Sisterhood Unfulfilled: A Story of Unspeakable Loss

This blog post is the first of a three part series written by: Abby Tseggai

Almost everyone knows a woman who has brought a baby into the world- and how expecting families share a similar joy, full of optimism and big dreams as they anxiously wait to hold their little baby. It is easy to forget in all the excitement that the possibility of an unfathomable reality—the death of a child—can actually occur.

I want to share with you a very personal story of girl named Fana, from Eritrea. At the tender age of seven years old, she and her family experienced a tragedy that was only the beginning of decades of havoc to follow. Fana’s little sister, died unexpectedly at just five years old from an illness unknown. The emotional trauma Fana experienced stemmed in part from losing her baby sister – but mostly, it came from having to witness her mother grieve for most of her life.

Her mother’s pain and depression was so severe that she struggled to be mentally and emotionally present for her surviving children. She couldn’t move past the loss – her mind simply could not release the intense grief. She fought her hardest to manage it daily for Fana and her older brother who was 2 years older than her. Sometimes, Fana’s mom neglected their needs, falling short on being the stable adult every child needs. What Fana did not know at the time was that this was her mom’s second such loss; a year-old son who died from an unknown illness, before Fana was even born. She knew Fana was too young to understand the magnitude of having to bury her sister too, so she sheltered Fana from that tragedy, hoping to preserve her daughter’s innocence.

As the years began to pass, Fana’s sweet memories of her litter sister were becoming more and more faint. Fana would desperately pray every night to have a little sister again. It was not until 6 years later that she was able to see her mother smile genuinely, when she told Fana she was pregnant and they were expecting a baby.  Fana was now 13 years old and able to remember every detail of hopefulness and fear she felt waiting to hold the new baby. She just knew in her heart it would be a baby girl and not a boy.

The day had finally come; Fana was waiting outside a hut made of clay. She could hear her mother screaming during labor. This was the first time she heard anything like it but luckily her mother prepared her for what to expect. After 4 hours of waiting patiently trying to ignore what sounded like a nightmare, the screams turned into desperate prayers and now included more than three people screaming and crying. Her father rushed out of the hut, picked her up and ran fast while screaming “No…No…NO!”  She begged for him to tell her what was going on because she was so confused. It was indeed a little girl her mother brought to term, however she was not breathing. No one could believe it – the baby was a stillborn. Fana’s family would now be grieving the loss of another child.

Fana’s family experienced the deaths of three children- one stillbirth and two from unknown causes. Although the stillborn mortality rate has gotten better over the decades, women and communities still suffer from the psychological, social and economic impacts of stillbirth. Africa still accounts for 2.7 million stillbirths a year. And 5.9 million don’t live to meet their fifth birthday, due to diseases that are mostly preventable. The lack of qualified midwives and health workers and the shortage of hospitals throughout the continent are still heartbreaking. Many of the deaths occurring are unnecessary. All lives deserve the same chance!

Read more about stillbirths in The Lancet Series: Ending Preventable Stillbirths.

Cover Photo Credit: United Nations, Flickr Creative Commons

Note: Cover photo is not connected to the above story. 

 

 

 

 

 

The Trauma of Stillbirths: A Midwife’s Story

By Kasule Ahmed, White Ribbon Alliance Uganda

“A stillbirth always traumatizes all of us: the midwife who wants to help the mother to successfully give birth to her child, and the mother who carries the pregnancy for a long time only to hear that her child is dead. As midwife and a mother, it makes me feel very bad.”

These are the words of Najjuma Kalule, a midwife in the Mityana District of Uganda. In Mityana Hospital where she works, 600 babies are born every month and of that number, between 10 and 20 are stillborn, with never a chance to take even a single breath.

“All midwives hate dealing with stillbirths,” says Kalule, “because of the deep feeling of discouragement it gives us. Some midwives – especially the junior ones – tend to refer such cases to their seniors, since the process recommended for handling a stillbirth case is quite long and needs extra supervision of a mother, including choosing the right words to comfort the mother.”

Najjuma Kalule 1

Kalule says that once it’s clear that the baby has not survived the pregnancy, a period of one and a half weeks is given before specific drugs are administered to induce labour. She adds that pushing a dead baby out is the most difficult time, because the midwife entirely depends on the strength of the woman who is already feeling devastated. “Some women are too distressed to push the baby out,” she says, “and end up having a C Section.”

Kalule sees malaria as the main cause of stillbirths in Mityana; other common causes include syphilis, poor nutrition and violence against women, together with accidents, diabetes, high blood pressure and HIV/AIDS.

