or feet will be positioned. This makes C-section the safest way to deliver.

Source: http://www.newvision.co.ug/news/636548-mom-delivers-triplets-on-her-own.html

 

Maternal health is a human right – activists

By Vicky Wandawa

The Population Secretariat (POPSEC) has started campaigning for maternal health as a human right. The project, launched on Thursday at Hotel Africana, Kampala, changes strategy from merely advocating for maternal health to creating massive awareness that it is a human right.

Dr. Betty Kyadondo, the Head of Family Health Department at POPSEC said they hope this will empower all women with knowledge regarding their rights to health. This will exert pressure on the government to respond accordingly.

According to the Uganda Demographic and Health Survey 2011, 438 mothers out of every 100,000 live births, die while giving birth. The figure has risen three points from 435 deaths in 2006.

Presenting a report by POPSEC, Kyadondo called it developing the capacity of duty bearers, the government, to meet their obligations and encourage rights’ holders, the community, to claim their rights.

“A woman in the village does not know that health is her right,” she said. “Once they do, and start demanding for them, then the government will shift priority. When the community gets empowered, then the voice will be even stronger.”

States are obliged, under international human rights law, to respect, protect and fulfill the human rights related to pregnancy and child birth, for example, ensuring women’s access to a wide range of sexual reproductive information and health services, including family planning, antenatal care, skilled delivery and post natal care.

Through the Partners in Population and Development Africa Region, POPSEC was commissioned by the World Bank to implement the project. Dr. Jotham Musinguzi, the Regional Director of Partners in Population and Development Africa Region, noted that mothers were dying from preventable and treatable diseases, and such approaches are needed to scale the numbers down.

The chief guest, Hon Gabriel Aridru Ajedra, the MP of Arua Municipality, also minister designate for investment, described the intervention as unique

source: http://www.newvision.co.ug/news/636714-maternal-health-is-a-human-right-activists.html

350,000 abortions in Uganda are induced – experts

Article by Catherine Mwesigwa Kizza ( New Vision)

Infanticide, child abandonment and abuse — the Ugandan media is full of the stories. The missing story though is that the abused and murdered children are most probably survivors of induced abortion.

“There are over two million conceptions in Uganda every year. 200,000 to 300,000 of these miscarry or abort spontaneously but 350,000 abortions in Uganda are induced,” said Dr. Charles Kiggundu an obstetrician and gynecologist at a breakfast meeting convened by the Center for Reproductive Rights and Centre for Human Rights and Development in Kampala Wednesday, to discuss the laws and policies on abortion in Uganda.

“90,000 of the induced abortions end up with severe complications but only a half of them access post abortion services,” he added.

“Only half of the women with complications seek medical care. A few survive but many others die,” he added.

Joy Asaasira of CEHURD said of the 20 women in Uganda who die due to pregnancy and childbirth-related complications every day, four to five of these are due to induced abortion.

Dr. Kiggundu says these are needless deaths. The policy environment allows women to receive healthcare for post- abortion complications, however, studies have shown that when they seek care, it takes about 44 hours for them to get attention compared to 35 to 45 minutes other women spend in hospital before getting a service.

“Health workers do not want to treat women with abortion complications because they do not want to be seen to be accomplices to the termination of pregnancy,” he said.

He also pointed out that phrases on hospital documents like “Police notify” worry health workers and are a deterrent to provision of care for women.

‘Health workers do not want to get involved with police. They want to do their work unencumbered,” he said.

Women induce abortions due to unwanted pregnancies due to wrong timing of pregnancy or economic and social hardships.

“Some men tell their wives to abort because ‘they stopped having children’ and yet did nothing about it,” Dr. Kiggundu said.

Those who survive death end up with chronic pain, anemia, and infertility among other complications.

He said safe abortion services were available but hidden to the poor.

“You must be connected and well-oiled to access the services. Some women fly to South Africa to terminate pregnancies and return,” he revealed.

The consequences for the majority who go to quacks or unskilled medical workers working undercover are dire.

“We recover forks, pens, knitting needles, bed springs, sticks, herbs from women who run to us with botched abortions. Some of these things kill the woman before they even kill the foetus,” he said.

Treatment for those who survive death is expensive. According to CEHURD, sh17.6bn is spent on treating abortion complications.

Not only can this money be saved and spent on worthwhile health causes but women’s lives can be saved as well.

According to Dr. Kiggundu, the Ministry of Health’s comprehensive abortion care includes sexuality education to promote safe sex practices, family planning use including access to emergency contraception, reducing fertility, providing safe abortion services and quality post-abortion care.

Government is also training nurses and giving them skills to perform manual evacuation procedures to attend to women with incomplete abortions.

“There are still many gaps,” said Dr. Kiggundu. “Uganda still produces health workers for export and retains only a few.”

He revealed that only 30% of the vacancies for skilled health personnel required to provide safe motherhood are filled.

It is no wonder that despite government commitments, advocacy efforts, plans and policies to reduce maternal deaths in the country, there has been no progress in this indicator in the past five years.

New data from the Uganda Demographic Health Survey report of 2011 show that the maternal mortality ratio increased from 435 deaths per 100,000 live births in 2006 to 438 deaths, though other international studies show a decline to 310 deaths per 100,000 live births.

“26% of these deaths are due to unsafe abortion,” said Elisa Slattery the Regional Director, Africa Program Center for Reproductive Rights.

Once addressed, reduction in unsafe abortion contributes to reduction in maternal death.

