Childbirth: When normal delivery is death sentence

Childbirth: When normal delivery is death sentence
Dr Benjamin Bol. [Photo Yiep Joseph, City Review]

The very thought of your child gives you the instinct to safeguard them from the world. It is suffice to say that children are the future of a family and our hidden treasures. But having a child, a process that starts from conception to delivery, has in some instances led to loss of life of the mother, the child or both.

According to Dr. Benjamin Bol, an obstetrician-gynecologist at at a local hospital pregnancy is ideally a physiological process, meaning there should be no threat to life attached to it.

“As professionals there is a good reason why we do not refer to pregnant women as patients. This is because being pregnant is not a disease by a natural or physiological process that has its beginning and the end,” he says.

Having said that, it does not mean that all pregnant women can then go ahead and carry the baby to right term, then ‘push’. That is where, according to Dr Benjamin, attending antenatal comes in handy, and if possible, these appointments need to be attended by both the man and the woman.

WHO defines antenatal care (ANC) as the care provided by skilled health-care professionals to pregnant women and adolescent girls in order to ensure the best health conditions for both mother and baby during pregnancy. The components of ANC include risk identification; prevention and management of pregnancy-related or concurrent diseases; and health education and health promotion.

“Pregnancy is a process, and once a woman embarks on this journey, and they start visiting health facility for antenatal care, among other observations we look at three ‘Ps’, that is power for expulsion since the mother will need to be strong to marshal the energy to push the baby out of the uterus.

“The second ‘P’ is the passenger, in this case the baby. From the time the fetus starts development, we monitor the size of it versus the size of the pelvic canal if its size will be pushed through naturally through the canal.

“The third ‘P’ is the passage. For some reasons the passage may be too narrow to allow certain or all sizes of fetuses to pass through,” explains Dr Benjamin.

One of the reasons why the passage may render birth through normal delivery is what Dr Benjamin calls ‘cephalopelvic disproportion’ or CPD. This occurs when there is mismatch between the size of the fetal head and size of the maternal pelvis, resulting in “failure to progress” in labor for mechanical reasons.

“From the three ‘Ps’ alone you can see some of the instances where we have to rule out normal delivery of a child who has come to term. However, the situations that may lead to medical personnel resorting to alternative ways of delivery such a woman are more than that. For instance, when we realise that the body of either the mother of the baby is not doing well, then immediately rule out vaginal birth,” he says.

He says there are women who genetically have contracted pelvis, making it suicidal to attempt to have vaginal birth.

“This is the reason why we encourage couples to visit antenatal clinics so that the man can get first-hand account of what they need to do as the pregnancy progresses. If such a woman carries the pregnancy to term, a normal delivery will rapture the uterus, and lead to the death of the baby. There are also some bone diseases that affect the bones that can as well lead to a constricted pelvis and in some instances accidents a woman got involved in previously can lead to such constrictions in the pelvis making caesarian section (CS) the next viable option of delivering the baby alive,” he says.

How long should pregnancy last?

No pregnancy should extend beyond 42 weeks, says Dr Benjamin. If that happens, then it means that something is not right and an opinion of a trained health practitioner will be required to avert the looming medical situation.

“Pregnancy is divided into three parts; that is pre-term, term and post-term pregnancy. If a baby is delivered before 36 weeks and 6 days elapse, then that is a pre-term baby which will need specialized care to survive,” says Dr Benjamin.

According to WHO, every year, an estimated 15 million babies are born preterm (before 37 completed weeks of gestation), and this number is rising. Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 1 million deaths in 2015.

“Three-quarters of these deaths could be prevented with current, cost-effective interventions. Across 184 countries, the rate of preterm birth ranges from 5 per cent to 18 per cent of babies born,” says WHO in a 2018 statement on their website.

From 37 weeks, the baby is considered a term birth and the mother has the go ahead to continue giving her the care needed. But anything beyond 42 weeks is considered post-term.

There are certain risks associated with post-term pregnancy. The chance of stillbirth or infant death increases slightly. Most post-term fetuses continue to grow, and the large size can cause problems during birth.

Infrequently, the fetus may not continue to grow and may become malnourished. Beyond term, the fetus is more likely to have a bowel movement, called meconium, into the amniotic fluid.