Kalule adds that in order to avoid stillbirths, women should start attending Antenatal Clinics (ANC) from the moment they learn that they are pregnant and should attend all the four appointments: “It’s through ANC that these causes of stillbirths can be detected and treated, and also women can be given advice on what to do when a stillbirth is detected during pregnancy.”

Kalule believes that a midwife needs to be especially sensitive from the moment of breaking the terrible news of the death of the baby. “As midwifes handling stillbirths, we do our best to calm the woman by carefully supporting and counseling her.”

 


 

  • A global ranking published by this week by The Lancet, shows that the estimated stillbirth rate in Uganda is 21 per 1000 total births, with Uganda the 39th highest for stillbirths out of 186 countries. Iceland has the lowest stillbirth rates at 1.3 and Pakistan with the highest at 43.1, all per 1000 total births.
  • According to new research published in The Lancet on January 19th 2016, there has been little change in the number of stillbirths (in the third trimester of pregnancy) even though the majority are preventable. The Ending Preventable Stillbirth research series states the annual rate of reduction for stillbirths is 2.0%, much slower than progress made for maternal (3.0%) and child deaths (4.5%). It also reveals the hidden consequences of stillbirth, with more than 4.2 million women living with symptoms of depression, often for years, in addition to economic loss for families and nations.
  • The Ending Preventable Stillbirth Series includes a global analysis of risk factors associated with stillbirth, underlining that many deaths can be prevented by, among other interventions; treating infections during pregnancy – 8.0% of all stillbirths are attributable to malaria, increasing to 20.0% in sub-Saharan Africa, and 7.7% of all stillbirths are associated with syphilis, increasing to 11.2% in sub-Saharan Africa.

 

Stillbirths – A neglected global epidemic reports The Lancet

Despite the fact that the majority of stillbirths are preventable, very little progress has been made to bring down the number of stillbirths. In the past 15 years maternal and child deaths have halved, while 2.6 million stillbirths continue to occur every year – a number much too high to be accepted.

This “silent” problem – stillbirths (in the third trimester of pregnancy) – has been studied in a new series by The Lancet. Not only does the Ending Preventable Stillbirth Research Series shed light on global reduction rates and risk factors of stillbirths, but it highlights the neglected psychological, social and economic impacts of stillbirth on women and communities. New evidence shows that at least 4.2 million women are living with the effects of stillbirth – suffering from depression, stigma, social isolation, as well as an increased risk of violence and abuse.

“We must give a voice to the mothers of 7,200 babies stillborn around the world every day. There is a common misperception that many of the deaths are inevitable, but our research shows most stillbirths are preventable.”

– Professor Joy Lawn, London School of Hygiene & Tropical Medicine

Women in the most disadvantaged communities are at a much higher risk of stillbirth. Yet, progress to decrease the stillbirth rate remains slow in high-income countries too, where the number of stillbirths is often higher than infant deaths. Globally, the annual rate of reduction for stillbirths is 2.0%, which is much slower than the progress that is being made for maternal (3.0%) and child deaths (4.5%). Nearly all stillbirths – 98% of them – occur in low- and middle-income countries.

Half of all stillbirths take place during labor and birth, usually when a pregnancy is in full term, and research shows that most of these 1.3 million deaths are preventable with improved quality of care. The first global analysis of risk factors associated with stillbirth is included in the new series – showing how deaths can be prevented. The research shows that the most effective methods to reduce stillbirths include: treating infections during pregnancy (Malaria and Syphilis in particular), tackling obesity and non-communicable diseases (diabetes and hypertension foremost), ensuring access to quality family planning services – especially for older women and girls, who face a higher risk of stillbirth, and reducing inequalities.

Evidence shows that prevention is possible.

The Netherlands is making the fastest progress, with an annual reduction rate of 6.8%. The United States is one of the countries making the least amount of progress, with a reduction of 0.4% per year. Rwanda is outperforming its neighbours with an annual rate of reduction of 2.9% – making it the fastest progressing country in Africa and showing that change is achievable everywhere in the world.

The Lancet’s Ending Preventable Stillbirths Series includes five papers developed by 216 experts from over 100 organizations. This series presents compelling evidence that most stillbirths are preventable, providing a platform for action by politicians, health care professionals, parents and pregnant women themselves.

Let’s make sure that ending preventable stillbirths does not only get on the agenda of maternal and newborn health, but that necessary action is taken and enough resources are allocated to this issue for there to be real, lasting impact and change.

Featured photo credit: Hien Macline / United Nations Photo (Creative Commons on Flickr).