PPH: a major risk caused by mishandling of deliveries

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Women leave premises of a health facility in Peshawar. – Photo by writer.

By Muhammad Shahid

Ayesha Khan cannot forget her first child whom she lost as her in-laws were unwilling to provide her maternity care treatment at a health facility for delivery of her first child.

Ayesha, an assumed name, suffered excessive bleeding while her child’s arm got fractured due to mishandling of her delivery case by a midwife in her locality.

Later, the midwife confided on condition of anonymity that, “The child had a bigger head and I was unable to extract it from his mother’s womb. I pulled the baby by his arm, which got fractured.”

Though her mother bled much during delivery, she survived due to assistance of a lady doctor in the area. However, the infant passed away the very next day, teaching a lesson to the family as not to handle such cases at home but prefer health facilities and trained medical staff.

Despite increasing education rate in society, there are still many who prefer deliveries at homes and avoid hospitals. However, medical professionals say that sometimes a normal case can be handled in houses but severe cases of delivery must be taken to hospitals.

In cases of the postpartum haemorrhage (PPH), there is loss of more than 500ml and up to 1,000ml of blood within the first 24 hours following childbirth. The PPH is one of the reasons of maternal mortality.

Asma, a LHW serving at a dispensary in Peshawar, states they avoid performing severe cases of delivery and advise them to approach hospitals, although they can work on normal cases.

A Peshawar-based gynaecologist, Dr Nasreen, mentions the main reason of bleeding or postpartum haemorrhage as the mishandling of labour process.

Dr Nasreen, who has been serving at the Expanded Programme on Immunisation (EPI), says that sometimes the PPH can be caused by excessive amount of oxytocin, an injection that is administered to a woman in delivery.

Delay in labour is another major cause of PPH because some women have to cover a huge distance from villages to visit hospitals in cities for healthcare.

“Mostly PPH is caused to women who travel long distances from far-off and hilly areas to visit health facilities in urban areas. This is because their delivery is delayed due to the long distance while at times they face delay and long wait in government hospitals as well,” she said.

Another gynaecologist, seeking anonymous, says: “After birth of a baby, a woman’s organs contract. But in case of PPH, it does not contract, which causes excessive bleeding due to mishandling by unskilled health staff. A woman can even die of this bleeding.”

According to Dr Iqbal Begum, a normal delivery can at times be done by trained staff even at home, but still people should prefer proper health centres.

“A woman should use health facilities for delivery cases in order to have timely information if they have any disease during pregnancy and childbearing period,” says Iqbal Begum, a gynaecologist who heads the Gynae Department of Hayatabad Medical Complex.

Maternal mortality rate

According to data collected by the District Health Information System (DHIS) during the first quarter of 2016, about 72 women died during delivery cases across Khyber Pakhtunkhwa. It says that maternal mortality rate remained 151 per a population of 100,000. According to the DHIS, Mardan district tops the list, with 12 deaths.

Similarly, Peshawar has reported 11 maternal deaths, Swabi five, Abbottabad eight, Haripur five, Mansehra six, Bannu, Lakki Marwat and Kohat two each, Nowshera four, Swat nine, and Shangla, Upper Dir, Buner, Chitral, Malakand and DI Khan have reported one death each.

KP’s incentive to promote use of health facilities

The Khyber Pakhtunkhwa government has started cash incentive program for mothers using services at health facilities for maternity care.

MNCH program provincial coordinator Dr Sahib Gul says: “The provincial government has recently started paying Rs2,700 to every mother who chooses to deliver child at health facility. This measure is meant to attract people to health facilities and to discourage deliveries inside houses. Only the KP province is providing this incentive to women in Pakistan.”

However, Dr Gul says that the cash incentive rule is not applicable in teaching hospitals, while this is provided in all other healthcare canters. He said the Maternal, Newborn and Child Health program has conducted a number of campaigns to encourage women to use maternity care services of state-run centers.


This story, which originally appeared on AWKUM VOICE, an online newspaper, has won Excellence in Journalism Award-2016.

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