The midwife left cotton wool inside me after birth

Soon after the birth of Lisa's third child, the midwife stitched her up and forgot cotton wool inside her fatter. Luckily, it was discovered hours later- after Lisa had been in a lot of pain. PHOTO/COURTESY

What you need to know:

  • If she had not had babies before and known that she was supposed to bleed after child birth, Lisa* would never have known to take the abdominal pain she was feeling seriously.

Maternal healthcare is a touchy subject for many women who have made the trip to Uganda’s labour wards. A good majority will tell you, “okuzaala kuffa” (to give birth is akin to dying).

If you look deeper into the cases of maternal deaths, you would be surprised at what you find. In 2011, Center for Health, Human Rights and Development (CEHURD) together with the families of two women who died in labour, sued the Attorney General.

They argued that the unacceptable higher maternal deaths in Uganda are due to non-provision of the basic minimum maternal health care, which violates Uganda’s constitution.
They also claimed that the non-attendance and improper handling by the health workers of expectant mothers are also unconstitutional. The case is still in court.

As Lisa*, a 34-year-old communications expert, narrates her experience, you can discern the sense of bewilderment in her voice; the disbelief that she could have been just another statistic of the deaths at a high-end city hospital.
On March 28, 2013, Lisa, then 32-years-old, went into labour and was driven by her husband to a prestigious hospital on the outskirts of Kampala. She was accompanied into the labour ward by her mother.

“I was going to give birth to my third child and the pregnancy had been without incident,” she says, adding, “I’d had my antenatal check-ups at the same hospital and the services had been good.”

Lisa* is a jovial, light-skinned woman, and as we have this interview over breakfast at Kings Hotel in Kabale, she speaks in earnest, holding my arm as if to keep my attention.

The ordeal
“We were two women in the delivery room, which was separated by a partition. I was on one side, while the other woman was on the other side. While there were two midwives attending to us, I got the impression that one was senior to the other. Maybe she was an intern.”

The midwives kept rotating between the two women, attending to one, and then the other. Lisa’s mother witnessed the birth of her grandchild, a boy.
After the delivery, the senior midwife decided that Lisa needed stitches.
Some babies need a bit more room to manoeuver as they are being pushed out. This stretches and tears the perineum (area between the opening of the vagina and the back passage). If the perineum does not stretch yet the baby is big, the midwife may cut it to facilitate the baby’s smooth passage. As the midwife prepared to stitch up Lisa, she first placed a cotton wad in her, to stop the blood flow.

“A friend had narrated to me an incident in which the midwife had forgotten the cotton in her vagina. So, as this woman was stitching me, to keep my mind off the pain, I told her about my friend’s experience. She was surprised that such a thing could happen in the medical profession.”
A few hours after the stitches, the mother of three started feeling pain in her lower abdomen.
“It felt like cramps. Very painful cramps. I had not experienced this kind of thing with the previous deliveries. When I told my mother, she said she had heard about such pains but she had never experienced them.”

Lisa’s mother advised her to drink a Coke and some black tea, suspecting it was the normal afterbirth pains. Afterbirth pains, also known as cramps are caused by contractions of the uterus as it shrinks back to its pre-pregnancy size and location.

Every woman has her own way of dealing with these cramps. Some will drink a bottle of beer immediately after giving birth; others drink strong tea, while others drink Coke soda. It is not scientifically proven that any of these remedies work.

“After drinking these beverages, the pain worsened,” Luyiga says. “My mother thought I was being dramatic, so I bore the pain in silence. I was discharged from the hospital the next morning.”

In all this time, about 15 hours, the mother had not bled a single drop of blood. After delivery a heavy flow of blood, mucus, and tissue is expected and can last up to 10 days, until it tapers off into light bleeding.

This bleeding is as a result of the placenta separating from the uterus, and it is a sign that the body is ridding itself of the extra blood and tissue that was needed to nourish the baby during pregnancy.

Taking matters into hand
Lisa returned home in terrible pain, having been assured by the midwives that the pains would subside in a few hours. Instead, the cramps got stronger.

“As I was bathing, I felt funny down there. It felt like something was trying to push its way out of me. Again, I told my mother that there was something terribly wrong.”

In desperation, she lay on the bed and asked her mother to inspect her private parts. They did not look alright to her mother, who informed her that they were swollen and looked bruised. The flesh appeared to be straining against the stitches.

“That evening, about 12 hours after I gave birth, we drove back to the hospital and I explained to the midwife who had delivered my baby that the pain I was feeling was not normal. I told her that my body was pushing something out of my vagina.”

According to Lisa, the midwife did not show concern or alarm. She told them that she had probably forgotten a wad of cotton inside and would remove it. She did not offer any apology for her neglect.
“She said if she failed to pull out the cotton with a pair of scissors, she would open the stitches, remove the cotton and then re-stitch. I was shocked. Did she know the pain of being stitched twice in as many days, in the same place?”

Fortunately, the midwife was able to pull out the large wad of cotton with the scissors, which was a very painful process.

“I started bleeding immediately. The blood, which had been blocked by the cotton and was what was causing me so much pain, gushed out. ”

Lisa believes that if she had waited for the pain to subside, as her mother and the midwife had advised, she would have contracted an infection or sepsis, or even needed an operation to separate the infected cotton from her tissues.

Three months later, her sister, went to deliver at the same hospital. She died due to gross neglect during labour, which led to acute hemorrhagic shock, caused by heavy blood loss.

A heavy loss of blood means that the cells and organs do not get enough oxygen and nutrients. This can lead to multiple organ failure, thus acute hemorrhagic shock. The baby survived, but suffers from cerebral palsy.

“If I had spoken out, maybe she, or her attendants, would have chosen another hospital,” Lisa says wistfully of the sister, who was also her best friend. Although Lisa would love to have another child, her experience and her sister’s death have left a mark of fear on her.

A legal point of view
According to Rebecca Nansukusa, Makeera and Company Advocates;

The above case entitles the mother to sue the midwife for negligence. You can also sue the hospital because the negligent party is their employee and they have a right to monitor their employees’ performance.

However, for the case to have more weight, one must have documented evidence that something was left in her. In this case, the mother should have first had a scan to show the extent of the damage caused by the negligence of the midwife.

Even after the cotton is removed in the hospital, this scan will help to convince the judge of the negligence.

On the other hand, without a scan it is very hard to prove the case, unless one is given medical records to show that something (that was left there due to negligence) was removed from them.

However, I do not think any hospital can risk giving a patient that kind of document.

Signs of danger

Sister Grace Nakku, a midwife at Nsambya Hospital tips on how to tell if something is not right after a natural delivery;

“During a normal delivery, the vagina stretches, leading to pain and discomfort. The pain is a little bit intense if there was a tear making it necessary to have some stitches. However, with good hygiene and pain killers, it can be controlled and should decrease progressively during the course of five to seven days. If something is left in the vagina while stitching, such as a piece of cotton or gauze, the pain from the stitches will be severe. The cotton is a source of infection, which will lead to the mother having high temperatures and a vaginal discharge with an offensive smell.

As midwives, we teach students never to leave anything in a woman’s vagina. They should carefully examine the vagina after making the stitches. We also encourage midwives to always have an assistant with them, who will reexamine their work, especially if they have a busy schedule. Of late, instead of wads of cotton, there are cotton swabs with strings attached to them. If you forget to remove the cotton, the dangling string will alert you to do so.”

*EDITOR’S NOTE: This story was updated on April 29, 2021 to protect the identity of the interviewee.