Dear Editor,
For most of our history, pregnancy and childbirth were dangerous for both baby and mother.
Should the care be feared?
What could be more tragic than a mother losing her life in the moment that she is giving life to her newborn? Or a mother being made aware during labour of intrauterine demise.
The period around childbirth is the most critical for saving the maximum number of maternal and newborn lives and preventing stillbirths. The World Health Organization sees a future in which “Every pregnant woman and newborn receives high-quality care throughout pregnancy, childbirth and the postnatal period”. To realize this vision, WHO has defined “quality of care” and has prepared a framework for improving the quality of care for mothers and newborns around the time of childbirth.
Sadly, in the past few months, the Georgetown Public Hospital Cor-poration (GPHC) has been investigating a string of maternal and infant deaths. My sympathy goes out to primigravida Sasha Sobers, her grieving significant other Jermain Grimmond, the numerous children left suddenly motherless, as well as all others affected by the sudden spate of maternal and neonatal mortality currently facing Guyana. The maternal mortality rate refers to the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management.
Mothers and their babies are at highest risk of death during labour, childbirth, and the first week after birth. Investing in improved access to, and quality of care around this time, and achieving high levels of coverage of effective interventions would go a long way in changing the trajectory.
During the presentation of Budget 2015, then Finance Minister, Winston Jordan, said the following“…we can all agree that no women should die giving life,” before announcing that “over $133.1 million will be spent on the expansion of the Georgetown Public Hospital Corporation (GPHC) Maternity Unit, increasing that facility’s bed capacity by 50 beds.” He also said that ongoing works at maternity waiting homes in Bartica and Lethem will continue, adding that “this year’s allocation will facilitate the purchase of equipment, with the aim of increasing the quality of service being offered at the institution’s Maternal and Child Care facility.” The former administration had come under growing criticism for its seeming inability to stem the growing number of maternal deaths at public health institutions. According to a joint-report by the World Health Organisation (WHO) and the United Nations Populations Fund (UNFPA) Guyana currently has one of the highest maternal mortality rates in the region.
Why are Guyanese women still dying from pregnancy-related causes that are preventable? Expansion of the facility should go concomitantly with an increased need to focus on quality of care, primarily provider competencies and environments that enable provision of essential clinical interventions. High quality healthcare is safe, effective, timely, efficient, and above all respectful. Based on past and current fatal obstetrical mishaps, it is clear that the care should be feared? The intent does not seem to be in sync with the patient.
On October 20, 2022 Rashanna Dindayal, 31, and her unborn child died at the Georgetown Public Hospital. News-paper reports state that the mother of two apparently collapsed at the hospital while making her way to the washroom unattended. She was said to have suffered a severe head wound and died thereafter. The mother of the deceased said that her daughter was rushed to the hospital around 3.00 am, in labour and called her around 7.00 a. m saying “Mommy I’m 4 cm dilated”. Note that the patient was going unattended to the washroom when she fell. Why was she going unattended? Women who have had previous pregnancies tend to move very quickly through labour. On December 2, 2022 27-year- old Sasha Sobers was admitted to GPHC after being told that her blood pressure had spiked above the more-than-average level. She was told that she needed to be monitored and keep her blood sugar low to avoid complications,” Grimmond said that his girlfriend was also told her pregnancy was considered high-risk. A high-risk pregnancy is a pregnancy that involves increased health risks for the pregnant person, fetus or both. According to the boyfriend, when the patient went into hospital, she was told that she needed to be given something to bring her pressure under control, and was subsequently administered magnesium sulphate. “They put in her IV drip around 7:30 pm and just after that, she started to complain about feeling a burning sensation and chills from within…The nurses told her that it is a normal feeling [as] it is a side effect of the medication,” he said. Grimmond said Sobers went to bed Thursday night and was examined by medical officers at the hospital sometime Friday morning. “They did an ultrasound and found the child had died,” he said. Magnesium Sulphate MgSO4 is the drug of choice for prevention and treatment of seizures in preeclampsia and eclampsia, and is usually administered parenterally by intravenous (IV).
Of obstetrical note is the fact that the drug is administered under a strict protocol. During IV magnesium administration, the patient’s vital signs, oxygen saturation, deep tendon reflexes, level of consciousness, and fetal heart rate characteristics with maternal uterine activity should be frequently monitored and carefully documented. What happened after the loading dose of magnesium sulphate? Was the patient’s condition monitored, especially her blood pressure and the fetal heart rate.? Did the recording show any elevation/diminution in the blood pressure? If the fetal heart rate was continuously monitored while on the magnesium sulphate then an ultrasound to confirm fetal activity would not be necessary, as the Obstetrical staff would have been prior aware of any fetal distress. If never before, the time has come for Guyana to keep in mind that carefully examining the practice and competence of those tasked with ensuring that all deliveries result in birth mirth, instead of making the womb a place of doom. In the UK qualified practicing midwives are required to complete refresher courses after five years. This is in addition to any that their place of employ may also make them a participant.
Yours faithfully,
Yvonne sam. R. N. S.C.M., R.M.N.,
B>Sc.N., M.ED., Dip. Adult Ed.
