Death at birth: Who is responsible?

 

Margaret Babirye, who recently lost her newborn baby at Jinja Referral Hospital, blames staff for negligence while handling her case. 

 She never got to see or hold her baby alive. He was dead before she came to from a Caesarean operation. Margaret Babirye and Benjamin Schaf blame their loss on hospital staff negligence, writes Dalton Wanyera

 

After months of anticipation, it’s hard to imagine anything more devastating than the loss of a newborn child. Benjamin Schaf and his wife, Margaret Babirye, have lived the reality of losing a child soon after birth. Their baby only lived less than 15 minutes after delivery at Jinja Referral Hospital on May 31 this year.

The 23-year-old mother narrates how she had arrived at the hospital two days before that, amidst labour pains.

Being a Sunday though, her appointed doctor was unavailable at the hospital and couldn’t be reached on phone until Tuesday around noon when he reported for duty, declaring her an emergency case requiring immediate surgery.

Schaf recounts that by then, his wife was too tired, in so much pain and had a greenish fluid flowing between her legs. The operation was done nonetheless and it was a success but its purpose, to bring forth life, had failed. The delivered baby didn’t even live long enough to meet its mother who was still weak and semi-conscious.

The couple has not been able to hide its anguish at their loss, which has been worsened by their conviction that their baby died due to neglect by medical staff.

Hospital medics neglected me

Babirye says she feels she was neglected when she couldn’t reach her booked doctor, even though she had paid all her dues in the hospital’s private wing. Well-wishers had, on arrival, advised her to seek help from nurses on duty in the general ward but she says that despite the unrelenting pains, the nurses, without a single test, had concluded that she was due for delivery the next day (Monday).

“The nurses who came to my bed just looked at me. One told a colleague I was not due. They advised me to stop ‘making noise’ because all the women in the ward were there for one reason, to deliver,” she recounts.

She says all medical officers in the hospital ignored her and instead kept reminding her that she was there to see a specific doctor. “When I go to a hospital, I expect to be worked on by any qualified person who was available. I had called my doctor but couldn’t reach him on phone; does that mean that if he never showed up I was to be left to die?” she reasons.

In his response, Charles Tumushime, the principal hospital administrator, explains that as is the norm in all hospitals, once a patient has booked for a particular medical personnel, it is an agreement. “It is presumed that this medic has better understanding of that patient, except when he asks for a hand from a colleague. Patients are seen by one person at ago,” explains Tumushime.

Causes usually unknown
Dr Michael Oscinde, a senior consultant obstetrician, who is also the director of Jinja regional referral hospital, explains that stillbirth, which is the loss of a foetus in the womb or of a newborn within 12 hours after birth, could be due to different causes, most even unknown.

Oscinde explains that there are basically two types of stillbirths. Fresh stillbirths, which is death within 12 hours and occurs in the process of child delivery. The other is macerated stillbirth, when a foetus dies in the uterus before its born. He adds a fairly new category of early neonatal death, where death occurs 24 hours after the process of delivery.

“The cause of many stillbirths is unclear, and while there’s increasing evidence of a strong link between stillbirth and poor growth in the womb, in many cases the reasons for death are unknown,” he says.

He explains that where the cause of death is identified, the most common reason is congenital problems, which are defects present at birth, whose causes may still be unknown, genetic or difficulties during pregnancy.

Other possible causes include a birth trauma, for example where the umbilical cord could become wrapped around a baby’s neck.

Oscinde, in his outline of the common causes of stillbirths, categorises them into two: labour-related conditions and maternal illnesses like malaria, high blood pressure, diabetes, among others. The latter, he says, usually cause premature labour and other complications which, he argues, are avoidable once a medic handling a patient is in the know.

He says worse results are expected when labour is not handled by a skilled person, like traditional birth attendants.

The obstetrician nonetheless agrees that prolonged labour could be a viable cause for still births. “In the case of Babirye, her labour could have stayed too long. At maximum, a mother should stay in labour not more than 10 hours. Beyond this, there will be a risk of losing both mother and baby. In most cases, the baby will succumb.”

He adds that the moment any patient, including mothers in labour, arrive at the hospital, medics should carry out a risk assessment. This helps in allocating who handles which patient depending on the condition and qualification of the personnel available, requires urgent attention.

In the meantime, however, Schaf and Babirye feel the hospital did not do the right things at the right time.
“It is out of luck that I survived. We got no attention until after the baby passed on. They were now treating my surgery wounds. I was in a lot of pain, from the wounds and the fact that I lost my child,” Babirye says.

Dr Oscinde, however, advises the bereaved couple who have insisted they feel their loss was due to medical neglect to desist from such hurried conclusions, as in Uganda, stillbirths cannot be limited to one cause.

“An autopsy to offer full explanation as to why a baby died may not be possible, but the investigation may show up information that could lower the risks in future pregnancies,” he says.