I recently had the opportunity and privilege of spending two weeks working at Kapenguria Hospital in Kenya through Saving Mothers. I returned from the trip with a mix of emotions – among them amazement mixed with sadness, overwhelming gratitude, and above all a greater desire to help. I am thankful now more than ever to live in a place where as an OB/GYN I have the resources at my disposal to ensure a safe delivery for both the mothers and infants I care for. This is not the case everywhere in the world. One of the most striking things I noted during my time at Kapenguria was how low-cost interventions, such as the use of ultrasound during pregnancy, can have such a huge impact.
One morning during my time at Kapenguria, I arrived at the labor ward to find a mother just coming through the doors and obviously in active labor. Unable to make it to the bed, she began to deliver on the floor. As the nurses helped her undress, it was clear the infant was not waiting for anyone. Before we knew it the baby was being delivered and was for the first time noted to be breech. It was also noted to be a preterm infant, likely just over 7 months gestation. At that point, we moved the patient to the bed and completed a very difficult breech vaginal delivery. Because the delivery took longer than usual, the newborn was at risk of increased morbidity and mortality.
In the United States, we generally do not allow vaginal breech deliveries due to the risk of head entrapment, meaning difficulty delivering the head. This can occur since it is the largest part of an infant and requires the greatest amount of cervical dilation to be safely delivered. Vaginal breech delivery also requires a provider trained in such techniques, which is also not something always available in other parts of the world.
This mother was just 18 years old and having her third child. This is not uncommon in the rural county of West Pokot, Kenya. This mother had also never received any prenatal care during her pregnancy. She had never had an ultrasound and was unaware her infant was breech and of the potential risks of a vaginal delivery for this child.
Increasing access to and utilization of prenatal services for pregnant women in Kapenguria is one of the primary goals of Saving Mothers. They are working in conjunction with the local government and health department to pursue this objective.
The overarching goal is to decrease maternal and neonatal morbidity and mortality.
One of the lowest cost and most beneficial ways of doing this is through training local health providers in obstetrical ultrasound techniques so that they may offer these services to the women of the community. One of the ways Saving Mothers is doing this is through outreach to the peripheral health clinics associated with Kapenguria Hospital. In addition to ultrasound, they are performing preterm birth screenings through the Preterm Birth Indicator Study.
During my time in Kenya I was able to attend a few of these outreach clinics and even during that short time we had a woman who was nearing her due date who we discovered to be breech on ultrasound. This was her first ultrasound in the pregnancy and because of this finding we were able to educate her on the danger of a vaginal delivery and scheduled her for follow up at the hospital. We were hopeful that through this ultrasound we had prevented that child from having a poor outcome. For many of the mothers, often the primary concern on the ultrasound is gender – whether they are expecting a girl (msichana in Swahili) or a boy (kijana). For the providers however, it is an opportunity to ensure fetal well-being, diagnose malpresentation, and improve care.
In the US, we take ultrasound for granted. Normally a woman will receive a minimum of four ultrasounds during her pregnancy – three antenatally and one at the time of admission for delivery. If there is any complication during pregnancy with either the mother’s health or the infant’s growth a mother will have even more ultrasounds. Although we often don’t recognize it as such since we are so accustomed to having it at our disposal, ultrasound, even a single one, performed during pregnancy truly can mean the difference between a child’s life and death.
I am so grateful for the opportunity to volunteer with Saving Mothers and for all it taught me and all I was able to teach to the providers at Kapenguria Hospital. Saving Mothers is truly making a difference in West Pokot and I was honored to be a part of it. Looking forward to heading back to Kenya soon!