STILLBIRTHS MAKE MASSAGES HARD TO STOMACH IN LAMU

PHOTO / Fotolia

PHOTO / Fotolia

When Joyce Karisa walked into the Faza Subcounty Hospital in Lamu East, she was in labour. She looked forward to delivering her first baby. She took the intense labour pains in great stride and courage, for she knew it was all for a good course. The only problem is, she, like many other women in Lamu and across the country, had sought the services of a traditional midwife. “It was just to ensure my pregnancy was okay and nothing more. All I did was for my baby,” she says.

Too bad, as Joyce came to discover that her pains were not from labour but rather from the decaying remains of the baby inside her womb. The would-be mother was shaken beyond relief. It was impossible to imagine that all the nine months of grumpiness, cravings, stretch marks and all that had been for nothing. Joyce was wheeled into the theatre for an emergency Caesarian section as soon as she was examined by Dr Salim Zubeir, who is also the medical superintendent, after it was established that her baby had died in the uterus.

Joyce Karisa had a stillbirth following numerous tummy massages
image: CHETI PRAXIDES

Joyce Karisa had a stillbirth following numerous tummy massages
image: CHETI PRAXIDES

As Dr Zubeir explains, Joyce’s baby died after his head was twisted during a belly massage and the placenta detached from the uterus, a deadly scenario for both baby and bearer. “We had to perform the emergency CS fast because if the foetus is dead and decaying, it means chances of the uterus and other internal organs equally starting to decay were high, and so the operation was life-saving for the woman," he said.

“During extraction of the foetus, we discovered the placenta had long detached from the uterus. There was no way the baby would have stayed alive since they depend on the bearer for food and nutrients, which come through the placenta. We asked the woman and she divulged that she had indeed sought massage services from midwives. Too bad it cost her her baby."

The medic said there is a limit to what traditional midwives can do to a pregnant woman at any given time. “But most of the time we would rather the belly remains untouched at all costs until they come to the hospital for deliveries," he said.

FALSE LABOUR 

Hadija Adnan from Siyu village in Lamu East also suffered a similar fate after she delivered a stillborn baby boy, all thanks to the services she sought of a midwife.“I have four girls and that was my only son and my lastborn. I was extremely cautious during pregnancy and I tried to do everything the right way," she said. "That included paying visits to the midwife for weekly massages once the pregnancy was around four months." She followed through with the belly massages until her ninth month of pregnancy. “I was okay, the baby was kicking. I was eating well and taking my medication. I was ready to have my son,” she said. One morning, while in the last two weeks of her pregnancy, Hadija woke up to stabbing pains in her lower abdomen. She called the closest help, which was her midwife, and less than half an hour later, she was delivered of her dead son. “There was no sign whatsoever that anything was wrong. When the pains came, I thought they were false labour because I was quite sure my due date was yet to come,” Hadija said.

"I pushed when I had to but when my baby didn’t cry after birth, I knew something wasn’t right. He was blue all over and his skin was peeling off. He was starting to decompose, too. It was heart-wrenching to see him like that."

She went to hospital and was told something must have gone wrong during her most recent belly massage since the foetus’s placenta had long detached from the uterus, leaving the baby without a supply of oxygen, food and vital nutrients essential for his survival. Dr Zubeir said the placenta is a structure that provides oxygen and nutrients to a growing baby and removes waste products from the baby’s blood.

“When the placenta detaches, the baby dies immediately as their supply of oxygen and the rest are cut out promptly. It can happen within seconds and doesn’t necessarily bring on immediate symptoms,” Zubeir said.

“That’s why many pregnant women never get to find out instantly that their baby is dead until after some days, though the situation is different for different women.” He said Hadija’s case is similar to that of Joyce, and that the baby probably died after an intense belly massage.

Faza hospital medical superintendent Salim Zubeir
image: CHETI PRAXIDES

Faza hospital medical superintendent Salim Zubeir
image: CHETI PRAXIDES

DOUBLE TROUBLE

Swafiya Adnan had the worst experience ever as she lost her twin daughters after a rigorous belly massage back in her village in Mararani, an area listed as terror-prone by security agencies. Swafiya’s village falls within Basuba ward, which is grappling with lack of medical care after dispensaries in the area were vandalised and looted clean by al Shabaab militants back in 2014 and 2015. Unlike her two counterparts, Swafiya knew something was wrong one afternoon after she left her midwife’s home for a routine belly massage of her growing bump.

