Archives: Case Studies

‘My labour pains started at midnight and my husband was so scared since it was our first baby. He rushed to tell my mother. She told my husband, Joseph, to put me on a bicycle, which was already on standby, and start off to the hospital.’

This is the beginning of the story of Mary and Joseph Chimwanza from a remote village in rural Zomba, Malawi. It is a story of how conditions in some areas of the world makes childbirth life-threatening both for mother and child. However, it is also a story of how help and kindness from strangers can save lives and inspire us.

‘On our way to hospital, we met some people who were coming from the beer hole. We become scared and because of my condition, we decided to face them and explained our story – that we were rushing to the hospital for delivery. The men then decided to escort us to the health centre.’

‘Later in our discussions with the men, we discovered that two of them belonged to the Participatory Learning Action (PLA) group in our village.’

In 2015, Maternity Worldwide introduced a project on improving maternal and newborn health to 80 villages in the Zomba region where Mary and Joseph Chimwanza live. As part of the project, Maternity Worldwide introduced Participatory Learning Action (PLA) activities to women’s groups in 80 villages in Zomba. At the meetings, participating women and men are educated about how women remain safe during pregnancy, about the danger signs of pregnancy and when should they seek help.

‘My condition become worse when it started to rain and it was cold. One of the men who joined us had a raincoat which he gave me and we had to seek shelter in the nearby village until the rain became less heavy. When the rain stopped, we continued our journey to the hospital where we were assisted quickly and it did not take long before I delivered our baby, Earnest. My husband was overwhelmed to learn that the men who helped us were part of the PLA Group and he was encouraged to join the PLA group in our village where he is still a member.’

‘As a small family, we are very grateful to Maternity Worldwide for having introduced the PLA to the women’s group in our village’

‘As a small family, we are very grateful to Maternity Worldwide for having introduced the PLA to the women’s group in our village and most especially that men should be part of it. If it were not for those men being part of the ‘women’s group’ it would have been very difficult for them to understand what I was going through as a first-time mother and difficult for my husband to realise the importance of being part of the group in our village.’

As Mary re-tells her story with baby Earnest in her arms, it is testament to the benefits of the Maternity Worldwide project. Mary and Joseph knew the importance of giving birth in a hospital and managed to get to the health centre safely, where they were met by a team of skilled medical personnel ready for delivery.

Meet Mary and her daughter Elen.  Elen was born 10 years ago after her mother, Mary, needed a caesarean delivery at the maternity unit set up by Maternity Worldwide in Gimbie, Ethiopia.  Mary needed to have a caesarean delivery as she had previously had one for the birth of her other child so was at higher risk.

Elen was born safely and we were lucky enough to meet her 10 years later as her mother, Mary, now works at the hospital as a nurse!  Mary has also assisted Maternity Worldwide volunteers working in the hospital to help other mothers give birth safely.

This was Qiybise’s fourth pregnancy. She had safely delivered each of her previous babies at home and was planning to do the same this time. The skilled Maternity Worldwide volunteer who was running the clinic assessed Qiybise to see if there were any factors in her pregnancy which would increase her risk. She also carried out an ultrasound using a small, portable scanning machine. This showed Qiybise had a very low lying placenta (after-birth) and which was extending across the cervix (the birth canal). This means the mother is at high risk as once labour begins the baby’s head descends and pushes against the placenta. This tears the placenta from the uterus and can cause the woman to bleed profusely. Haemorrhaging in such situations is a leading cause of death in childbirth. 

The volunteer explained the risk to Qiybise. Blood loss is so rapid in these situations that it is unlikely the mother will survive more than an hour without intervention. This condition put Qiybise at particular risk as she lives a two hour walk from the nearest bus station and it would be a further three hour journey to the hospital from there.  The volunteer explained to Qiybise that the safest option would be for her to have her baby in the hospital by caesarean section at 38 weeks.

“I only came to the clinic because I heard that another woman had got good information there. She told me her life had been saved because of what she was told. I wanted you to know that my baby was OK. We are so happy that you help our people and that you really care for us.”

Qiybise accepted this advice and arrived at the hospital when she was 37 weeks pregnant.  The evening before her caesarean section was due to take place she had a massive bleed. An emergency caesarean was carried out successfully by the Maternity Worldwide volunteer obstetrician at the hospital.

The risk assessment clinic ensured that the risk to Qiybise and her baby were quickly identified and that she had the information she needed to enable her to choose a hospital birth. Coupled with the skilled care she received at the hospital, this ensured that Qiybise was able to give birth safely.

