Maternal Mortality and C-section Complications

The woman lying expressionless on a cot in the dimly-lit I.C.U. was about my age. She had highlights in her braided hair and deep brown, sunburned skin. She arrived at Centre Hospitalier Universitaire de Kigali (CHUK) yesterday for management of postpartum hemorrhage.
I listened to the resident anesthesiologist present her case. Her name was Clementine. She was a 22-year old farmer who had delivered at a rural district hospital. Within hours of her C-section, she began bleeding due to a suspected ruptured uterus. However, the amount of blood loss was underestimated and she was not managed appropriately. Later she was transferred to CHUK for surgical intervention. But by the time she arrived, she was already in severe hypovolemic shock. Her prognosis now was poor. I wondered about the baby boy she just delivered. He would likely never know his mother.
Clementine’s story is becoming disturbingly familiar to me. Since arriving in Kigali, we have sifted through over 300 medical records of complicated C-section or vaginal deliveries from the past year. The data tells a bleak story. So far we have counted 56 maternal deaths and 70 infant deaths – a startling number given our small sample size. The worst complications occur in young rural women who have C-sections, like Clementine. And the most common causes of death – hemorrhage, eclampsia, sepsis – are preventable.
Our project, supervised and led by three CHUK anesthesiologists, also aims to “audit” each district hospital in Rwanda for the number of C-sections performed and indications for each. Hopefully, this data can then be used to reduce Cesareans that are not medically indicated. Because CHUK is a tertiary referral hospital, it is an excellent place to conduct this research and implement protocols to address the problems.
It is often forgotten how dangerous childbirth can be for mothers, particularly in low-resource settings. But we must keep asking: Why must women face death or severe injury for carrying out a basic reproductive function? I am grateful to be working with doctors who have made addressing this question a priority.
I am also grateful to be living in Kigali, Rwanda, one of the most beautiful places I’ve been.
-Shefali Hegde

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