She says on that day, the belly massage was utterly out of the norm as her midwife observed that one of the babies was in breech presentation and insisted on turning the baby back to normal through massage. “I was aware I was carrying twins. She had told me and I also felt it. You just know. On this day, she said one baby wasn’t seated well and that she had to push it into position, which she did, or so I thought. We were done in less than 40 minutes and I went home," Swafiya said.

However, walking became extremely painful for her and for the next two days, she experienced sharp piercing pains all over her tummy. The nearest hospital from her village is located in Kiunga, on the border of Lamu and Somalia.

“I knew my due date was nowhere close. I knew the pain was unusual and so my husband hired a bike, which took us to the hospital. On arrival, they examined me and referred me to the King Fahad Hospital in Lamu island. That is like a two days' journey from my village. I knew I wouldn’t make it," she said. That night, with the help of her midwife, she delivered a set of twin boys, both dead and blue. It was sad, she says. It killed her inside. She was longing to be their mother but that would never be.

“I went back to the hospital the following day and told them what happened. The doctor asked if I had procured the services of a midwife, to which I replied yes,” Swafiya recalled ruefully. "She said I shouldn’t have let her touch me, let alone massage my belly. How was I to know? There is no one else to help us out there except the midwives." Dr Zubeir said it's wrong for midwives to attempt turning babies in the uterus as the result can be deadly.

SCOPE OF THE PROBLEM

In Africa, pregnant women have always made use of the traditional midwives commonly known as ‘wakunga’, who are known for massaging their bellies and even helping to turn babies who are in breech position in a process known in Kiswahili as ‘kukandwa’. Medics in the region have raised alarm over the number of women who lose their babies shortly after birth, after which inquiries normally show they had made use of the now deadly massages in the course of their pregnancies.

Dr Zubeir says out of 20 women who come to deliver at Faza Subcounty Hospital, seven have to undergo emergency Caesarian section from complications arising from belly massages. The medic adds that at least two out of five babies die from the effects of the tummy massages each month. He advises midwives to desist from massaging pregnant women and instead accompany them to hospital so as to guarantee safe delivery and that of babies. “Many women coming here have already been massaged. It’s deadly. They believe so much in it but they need to know it's killing their babies and stop already," Dr Zubeir said.

"The situation has also increased the need for emergency and life-saving CS. Let them be advised that the hospital can take care of them better. “A pregnant woman should be left alone and if they have any issue, they must be rushed to hospital."The most affected areas are Faza, Kizingitini, Tchundwa, Mwajumwali, Siyu, Mkokoni, Kiwayu, Ndau, Basuba, Milimani, Mangai, Mararani and Kiangwe, all in Lamu East.

MIDWIVES’ DEFENCE

Mashrab Sagaf, medical superintendent of the Lamu King Fahd Hospital in Lamu island, says pregnant women can still make use of traditional midwives but not for belly massages. He says in as much as some of the symptoms take time to manifest, pregnant women need to look out for spotting or bleeding from the vagina. abdominal cramps, whether mild or severe, dizziness or fever.

"But the biggest clue that something is wrong with your baby is the lack of foetal movements. You experience those, rush to hospital," Sagaf said.

Lamu East remains without adequate health facilities after most dispensaries and hospitals were looted and vandalised by al Shabaab militants years back, leaving the locals to their fate.

Traditional birth attendant Shumi Mkunga, 60, in Lamu
image: CHETI PRAXIDES

Traditional birth attendant Shumi Mkunga, 60, in Lamu
image: CHETI PRAXIDES

The obvious victims in this situation are the pregnant women and children who now find themselves at the mercy of traditional midwives who, most of the time, operate out of their depth, especially when dealing with pregnant women. However, Shumi Mkunga, the spokesperson of traditional midwives in Lamu, said it is malicious to claim women lose babies because of their actions, as many of them have been trained by medics in the region to do what they do. “We believe some babies die out of sheer bad luck and not what we do. We don’t just do anyhow because we understand a pregnant woman is very fragile,” Mkunga said.

"Plus, they trained us to do this. They shouldn’t blame us for anything. We try to help since the government has refused to put up hospitals here."