Chaltu came to our maternal health risk assessment clinic at Ganji when she was 34 weeks pregnant. Her last pregnancy had ended in a stillbirth at home and, even though it was a two hour walk from her village, she was intending to come to the health clinic for this delivery. Chaltu was surprised to be told that she was in fact expecting twins. In rural Ethiopia childbirth can be hazardous and even more so when twins are expected. Without the support of a skilled midwife or doctor at time of delivery, babies can die as a result of long and obstructed labour and the mother’s life can also be at risk.

Using a portable ultrasound machine, the professional volunteer from Maternity Worldwide was able to show Chaltu that one of the babies was in a transverse position (that is lying across the uterus) while the other was breech (lying feet down). This meant that Chaltu would almost certainly require a caesarean section and she was advised to come to the hospital in 3 weeks time. When she arrived at the hospital the babies were found to still be in the same positions. A caesarean was carried out and Chaltu safely delivered two healthy babies, a boy of 1.9 kg and a girl of 1.7kg. Four days later Chaltu, her husband and the twins were able to return to their village.

In rural Ethiopia women are often discharged quite early after their caesarean sections. Many families live in small and remote villages considerable distances from the nearest health post or clinic making it difficult for mothers to get post natal care and information about both maternal and child health. Two weeks after they had returned home from the hospital, Chaltu’s husband made the long journey to the health centre to get advice as he was concerned about his wife’s condition. Chaltu had been experiencing considerable pain around her caesarean scar and was struggling to produce enough milk for the two babies. Having assessed all the information, the Maternity Worldwide volunteer advised Chaltu’s husband to ensure his wife got plenty of rest, food and fluids.

Two days later Chaltu’s husband returned to the clinic as he was still concerned about his wife. At the end of the ante natal care clinic she was running, the Maternity Worldwide volunteer drove over to the family’s home with him. Chaltu was clearly tired and anxious. She was in some pain around her operation scar but this was healing well despite a minor infection. Chaltu was given some antibiotics for the infection, iron and vitamin tablets to increase her energy levels and some pain killers. The twins were doing well and Chaltu was producing enough milk for them.

Due to Maternity Worldwide’s programme of running a cycle of maternal health clinics in rural communities, Chaltu and her family were able to get the reassurance, support and medicines that they needed for both the mother and her babies to thrive.

Burane is a young woman of 25 who lives in a small village in the West Wollega area of Ethiopia. Her village is almost two hours walk from the nearest health centre.

Despite the distance and being well advanced in her pregnancy, Burane walked to the health centre as she had heard that at the maternal health clinic Maternity Worldwide was able to provide women with a rare chance to have an ultrasound scan which would show a picture of her baby in the womb.

Although this was Burane’s fourth baby, she had considered it important to have antenatal care and had therefore been to the clinic for three earlier check-ups. She knew that she was now near to the end of her pregnancy, and she wanted to make sure that her baby was well.

When Burane arrived at the health centre, she mentioned that she had experienced some back pain that morning. When she was examined it was clear that the baby’s head was firmly engaged which was confirmed by an ultrasound scan and suggested she was ready to go in to labour. Indeed, as the scan was being completed, Burane’s waters broke.

She was carried on a stretcher to the delivery room, where within 30 minutes she safely delivered a healthy baby girl.

 

Bultu is a 32 year old woman who lives in a remote village in the West Wollega region of Ethiopia. Her village is almost 2 hours walk from the nearest health centre.

When she was 34 weeks pregnant, Bultu attended the new Maternity Worldwide maternal health clinic at her nearest health centre at Homa. Staff at the clinic had been trained by Maternity Worldwide to identify which mothers face the highest risks when they deliver their babies.

One of the leading risk factors is the number of pregnancies a woman has had previously. This was Bultu’s 5th pregnancy which meant that she was at risk from post partum haemorrhage (that is heavy bleeding following the birth, a major cause of death in mothers in developing countries). The nurse therefore advised Bultu to come to the clinic to have her baby so she could get the skilled care she needed.

Bultu followed this advice and came to the clinic when she was 41 weeks pregnant. She told the nurse her waters had broken a week earlier. The nurse, who had been trained by Maternity Worldwide in the procedure, carried out an ultrasound scan on Bultu which showed there was no fluid around the baby. Because of this both mother and baby were at risk of serious infection and Bultu was advised to have her baby at Gimbie Hospital.

