Midwife Margaret Baru, 46, left, checks on a newborn baby at Nyumanzi Health Centre II in Adjumani district, Uganda before handing it back to its mother. Photo: Sylvia Nabanoba/Save the Children
Maternal and newborn health in Nyumanzi refugee camp
Every midwife’s nightmare is losing a mother or baby on her watch. They know that these are things that do happen, sometimes because you simply cannot prevent them, but it is still heartbreaking when they do.
This is what 46-year-old Margaret Baru dreaded when one night in June the watchman called out to inform her that a mother in the maternity ward was bleeding uncontrollably.
“She had delivered very well and seemed to be recovering well too. After the delivery, I let her rest before transferring her to the ward. But then the watchman summoned me,” narrates Sr. Baru. “I found her in a pool of blood that kept growing.”
Sr. Baru put the mother on intravenous treatment, but the bleeding did not stop. She had to think and act fast if the mother’s life was to be saved.
“I literally held her uterus for close to two hours in order to make it contract and stop the bleeding. How did I do this? I laid my hands on her stomach and held the uterus. The bleeding eventually stopped,” she says.
Sr. Baru practiced this unconventional method at Nyumanzi Health Centre II in Adjumani District. The health centre is one of those meant to serve refugees who since December 2013 have fled fighting in Southern Sudan and been resettled in several refugee resettlement camps in Adjumani district, Uganda. Nyumanzi is one of the 19 settlements in the district. Currently the health centre serves a population of 25,000 refugees and 5,000 Ugandan nationals who still access services there.
“We are very busy. We have many mothers giving birth here,” Sr. Baru says. “In June (2014) we had 90 deliveries.”
She explains that the high number of births is partly a result of the refugees’ shunning of birth control. According to her, the women say their husbands do not allow them to use modern methods of family planning. They opt for the natural methods, which frequently fail them.
It is these barely spaced pregnancies that result in the very common complications that Sr. Baru has encountered at Nyumanzi since she was posted there in April 2014. She explains that bleeding before and after delivery is a common complication, coupled with mal-presentations such as arm prolapse and delayed labour pains. Frequent pregnancies make the uterus flabby and it fails to contract quickly after childbirth, thus the post-delivery bleeding. A flabby uterus also increases the chances of mal-presentations, Sr. Baru says, because it gives the baby a lot of space to wriggle and move about in different directions.
Keeping alive newborns that suffer complications such as asphyxia is another challenge, since the health centre does not have any oxygen or resuscitation equipment.
“We once had a stillbirth. The mother delayed to come to the health centre yet she was in labour, and the baby got tired. It was alive when it was delivered, but had problems breathing. We could have resuscitated it if we had the facilities, but we did not. So sadly it died,” narrates Sr. Baru.
Encouraging mothers and their partners to attend antenatal care (ANC) sessions is the most important avenue the health centre is using to reduce these challenges. When they come for ANC, the mothers are taught how to prepare for birth.
“Many of them would come to give birth without anything – not even a bedsheet in which to wrap the new baby. Or bedsheets for themselves. Now that they are learning, they come prepared,” says Sr. Baru.
She adds that during ANC the mothers are taught about family planning and the importance of giving birth in the health centre, as opposed to delivering from home. They are tested for HIV, too, and those found to be HIV-positive referred to Dzaipi Health Centre II, where they are enrolled on the Prevention of Mother to Child Transmission of HIV to ensure they do not transmit the virus to their newborns.