The things we consider inconsequential to our existence are quite often the very things that save our lives. For many people in Ghana, the onus of providing quality maternal care lies squarely on the laps of the government.
This assumption may, to some extent, hold truth in the face of the taxes which Ghanaians are saddled with; but a more discerning way of considering this matter is to look to one’s self first before laying perpetual blame on others. What am I doing in my own way, however little, to save a life? How can I help to ensure that mothers and children don’t become mere statistics in the tally of fatalities every year?
The World Health Organization estimates that for every 100,000 live births, 350 women will die. This means that one out of 70 Ghanaian women aged between 15 and 49 will die from pregnancy and childbirth.
In this interview with a mother who was snatched from the excruciating sting of death during delivery by four pints of blood and a team of dedicated medics, we examine what we must do in Ghana’s quest to ensure greater maternal survival in Ghana.
MamaYe GH: How did you feel becoming a mother for the first time?
ELIZABETH: It was very exciting. You can’t imagine what it is like until you experience it. The sense of joy of seeing a little bit of you in another person and a bit of his father… It’s a lot of joy. MamaYe GH: Has it changed you in anyway?
ELIZABETH: Of course, because now you have somebody that you have to answer to. Babies are generally selfish. They want your attention, they are hungry, they cry so yeah, it changed my life. You get more responsible.
MamaYeGH: Tell us a bit about your encounter with near death. How did it happen?
ELIZABETH: This was the birth of my third child. The first one had been relatively easy. Even though I bled a bit after the birth, I was given some injection and it stopped. The second one was very smooth. No problems at all. Then I had the third one three and half years later in the same private clinic I had the second one. I was very fit, a very good patient. My blood pressure was good. I took my antenatal very seriously so I was ok. On the 24th of February 2003, that is, the night before I had the baby, there was quite some movement in my stomach. Later by dawn it had subsided and I woke up and I was quite okay going about my chores. Then around 12 o’clock I 'saw the show' and knew the baby was due.
My husband was at work and I couldn’t drive so I called a taxi cab which took me to the hospital that was some 10 minutes’ drive from my house. I got down and walked in.
MamaYeGH: So you did all that by yourself and all this while you were ok? ELIZABETH: I did everything by myself. I was fit so I went to lie down and they checked me. At that point they said I was two fingers or two inches but I wasn’t contracting. That for me was normal. For both previous births, I would dilate the first few inches without contracting so they decided to induce the birth. This was also the case with the two previous ones. So they started inducing me and I was lying there chatting with a young doctor. I was fine. After sometime, a midwife came to listen to the heart rate of the child and I guessed from her gestures and body language that something wasn’t right because she kept on checking the heart rate of the child. Not long after, they decided they will break the waters because that was what was supposed to help quicken the dilation. Again with both previous births I had gone through that process but this time, what was different was that, when she broke the waters, it hurt. It hurt quite badly so I remember shouting ‘ajeei’ (ouch). Not long after that, I felt this sharp pain going through my spine and my back and for a moment I thought that I would never walk again. It was a paralyzing feeling. So they rushed the gynaecologist in. Apparently my eyes were bloodshot at the time so he told me to relax but I told him “no something terrible is happening to me.”
I then felt like pushing and the nurses said that place was not the delivery room so I shouldn’t push but the doctor overruled and allowed me to go ahead. I pushed and of course with a lot of pain and by God’s Grace, the baby came. When the baby came out, I realized he wasn’t crying so I asked them but in fact they rushed to work on him immediately because the cord was wrapped around his neck twice.
Afterwards, the midwife who was in charge came to clean me up and then she asked me to urinate but I couldn’t and this was after the placenta had come out. Then I started bleeding so they called the doctor and I guess they gave me some injections to try and stop the bleeding. By this time my brother who was a surgeon at 37 Hospital had arrived with my husband and mother.
I was bleeding and started feeling weak and dizzy so I thought that it was because I hadn’t eaten. I had read somewhere that pregnant women shouldn’t eat when they get into labour because they could go into surgery. I asked for a bottle of malt and drank it but afterwards, I started shivering, and all the blankets in the hospital couldn’t keep me warm. I was pouring (blood) severely at this point. So they put plasma - a blood substitute - on me. They didn’t have blood; it was a private hospital. They then decided that they had to send me to the theatre quickly because it had been decided that maybe my uterus had ruptured.
Before I went into the theatre, I told them to bring my child to me and at that time they had finished working on him and he was okay. MamaYe GH: What went through your mind between the time the baby came out and when you were about to go into the theatre room?
ELIZABETH: When the nurse was preparing me, I saw her praying saying “God please help me. I only came to look for my daily bread. Please help me. Don’t let this woman die.” And I knew it was bad. I looked at my brother and I said “Are you people going to watch me die?” He did not answer but the look on his face was very grave. But I had faith, the faith of a Hebrew woman. My father had told me that I wouldn’t die giving birth – it was a covenant in the bible in which he believed. I held my son in my arms at this point and said to him, “your name is Mawuena” - We named him after my father once I realized he was a boy and I said: “you wait for me. I will be back to breastfeed you”. But at this point my biggest worry was my second child. He was only three and half years old and he was very, very close to me. During my pregnancy, he would always be with me and I was only 38 years at the time. Who would take care of my three children? It was a frightening experience; very, very traumatic because you are losing a lot of blood and it’s a life and death situation. You can’t imagine the trauma!
Actually, I prayed and I negotiated with God to give me life and that I would be a better person. You go through those emotions because you are going down but somehow I was a bit assertive when I noticed I was blacking out. I shouted “eeee I’m going down oooo.” They administered more plasma and I felt a bit better.
