26 Apr 16 28 Nov 16

Afghanistan: Complicated births in Kabul

While visiting Dasht-e-Barchi to give birth to her fourth child, 28 year-old Zainab faced a potentially life-threatening postpartum haemorrhage...

In Dasht-e-Barchi, one of the poorest neighbourhoods in Afghanistan’s capital Kabul, Médecins Sans Frontières (MSF) runs a busy maternity service in the district public hospital.

Emergency obstetric care is crucial to reduce the risk of maternal mortality, a risk that is typically elevated where access to healthcare is limited. In the South Asia region, maternal mortality is highest in Afghanistan.

While visiting Dasht-e-Barchi to give birth to her fourth child, 28 year-old Zainab faced a potentially life-threatening postpartum haemorrhage. MSF Medical Advisor and midwife, Kara Blackburn, attended the emergency.

Complications during delivery

Zainab had delivered her fourth son at 6:30am without complication, and after systematic observation in the delivery room was admitted to the high dependency unit (HDU).

The four-bed HDU, staffed by a midwife, provides additional observation for women who have experienced a complication during delivery, or women with risk factors that might yet cause a complication post-delivery.

In the HDU with Zainab were two new mothers with pre-eclampsia (high blood pressure and protein in the in the urine during pregnancy) and another, post-caesarean section, with severe anaemia.

Zainab’s complaint, and the reason for the special attention, was a history of heart disease.

She was last treated when it exacerbated four years ago, but had stabilised on treatment since then. When she gave birth to her third baby she was advised to deliver any future babies in hospital so that she could be monitored in case of further complications with her heart.

Specialised maternal care

Thankfully, Zainab had followed the advice. When she, unrelatedly, started haemorrhaging around 8:30am, there were trained staff, and all the necessary equipment and medicines, available on the spot.

A haemorrhage can quickly get out of control and later that day Zainab recalled, “There was so much going on I don’t remember the details of the bleeding being stopped.”

She also explained that she came to the hospital because it is situated close to her family and she had heard good word-of-mouth.

And because they are tending to come in time, any complications are easier to manage.

If Zainab is to have more babies, she will need again to present to hospital sooner rather than later. She confirmed that she would come without delay. In the meantime, Blackburn advised plenty of rest.

Zainab was fortunate to have her mother-in-law already by her side, who would also be caring for Zainab during the traditional lying-in period once she was able to return home.

Dasht-e-Barchi photostory

In 2015, of the 11,787 admissions in the Dasht-e-Barchi maternity service, over 28 percent were complicated cases. Typical complications are postpartum haemorrhage, pre-eclampsia, and placental abruption.

According to World Bank data, Afghanistan’s maternal mortality rate for 2015 was 396 per 100,000 live births.

In the delivery room, an MSF midwife dries a newborn. This is part of the routine care all newborns receive in the first minutes of life.

Low birthweight babies like this set of twins need to stay in the newborn unit until they gain weight. They must be fed and monitored regularly, and kept warm, to help them grow.

An MSF doctor listens to a premature newborn's chest, as part of the daily care and follow-up provided in the Kangaroo Mother Care unit.

Premature or sick newborns who find it hard to feed can receive breast milk from their mother with the help of a syringe. This baby is also suffering from jaundice.

A new mother performs skin-to-skin care, which helps her pre-term baby grow by keeping it warm, promoting breastfeeding and bonding, and reducing the risk of infection.

Australian paediatrician Nikola Morton checks a baby in Dasht-e-Barchi’s Kangaroo Mother Care Unit.

Jaundice is a complication that can affect newborns, but can be treated by exposure to UV light under a phototherapy lamp.

This mother of eight sits with her sick newborn in the MSF newborn unit in Dasht-e-Barchi. Her first seven children were all born at home but now that MSF offers free delivery and maternal care, she decided to come to the hospital.

Having shown good progress since their birth three weeks ago, low birthweight twins Zohal and Ojate Hosine have been discharged from hospital and are now home in Kabul.