On arrival at the hospital the baby was found to be in distress and an emergency caesarean was carried out.

Bultu delivered a baby boy, Elsay, weighing 3.7kg and both she and the baby are healthy and well.

Two years later on a recent visit to Ethiopia we were able to catch up with Bultu to find out how she is getting in, you can read about her and Elsay here.

Alemi, who is 25 years old, arrived at our maternal health risk assessment clinic with very swollen ankles. We found she had high blood pressure, a potentially life-threatening complication in pregnancy. She had been pregnant twice before but on both occasions, the baby died near to the time of delivery.

Since Alemi was just 29 weeks pregnant, we decided to try and treat her high blood pressure with oral medication and manage her in the community for as long as possible. She was advised to return to the clinic a week later and told to come to the health centre immediately if she experienced headaches, blurred vision or worsening swollen ankles. Each week Alemi was seen in the health centre but despite her medication being increased, her blood pressure remained dangerously high and the baby failed to grow any bigger.  She was therefore taken by car to the hospital, where she was started on a drip with medication to lower her blood pressure and to reduce her risk of having a fit. After a week, however, Alemi’s liver started to show signs of failure and she was not maintaining her blood levels of protein. A difficult choice had to be made; the baby needed to develop further before being born but Alemi’s life was increasingly endangered by the baby remaining inside her. In situations like this, the mother’s life takes priority and so Alemi was given some steroids to reduce the risk of lung disease in the baby, who was to be born via caesarean section the following day.

Just prior to the caesarean section, Alemi’s blood pressure increased to dangerous levels. She also had vast amounts of protein rich fluid in her abdomen, which had been slowly leaking out from her blood over the past few weeks. It became very clear that doing the caesarean section immediately was the right decision and probably saved her life.

Although the baby girl was only 1.4Kg at birth, with careful management of her fluids and maintenance of her temperature, she was soon able to feed from her mother’s breast and after 10 days she put on enough weight to be taken home by her mother and father.

Alemi and her husband told Maternity Worldwide volunteers that they had not previously been able to have a baby that survived because they were too poor to provide a healthy environment. They could not afford any medical treatment or transport to a hospital and they feared that they had little choice but to wait and see what would happen. Alemi walked the 2-hour journey each way to attend our clinic when she heard that we were doing ultrasound scans for pregnant women. She continued to make this journey each week to have her blood pressure checked as she was confident we could provide the help she needed to enable her to have the healthy baby she longed for.

Alemi’s story shows how important it is to provide a range of effective services in order to enable women in often remote rural areas to give birth safely. Maternity Worldwide’s programme of providing maternal health clinics and high quality services in the community ensured Alemi received the help and support she desperately needed.  Combined with this we were able to provide transport to the hospital, skilled care while she was there and the finances to pay for this care. This comprehensive programme of maternal health care enabled Alemi to finally give birth safely to a healthy baby.

Ayantu is a 20 year old woman who lives in a small village in the West Wollega area of Ethiopia. From her village it is almost two hours walk to the nearest health centre.  The long distances involved is just one of a number of reasons why the vast majority of women in rural Ethiopia don’t attend a health clinic for ante natal care and give birth at home without being able to access skilled help from a midwife or doctor.

Ayantu had not been to the local health centre for previous ante natal care but she had heard from other local women that a maternal health clinic was being held there and that she would be able to have a check-up and an ultrasound scan which would show her a picture of the baby inside her.  This is a very rare opportunity in Ethiopia so Ayantu decided to make the long journey. She attended a clinic being held there as part of Maternity Worldwide’s Safe Place of Birth Project which assesses the risks which women will face when they deliver.

Ayantu did not know how far through the pregnancy she was but the ultrasound showed she was about 40 weeks. There was little fluid around the baby indicating that Ayantu’s waters had broken some time ago. More worryingly, the baby was shown to be in a transverse position (lying sideways) which would make it very unlikely she would be able to deliver naturally. The risk to Ayantu was further increased by the fact she is very short in height, only 1.43m, and that this was her first baby.

Because she was so high risk Ayantu was advised to go to the hospital to have her baby. At the hospital she was met by a highly skilled volunteer obstetrician from Maternity Worldwide who was able to carry out the caesarean delivery she needed. Ayantu safely delivered a baby boy. Both mother and baby were healthy and well and were able to go home just three days later.

If she had stayed at home to deliver as she had originally planned then there is a very strong possibility Ayantu and her baby would have died.

