Sunday September 21 2014

A 23-year-old’s tale on how she delivered by the roadside in the night

birth in a roadside ditch


By Didas Kisembo

On a cold drizzly night at about 11pm in Kakindo Village, Kiboga District, the pangs of her labour pains started. 23-year-old Jennifer Nabakooza, who lives with her mother, shares her harrowing ordeal which started with transport woes to the nearest health centre, five kilometres away.

“It was around 11.30 p.m. when we tried to look for a boda boda, but even the one that was available had no fuel. So, we had to wait a little longer for the man to first refuel then come and pick me up.”

“Finally, the boda boda came as it was approaching midnight and the pain had increased but I still got onto the motorcycle. However, along the way the pain became excruciating and I requested him to stop and I get off,” narrates Nabakooza.
“I was in so much pain and the boda boda rider helped me to the side of the road. The drizzle had ceased but it was very cold and I started pushing for the baby to come out.”

While she was at it, the boda boda rider called the nearest health centre, Mujunza Health Centre II which is about five kilometres of winding, ragged and muddy dirt road from her home and asked them for help. “Luckily enough, I had contact of Adnan Asumani, the village ambulance rider and I handed over my phone to the bodaboda rider to make the call,” she says.

Meanwhile I felt too much pain. At some point, it felt like I needed to answer the call of nature. I supported my stomach and put my hand on my back as I pushed. Then, I lay on my back next to a gaping ditch by the roadside. I had wrapped my waist with a kikoy. I undid the kikoy and lay it on the ground.

Within a few minutes after the phone call, the baby was delivered, however, he was still attached by the umbilical cord. It took some minutes before her body partly expelled the placenta.

“I have never felt like that my entire life. I thought I would die, Nabakooza says. The boda boda man was on phone most of the time and kept telling me to be patient.” “I held up my baby to my belly with one hand, I was so scared and used the other to hold my thing (the placenta) between my legs.”

The village ambulance dispatched by the health centre arrived past 3am, same time as her old mother who was acting as her caretaker and had been called in to assist.

Together with Asumani, they quickly but carefully helped Nabakooza to clean the baby, with the placenta craddled between her legs. Nabakooza’s mother held the placenta and helped the new mother into the cabin and they set off to the health centre. “I do not remember much at that point, except for feeling like I was floating in the air while aboard the cabin. I had seen it before but I had never taken a ride or used anything like it,” she recounts. “The five-kilometre journey felt like a 15km one as it took us three hours to get to the health centre.”

“When they came in, I noticed they had tied the cord but had not cut it. I then carried out the necessary checks to make sure there was no bleeding along the umbilical cord and then proceeded to work upon the placenta.” “At the time, some of the necessary tools and drugs that were needed to treat a mother in her state were not available – and still are not. So most of what I did was to improvise,” she says.

The nurse was finally able to help Nabakooza finish delivering the placenta and give both mother and baby the immediate care they needed. Today, Nabakooza and six weeks old baby Alvin are in perfect health.

As Nabakooza reflects back on her story, she notes, “That night, I could have lost both my life and my child’s, had it not been for the efforts of the boda boda rider, Asumani, my mother and the health workers. I’m grateful to them.”

In the developing world only 58 per cent of births are attended by a skilled assistant, such as a midwife, nurse or doctor, according to United Nations Family Planning Association; a shocking 90 per cent of births take place without trained assistants.

Giving the ride of hope
“I was hired by Infectious Diseases Institute (IDI) to the motorcycle rider of the village ambulance stationed at the Mujunza Health centre II this year. Before this I was a boda boda cyclist. The personnel IDI and from Pulse Uganda came and trained me on how to use the ambulance and since then I have been picking up patients suffering all sorts of ailments.

IDI pays for the fuel used in transporting the patients and in addition, gives me an allowance for my services. So people in the community are transported for free. Most of the time I transport patients with severe fever because they cannot move, other times it is cases of pregnancy like that of Nabakooza. What was unique about her case however is that she gave birth along the way.

I had never seen anything like that in my entire life. I just got there in the middle of the night, around 2am, and found her and her mother waiting for help. I was shocked and can only say it is God that kept those two – the mother and child – alive for that long.

There is one mother I recently picked up on an afternoon. They had delayed to call me and the time they did so she had gotten worse. She was in bad shape when I got to her home to pick her up, she managed to make it to the Health Centre. It usually takes me about an hour to leave what I’m doing, rush to the Health Centre, ready the ambulance and pick up the patients.

While heading back to the health centre we have to move slowly because the terrain is bad and that is why in Nabakooza’s case, it took, almost three hours to get her to the top health Centre. My experiences have struck a chord deep inside my heart. There is a compassion I now feel because I have seen so much pain and whenever I’m called, the urge to help is overwhelming.

However, it is not an easy job, one has to be alert at all times as patients may need medical assistance in the wee hours and thus when that call comes in, I have to answer and ensure that I’m available to do my job,” Adnan Asumani, 26.

Nurse’s account
I heard a knock on my door in the wee hours of the morning. It was a man’s voice speaking loudly that a mother delivered from the road but the placenta has failed to come out.

So, I sent out the village ambulance. The ambulance man went and brought the mother. When Nabakooza came into the health unit, she was holding the baby against her belly and the placenta in the other hand as she cried out in pain. I tried my level best but it is not a well-facilitated unit. I noticed that the umbilical cord had been tied.

The first thing I did was to check the umbilical cord for any bleeding because you know those mothers do not know how to tie the cord and may damage it along the way which may cause complications. The baby may bleed to death.

So I tied the cord, and cut it very well and wrapped the baby well in swaddling clothes and then I returned to the mother. In midwifery, we call it involution. When you take sometime and when you delay, the placenta goes back but luckily in this case they did not cut the cord.

We usually administer Pitocin when we know that the baby is about to come out. We administer the drug and then wait for a certain contraction. I assumed time had passed and that contraction would happen, so I used Misoprostol to induce it. There was still no contraction. So I asked the mother whether she had passed urine. So I did the manual removal of the remains of the placenta. I had to insert my hand to remove the membranes plus the remaining products.