Slattery said studies on the law on abortion in Uganda have found that “abortion is permitted where a mother has severe illnesses threatening her health like cardiac disease, renal disease, eclampsia.”

The Centre for Reproductive Rights study also found that healthcare providers are not required under the Uganda law to consult one or more providers to get their consent before terminating pregnancy as has been previously believed.

The organization is calling on government to broaden access of information among healthcare professionals and the public as a means of stopping the tragedy.

source:http://www.newvision.co.ug/news/634689-350-000-abortions-in-Uganda-are-induced—experts.html

Functional health delivery system is the right answer, not legislation

I would like to respond to the story titled, ‘Kabale considers a by-law to force pregnant women into hospital’ in the Daily Monitor of July 27. The story said the by-law will compel pregnant mothers to deliver in a health facility and penalise those who deliver under the care of a traditional birth attendants.

Experience from around the world suggests that about 15 per cent of all pregnant women will develop obstetric complications and that not all these complications can be predicted. Delivery under the care of a skilled health care provider – midwife, doctor, or nurse with midwifery skills – is the safest method for saving the lives of mothers and their newborn.

Countries with the highest skilled attended deliveries such as Sweden and Malaysia are also the nations with the lowest maternal and newborn deaths. Every year, 350,000 women worldwide die during pregnancy, or during labour, almost 1,000 a day. Of these deaths, 99 per cent occur in developing countries such as Uganda.

Every year, up to 2 million newborns die within the first 24 hours of life. Uganda looses 45,000 newborns annually; many more suffer birth trauma that impairs their development and future productivity.

In recognition of the critical role of skilled care in reducing maternal and newborn mortality and morbidity; Uganda has committed itself to increasing skilled attended deliveries from 53 per cent to 90 per cent by 2015.

I would like to commend the local leadership in Kabale District for recognising the importance of skilled healthcare and their intentions to encourage mothers to deliver in a health facility instead of under a traditional birth attendant. However, enforcing skilled attended delivery through a by-law is not the answer.

A survey conducted by White Ribbon Alliance for Safe Motherhood in six districts in Uganda (Assessment of Maternal Health Services in Six Districts in Uganda, 2010) showed that health facilities in Kabale had only 2 per cent of the required midwives and only one doctor. None of the health centre IVs could provide blood transfusion services or caesarian sections. Many facilities lacked essential supplies, transport for referral of obstetric emergencies at HC4 and 3.

I would like to request the decision makers in Kabale District to examine the current healthcare delivery system and make it attractive to the clients by providing an attractive healthcare delivery package to women. That means adequate supplies, equipment, provision of emergency obstetric at HC 3 and 4, adequate midwives. Conduct community awareness raising about the benefits of skilled attended births in addition to addressing social-cultural factors that limit a woman’s ability to access her maternity care services.

The government should play its role of ensuring adequate financial and human resources towards meeting its national and international commitments on Millennium Development Goal 5 and support local governments to deliver quality services to its citizens. Uganda committed itself to giving the health sector 15 per cent of its annual budget.

Robina Biteyi,
biteyi.robina@gmail.com

Source: http://www.monitor.co.ug/OpEd/Letters/Functional+health+delivery+system+is+the+right+answer/-/806314/1470142/-/4crjqsz/-/index.html

Kabale considers law to force pregnant women into hospitals

 By Robert Muhereza

Kabale District is working on a by-law to compel pregnant women to give birth at health facilities and penalise those who deliver aided by traditional birth attendants (TBAs).

District speaker Pastoli Twinomuhangi said on Wednesday that he is ready to present the draft by-law for the council’s consideration. This follows a recent survey in Rukiga, one of the four counties in Kabale District, where it was found that nearly one in every two expectant women that TBAs help to give birth, die.

“An ordinance is already being drafted to compel mothers in labour to deliver at the established government health centers in order to save their lives and that of the babies,” Mr Twinomuhangi said.

However, according to District Health Officer Patrick Tusiime, the number of women delivered by TBAs has reduced due to intensified mobilisation through media and community meetings.

Half of pregnant women in the district now deliver at health facilities, up from 12 per cent five years ago, the doctor said.

Complaints
However, Ms Allen Busingye, a businesswoman in Kabale town, said some of them prefer the services of TBAs because they offer “motherly care unlike in the health centres where we are attended to by young and abusive nurses.

“The young nurses are rude to the mothers in labour pains,” she said.

The government outlawed the traditional birth attendants, but they continue to thrive especially in rural areas where public health services are either lacking or unaffordable.

The District Deputy Resident District Commissioner, Mr Nickson Kabuye, said his office is investigating reports that some health workers in the district on government payroll extort money from women seeking antenatal care, forcing them to turn to TBAs. The culprits, he said, will soon be exposed.

TBA head responds
The head of TBAs in the district, Mr Charity Mugisha, said an accusation pinning them on causing maternal deaths is baseless because reports of women dying in labour at hospitals are a common place hence not of their (TBAs) own making.

“Traditional Birth Attendants are complementing the government efforts in assisting pregnant mothers to have safe deliveries,” he said.

District vice chairperson Mary Bebwajuba noted that a shortage of qualified staff coupled with lack of ambulances are the reasons behind the delay of referrals, leading to many deaths of expectant women in the area due to delayed birth.

Source: http://www.monitor.co.ug/News/National/Kabale+considers+law+to+force+pregnant+women+into+hospitals/-/688334/1463854/-/iox4poz/-/index.html