The pain only she can tell

Wendy Ejang has been to hell and back and she is still trying to find meaning in life.
For one that got pregnant in her third year in marriage and was thrown out of home, pain had just started.
In July 2012, she had her first child. That joy made her forget the previous painful two when her baby fell from her legs.
During her second pregnancy, which was characterised with heavy bleeding and news that her cervix was too weak to hold a baby to full term, she was subjected to several stitches to keep the pregnancy.

Slated for C-section to save mother and child, they were late owing to the distance from her home to the hospital. Seventy two hours later, her gynaecologist showed up.
“I was bleeding when the doctor arrived and I was wheeled to the theatre immediately. The baby was removed but the bleeding continued and with every stitch, came heightened uterine tearing to the point of the doctor suggesting its removal,” she sadly recalls.

Ejang lost consciousness only to awake to tales of what transpired. Thankfully, her uterus was intact and her baby, who was now in Neonatal Intensive Care Unit (NICU) had survived. As if the journey had not already been thorny enough, Ejang suffered seven more miscarriages and lost an infant. “In May 2018, I conceived and was excited about the miracle baby. Unfortunately, I started bleeding and when I checked into Bugolobi Medical Centre, the doctor advised me to change environment.”
Ejang decided to go to her mother’s home with the children for a week. Going for her first antenatal in August 2019, she was advised to get three injections for her baby that was due on Dec 14.

On December 13, she started feeing labour pains and prepared to receive her new bundle of joy. The hours and days that followed were characterised by pain as her baby was visibly unconscious after delivery.
“I was told my baby was not passing stool and her condition started getting worse. X-ray showed that her stomach was beginning to swell and she was finding it difficult to breathe.”

Although she tried to convince the doctors to transfer her to another hospital, the hospital administrators were hesitant to let them go even after clearing the bills.

After several tests, Ejang’s baby was taken for surgery the next day. Unfortunately, she did not live long to have it done as she passed on at 6am the following day. The doctors revealed that the baby suffered from intestinal obstruction.
As if spending four days into labour wasn’t horrifying enough, the loss of a baby was a devastating experience for Ejang. “I have contemplated committing suicide but what has kept me going is the fact that I have other children. I have several unanswered questions. Why did God allow me to see Kaitlyn and then choose to take her away from me?”

Ejang is not an isolated case. Winnie Alum started feeling feverish and weak after returning from her honeymoon. At first she thought it was malaria but her lab test turned out negative. This was followed by spotting and her mother advised her to go to hospital.
“At Paragon Hospital, it was discovered that there was no foetal heartbeat. We decided to get a second opinion from Nsambya Hospital. After several scans, we were told that the baby had died in the womb three weeks ago. I broke down and cried my lungs out,” she remembers.

Her husband, who had gone upcountry, arrived at night as she waited to be taken to the theatre. “He said he was man enough to get me pregnant and I was not woman enough to carry his baby to full term. And off he went,” she says.
This cut through Alum’s already injured soul like a double edged sword and she couldn’t hold back her tears. After the surgery, he was called and he promised to send money but he had no plans to return to the hospital.
At home, her husband blamed her for the loss of the baby. The excruciating pain made her contemplate filing for divorce. Sometimes Alum finds herself thinking about her angel when she looks at other children.

However, through prayers, counselling, and medical attention, Alum started feeling better. She was also connected to a support group of women who have had a similar painful experience, who support each other.
Dr Paul Nyende, a counselling psychologist at Makerere University, says loss of a baby leads to depression. “Depression feelings make these parents withdraw, feel frustrated and angry. They also feel useless and hopeless.”

Dr Nyende says ultimately, after loss, there is loss of energy and lack of interest in things that they once did well such as work, relationships and other daily activities. “It impacts on interpersonal relationships as these reactions of depression show that the affected person wants space which causes many to withdraw. The person also starts to isolate themselves.”
“We emphasise that these persons learn to view the world in a positive way because depressed people tend to look at things negatively. If you feel worthless, for example, capitalise on all the good things in your life such as having completed your Master’s degree in record time, having survived because you could also have passed on,” says Dr Nyende.

The Unicef Maternal and Newborn Health Disparities report of 2015 states that 81 babies do not live to make one month and 96 still births occur everyday. Uganda’s neo- natal mortality rates 20 deaths per 1000 which excludes miscarriages and still births below 28weeks.
Peter Wasswa, an associate professor from Makerere School of Public Health, says 40,000 babies die in their mothers’ wombs while 39,000 babies who are born die before they make one month.

Complications that lead to miscarriages or still births
Dr Robert Busingye, a senior gynaecologist and obstetrician from Mulago Women’s Hospital, says the causes can be grouped into two groups; deaths before labour and deaths during labour.
He says causes before labour include malaria, any infection that causes high fever such as severe urinary tract infections, and syphilis, while causes during labour constitute pre-existing illnesses such as diabetes, and hypertension.

Labour complications may also include raptured uterus, where mother and child are at risk, raptured membranes which lead to infections, prolonged or obstructed labour, which if not detected early and dealt with leads to death, and fetal distress. Dr Busingye says there are also complications during pregnancy and these include bleeding during pregnancy and hypertension. He also notes that umbilical accidents such as an umbilical cord around the neck can also cause still births.
To mitigate mortality rates, Dr Jolly Nankunda, a senior paediatrician and neonatologist, advises women to attend antenatal classes the moment they discover that they pregnant. “Once you miss your period, go and see the doctor. In case you are pregnant, check-ups are done and some of these complications, if any, will be noticed and dealt with at an early stage,” she says.

Dr Nankunda also urges pregnant women to take medication given to expectant mothers such as anti malarial tablets and Fefol- a drug that helps maintain both iron and folate levels in the body, to guard against illnesses that can affect the baby.

While the deaths still persist, Dr Nankunda says government has made significant strides to reduce the number. She adds several campaigns aimed at encouraging expectant mothers to go for antenatal care have been instituted.
Health centres have also been equipped with routine check-ups for pregnant mothers that are vital in identifying complications, should they exist. “Nonetheless, It is one thing for these to be in place, and another for women to use them,” she says.

What can women do to overcome this horrific experience?
The loss of a baby, either in the womb (still birth) or immediately after birth is an emotionally painful experience for any mother. Evelyn C Kharono Lufafa, a counsellor, says the experience is different for every woman.
“Family beliefs, culture and religion will influence how a woman deals with such a loss. Society tends to silence these mothers because still birth is an uncomfortable topic to address,” she shares.

Kharono says talking to close family members or friends about your experiences lessens the grief and pain. She also believes that there is need to deal with the guilt. “It is normal to think there is something you could have done to save the baby.” While the list of blames you may hurl at yourself is endless, the truth is you may not have changed anything but at least talk to your doctor. “Ask questions about the death of the baby and get answers so that when you get pregnant again, you will prevent such from happening,” she says. Seek professional support. “This gives you the space to speak to someone who will not judge you and help you to accept that your partner too is grieving but may be doing it differently.” Kharono says grief has no deadline and the mother can take as much time as they need. “You will have good and bad days, sometimes grief can come up in the middle of a good time. Be kind to yourself and remember this is normal.”