Ayantu wanted other local women to be able to take advantage of the ante natal and delivery care which had helped her so much. She came along to one of the maternal health promotion sessions arranged by Maternity Worldwide to tell her story. In front of 300 women from surrounding villages, Ayantu spoke movingly of how the staff and services at the health centre and hospital had enabled her to give birth safely and bring home her healthy baby boy.

The role of a Maternity Worldwide Volunteer obstetrician

Aster successfully gave birth to her fifth baby at home with just her mother to help. Initially the birth seemed to have gone well and Aster delivered a healthy baby girl of 3.5 kg. But the afterbirth (the placenta) would not come out and Aster started to lose a large volume of blood. Her family carried her to the hospital but by the time they got there Aster was unconscious. She also had a seizure, which may have been due to her having high blood pressure, a recognised complication of pregnancy.

One of the key elements of Maternity Worldwide’s integrated maternal health approach is that we provide highly skilled volunteer doctors to train and mentor local clinical staff.  In rural Ethiopia it is often difficult to recruit and retain qualified doctors and midwives to provide the necessary level of skilled care to ensure women with serious complications can give birth safely.  When Aster arrived in the hospital the experienced Maternity Worldwide volunteer obstetrician was able to call together a team of people with the necessary skills to keep Aster alive. They manually removed the afterbirth to stop the bleeding and after 20 minutes Aster’s condition had stabilised.

Aster had lost a great deal of blood. She needed a transfusion but this was complicated by the fact she had a fairly rare blood type.  Fortunately one of the other Maternity Worldwide volunteers was a match and she donated blood to her.

Aster suffered further bleeding later that evening but the Maternity Worldwide obstetrician was able to treat her successfully with medication. By the following morning the bleeding had stopped. Aster made a good recovery and two day later left the hospital with her baby and husband.

By working in partnership the Ethiopian staff team and the Maternity Worldwide volunteers were able to provide the skilled care which Aster needed and helped to save the lives of both mother and baby.

At Maternity Worldwide we know that one of the key factors in ensuring sustainable improvements to maternal health services is that local clinical staff develop the knowledge and skills to enable them to carry out the procedures needed to save mothers’ lives.

Lensa is a Diploma Nurse who works in the Homa Health Centre in West Wollega, Ethiopia.  Lensa qualified two years ago and since then she has attended a series of training sessions run by Maternity Worldwide which have enabled her to increase her skills and confidence. The importance of this was clear when Lensa had to cope single handed with an emergency delivery at the health centre.

Birhane was expecting her second baby. As her first had been delivered by caesarean section, Birhane was advised by health centre staff that she should have her baby in hospital. She went in to labour late in the evening by which time no public transport was available and it took her family some time to find someone to drive her to hospital. They started the two hour journey to the hospital but heavy rainfall had made the road inaccessible and they had to take a long detour. About half way through the journey Birhane realised she was about to deliver. Fortunately she was near Homa Health Centre where Lensa was working.

Birhane was rushed in to the delivery room.  Lensa realised that Birhane was fully dilated and the baby’s head was visible. Just 20 minutes after arriving at the health centre, Birhane delivered a health 2.5kg girl. Lensa was just about to deliver the after birth (placenta) when Birhane experienced further contractions and started pushing again. Lensa’s examination revealed that there was a second baby, a complete surprise to Birhane who had no idea she was expecting twins.  With Lensa’s help Birhane delivered a second healthy baby girl.

After the delivery Birhane suffered considerable bleeding.  Because of the training she had received from Maternity Worldwide, Lensa knew what action to take and she was able to administer a drug to help the uterus contract. Birhane’s bleeding subsided and Lensa was also able to stitch the tear which had occurred during delivery. Birhane was soon well enough to have her two new babies in bed with her.

Without the skilled help which Lensa was able to provide it is possible that Birhane and her babies could have suffered serious injury and even death.

Lensa admitted that she had been anxious at the time but that her training had made her confident she could deliver the babies safely.

“I had the confidence to manage the situation. Before I would not have been confident to  deal with the things that happened but now I have had training from Maternity Worldwide and I know what to do. Before I couldn’t do that.”

Afterwards we asked Lensa  which aspects of the training had helped her to enable Birhane to give birth safely. She said the importance of not referring a woman on to hospital when she is fully dilated; the skills to rupture the membranes of a second twin; being able to suture a tear; knowing what to do to help contract the uterus and being able to administer the necessary drug.

Maternity Worldwide is now providing the funding to enable Lensa to become a fully qualified midwife, you can read updates about her progress on our blog here.