My mum said while she was out there and I had been taken into the theatre, the nurses would come and pour something out, so when she noticed it was my blood, she also almost passed out and had to be treated. Well, since there was no blood at the hospital, my brother had called a colleague at 37 Military Hospital to arrange blood and had rushed over there to pick it up. In the end, they got only two pints.
MamaYeGH: How many pints did they need to take care of you?
ELIZABETH: Eventually they gave me four pints. I am sure I may have received more if it was available. Even with the two from 37, the ambulance bringing it was slow because it was rush hour and it was getting late. I’m told it was the driver’s first day on the job as well so you can imagine his confusion. During the surgery, I am told the doctor and nurses kept asking for the blood and eventually when they brought it, they screamed: “only two?” My husband and my brother had to go to the Tema General Hospital for more blood this time in his car.
The surprising thing is, the doctor told me the lights went off during the surgery whilst I was on the operating table. For nearly 10 minutes the stand-by generator wouldn’t come on and at this point the doctor said I was bleeding profusely.
According to the doctor, what had happened was a case of Amniotic Fluid Embolism. This means the amniotic fluid had gone into my blood stream and was preventing my blood from clotting. A condition known as DIC (Disseminated Intravascular Coagulation) set in making it even more difficult for my blood to clot so my blood was just pouring all over. My brother said when they brought the first two pints of blood and he was handing it over, he caught a glance at me on the theatre table and I was ‘paper white’. I mean ‘paper white’ – my brother is a surgeon and does not need to exaggerate.
The doctor had removed my intact uterus and one ovary just to try to save my life. He told me that at a point he almost gave up because the situation was really bad. He confessed it took a jolt from the anaesthetist at that point for him to continue with the work. He could not get a pulse at one point. But by God’s grace, God’s grace, God’s grace; I came out of the surgery alive. My husband saw him leave the theatre bare chested, sweating profusely to try other stethoscopes.
MamaYeGH: How long did the surgery take?
ELIZABETH: From what I have been told, I estimate that the surgery took at least an hour and a half. I also spent some time in the recovery ward. I had the baby at 3:20pm. They took me into the operating theatre around 4:00pm and I regained consciousness after midnight.
MamaYeGH: What happened next?
The doctor told me that my situation is a rare case which he had only seen once in his career and that even in the developed countries the mortality rate is 80 percent and a large proportion of those who survive become" vegetables."
I stayed in the hospital for a week after which I was discharged. But I don’t know which one was worse – before or after being discharged. I had lost muscle and was completely flabby everywhere. I was anaemic; my Hb was only 8 even after the four pints of blood.
Every part of my body ached. I had to be bathed and fed. I struggled to regain the lost energy. Eventually, I developed Post-Traumatic Stress Disorder (PTSD); my blood pressure and high heart rate had become major problems. My physician told me that they mostly see this level of traumatic disorder among soldiers who have returned from war.
I was still seeing spots of blood weeks after I was discharged but the doctor said there was nothing wrong until I drew his attention to how severe it was becoming. Then he asked me to do some tests after which I was taken to the theatre again to stop the spotting.
The sheer pain and trauma I went through is inexplicable no matter how hard I try. To date I am on daily medication to control my blood pressure and heart rate.
I had to resign from my job at the Pioneer Aluminium Company as a Marketing Manager and my husband, brother and my mother were such strong pillars in this trying time that I cannot thank them enough. MamaYeGH: So who do you think was at fault in the whole process leading up to the surgery?
ELIZABETH: The gynaecologist says that they couldn’t predict that I would develop any such complication during delivery. I would not want to blame anyone. I am truly grateful to God that I had people who were committed to ensuring that I was fine. Even though I prayed and told myself that I would not die and kept reciting Psalm 23, the doctors did well to revive me despite the difficulties. Clearly, their expertise helped to ensure that I am still alive today.
It was really risky you know? If I was in a place where there was no generator; if my brother didn’t work in a hospital and have relatively easy access to blood at the time; if I wasn’t lucky to have the doctor and the officials like the anaesthetist; if the roads were not good enough – see what the traffic nearly caused – so it was a number of factors that contributed to saving my life.
MamaYeGH: You have been there and survived. What would you say must be done to ensure that as many more lives like yours are saved?
ELIZABETH: There are many things that can be done but I believe that one of the most important is to make blood readily available to any Mama who needs it. That is why we must intensify this MamaYe campaign on blood donation. We must ensure that people know that blood has no substitute and it is a matter of life and death. One pint can make a difference. We must encourage people to become regular donors and get corporate Ghana to sponsor people to donate blood.
For me it’s a question of priorities. Where are we putting our priorities? I don’t want to sound political but is it in political billboards? Is that our priority as a nation or is it in getting one air ambulance that can move from Kumasi to Takoradi and to other places quickly?
If we make safe birthing a topical issue, the district assemblies and corporate bodies among others can contribute to change the situation because if women are dying at the rate of 8 per day – healthy women – leaving behind their husbands, their children and their jobs then maybe we haven’t made enough noise to bring the situation home to policy makers and implementers. My situation was one of the extreme ones but many women die from less severe complications due to the absence of the right services and infrastructure. I believe with the right structures, ambulances, good roads, availability of personnel, proper training of midwives and nurses, availability of safe blood and avoidance of fake drugs, it can be done.
That is why I am all for maternal death audit review. Let’s understand every maternal death in this country. Can we draw any lessons from it to reduce maternal mortality? I am confident that if we checked and did an audit with some neutral people on the review teams, a lot more could be done to save our mothers. MamaYe!! We all love our mothers, don’t we?
The Ghana Health Service says haemorrhage or what we call loss of blood during delivery is the leading cause of maternal deaths in Ghana.
NO WOMAN SHOULD BE ALLOWED TO DIE WHILST FULFILLING HER BIOLOGICAL ROLE. IT’S A TRAGEDY. Donate blood today! Save a mother!
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