It was an emotional moment, the words of Maya Angelou rang true as I held hands with a young couple in prayers, “There is no greater agony than bearing an untold story inside you”. I could see the tears in both of their eyes as the husband recited a prayer while I and his wife responded with “Amiin”.
I had met them while I was on my way out and well, I was late already so I decided why not see one last client before going to fight for Daladala.
I went through their referral letter and took the young woman’s history carefully. After extensive physical examination and collecting samples, I wheeled her to the radiology department for further tests.
The radiographer looked at me and we both knew it. I think this was one of the hardest news I have ever had to deliver, both twins were dead. I could hear her voice break as she tried to ask me if there was anything that could be done to save them. There was nothing any of us could do.
It was her second pregnancy, and her second miscarriage. She tried to hold herself together but the moment her husband appeared she broke down in tears. I have seen my share of the pain and grief that come with pregnancy loss and it’s something that sticks with you.
A lonely journey with scary outcomes
Pregnancy loss before 28 weeks gestational age is termed as spontaneous abortion or in common terms, miscarriage. After 28 weeks it is called stillbirth, which in medical settings can be macerated stillbirth in which the fetus died well before delivery or fresh stillbirth in which the fetus recently died during delivery.
I have always argued that women who experience pregnancy loss have quite a hard time even in terms of the help they are provided with during medical procedures. They do not receive enough psychological support, not just because of losing their unborn child, but also the trauma that comes with evacuation or delivering a child that they know will never cry or breath.
From being given a limit to grieve because “it’s God plans” to not receiving enough care, these mothers go through a lot. While mine can be regarded as just an opinion, the recently released Tanzania Demographic Health Survey and Malaria Indicator Survey (TDHS-MIS) 2022 backs me up as it reports, “The percentage of women who felt that they did not receive respectful care is higher among those who had a stillbirth than among those with a live birth.”
So what are the exact numbers? According to TDHS-MIS 2022 report, 7% of women who had stillbirth reported that they were not treated with respect at all (versus 1% among women with a live birth), while 11% reported that healthcare providers did not take the best care of them at all (versus 1% among women with a live birth).
There is a need to reconsider maternal care for women who have had stillbirths, evidently what is done is not enough. It seems that the psychological support is not enough but also in a bid to save mothers and their unborn children, those with stillbirth may be left behind.
Understanding the emotional trauma
I firmly believe that it is unfair to put women who have had stillbirths in the same ward as those who have had live births. I think the least that could be done is to give them their room with those who have had early neonatal deaths.
It is not easy to lay in bed in recovery alone while everyone beside you is holding her baby, breastfeeding knowing that you cannot do that as your baby is gone. Having to state that your child has passed away every time someone asks you where your child is and why are you not breastfeeding, it is hard.
Post-abortion and postpartum care for mothers who have had stillbirths is also a challenge. Many of them do not see a need for follow-up visits as they feel that they have lost already. The socio-cultural aspect of pregnancy loss is not helping either.
From being met with suspicion when they seek post-abortion care to being accused of inducing abortion despite spontaneous abortion (miscarriage) being more common than induced abortion. “Among pregnancies to women aged 15–49 years in the 3 years preceding the survey, 90% ended in a live birth, 8% resulted in miscarriage, 2% resulted in a stillbirth and less than 1% were reported as induced abortions”, reports TDHS-MIS 2022.
This reminds me of a middle-aged woman who was admitted in septic shock, the whole ward was in chaos trying to save her life. Everyone was on their toes with sweat on their foreheads by the time she was stabilized.
READ MORE: Abortion is Healthcare
When she finally got to tell her story, she admitted that she lost her pregnancy a few weeks back and despite knowing that she needed to seek hospital care, she opted out because in her words, “You know how you guys [healthcare providers] are, I didn’t want to be accused of terminating my pregnancy. And when the bleeding and blood clots stopped, I assumed that it was over.”
Little did she know that she was walking with a ticking time bomb that was about to explode at any moment.
While statistics show that miscarriage (spontaneous abortion) is more common in urban areas than rural areas, these numbers may not reflect the reality at ground level.
Pregnancy loss in rural areas is met with shame and stigma, and so is early neonatal death. This contributes to many women not reporting that they have had pregnancy loss before. On the other hand, limited access to healthcare services also plays a part in the underreporting of pregnancy loss in rural areas.
If the stigma and unexpressed grief is not enough, pregnancy loss has been associated with couples’ separation and divorce. A study done in 2010 showed that married or cohabiting couples who had a miscarriage were 22% more likely to break up compared to those who had a healthy baby at term.
For couples who had a stillbirth, the number was even higher with 40% of couples ultimately ending their relationship. According to the International Federation of Obstetrics and Gynecology (FIGO), 30-50 percent of women who have had miscarriages experience anxiety, and 10-15 percent experience depression.
Pregnancy loss is as expected linked to adverse mental health and unfortunately, there are no well-developed psychological care guidelines in place to support these women. Some women have reported experiencing symptoms of Post Traumatic Stress Disorder (PTSD) after miscarriage and/or stillbirth.
It is no surprise that some women who experience pregnancy loss, ask the hospital to take care of the remains. In some cultures, it is alleged that those who have a stillbirth or early neonatal death are supposed to bury the remains within the house for fear of witches digging them up to use them for witchcraft practices.
I cannot imagine living in a place knowing that my child is buried underneath, that is enough to make anyone mentally unstable.
A systemic failure
For those who have had babies, they know how the world looks at you after the birth of your child. Most times, your world begins to revolve around your baby since pregnancy and it even gets better after birth.
Those close to you are more likely to ask about the baby than about you when they reach out. When you experience pregnancy loss, many people do not reach out; some because they do not know what to say, some because they do not want you to feel like they are pitying you especially those with children.
Women who experience child loss are met with societal failure and systemic failure. They are failed by everyone; more likely to be treated with less respect in healthcare facilities, shunned by society, and more likely to break up with their spouse and even the work environment does not favor them either.
I combed through the Tanzania Employment and Labour Relations Act trying to find if at any point women who have had pregnancy loss either miscarriage or stillbirth.
Those who have had peripartum stillbirths experience postpartum like a mother who had a live birth. Breastmilk production does not cease because a child is dead. While doctors can prescribe you medication to suppress breast milk production, some mothers opt out of it because of different reasons.
Several countries have already shown a way of providing a form of leave for women who experience miscarriage and stillbirth this includes New Zealand, Canada, and India.I believe that Tanzania can join these countries to provide support for women who experience pregnancy loss.
October is International Pregnancy and Infant Loss Awareness Month, and it is barely recognized in Tanzania. The least we can do is acknowledge and commemorate this month to create public awareness.
Kuduishe Kisowile is a medical doctor and public health commentator based in Dar es Salaam, Tanzania. She is available through firstname.lastname@example.org or on X as @Kudu_ze_Kudu. Want to publish in this space? Contact our editors at email@example.com for further inquiries.