Immediately after Eva gave birth to her child, she felt strange. Being her third time in the delivery room, she knew how to pay attention to her instincts and her gut feeling told her something was off. So she turned to her husband and said, “I feel weird.”
“What do you mean?”
“I can’t explain it. But something feels odd.”
Her contractions had began at 10pm that night. Initially, the pain had been distant, so they took time to put a few things in order and arrived at the hospital at midnight. When her doctor checked her, she was 6cm dilated but with inadequate contractions. So he decided to augment the labor. The moment that clear liquid seeped into her veins, Eva curled her hands into fists. The room that at first was so spacious, lost it’s structure. It now lacked edges, was small and airless. The pain descended on her with such force she felt as if she was going to turn into liquid and pool to the floor. Two hours later, she had a baby.
“Well, you have just gone through a harrowing two hours,” her husband Mau said to her, “the other two times the labour was just as fast but this one,” he leaned back clasping his hands above his head, “this one was something else. So it’s not surprising that you feel odd.”
“Maybe…buth shomething ish…” Her tongue was stuck to the roof of her mouth. Suddenly, the left side of her body went numb as if a weight was pressing one half of her down. The right side, as if trying to resist, started to twitch. She tried to shake her head slightly as if something was stuck in her ear. Maybe recalibrate her brain, but the words instead of coming out of her mouth, were swallowed back into herself.
Eva and Mau (short for Kamau) went as far back as Primary school when they were 11 years old. He was a new student in the school who won people’s hearts by dishing out sweets and treats to the other kids. Most of which he got from his dad when he travelled. Somehow the sweets never got to her. Probably because she was the kind of girl who sat beneath the teacher’s nose, drinking up knowledge as if it would become stale if she didn’t get it first. And it paid off because she was almost always at the top of her class. So when she found neatly written, tightly folded anonymous notes in her desk every morning, she was more irritated than flattered. What sort of distractions were these? And from who?
It didn’t take long for her to find out that the man sitting next to her hospital bed was the boy who wrote her notes when they were kids.
Lying there, she tried to stretch her hand to alert him. To tell him to call the nurses. But gravity held her hand in place. She maintained a steady line of eye contact, trying to speak with her eyes but only a tear drop fell. Then she began to feel weighted to a cloud, like energy was leaving her body. A blade of dread passed through her. Is this how people died? While their loved ones sat by their side? While their freshly born babies lay clueless in a warming tray right next? A baby who she had never held?
As her mind started to drift, she thought how devastating it would be to Mau if she left him. Because this would not be the first time.
Several years prior — after high school where he had written her letters confessing that he was the anonymous note writer and that he had liked her from the time he saw her, after they had completed high school and ended up in french school together, after they both joined uni; her in medical school, him in engineering school, after he asked her to be his girlfriend at Antonio’s restaurant, after they waited for free safaricom tariffs to talk all night, after he had left the country to pursue a degree overseas and she became a cyber cafe regular, after his communication became erratic — she left him.
And now she felt like she was leaving him again — maybe for good.
Then a rush of wind went through her and the odd feeling subsided and she said to the nurse, “Get me out of here.” She was still in the delivery suite and felt like the walls were closing in on her.
“Ok Eva. We will move you to a room.”
“Please move the baby with me. I would like to breastfeed him.” But what she really wanted was to hold him. What was that thing that had gripped her?
When she had settled onto her bed, she put her boy to her breast. He suckled once, twice, thrice and then she felt a foreign body slip out of her. Followed by a sudden wetness and to her horror, excruciating low abdominal pain.
“Mau, hold the baby please. Take him.” She winced in pain when she turned to hand him over.
“Why? Are you ok? You look…you dont look so good.” His dad who was with them ran to call the nurse.
When she got there, she took one look at Eva who was folded on her bed, groaning in pain. When she pulled away her beddings, she got a slightly manic look, her eyeballs popping out.
She bellowed out into the corridor, “PPH!” and pulled the curtains, shutting everyone but Mau out.
In a split second, a river of nurses in white had appeared by Eva’s bedside. One of them — who she later learned was the team leader — was giving instructions to the rest, as they waited for her doctor to arrive. “You, take her vital signs. You,” she turned, “put in wide bore cannulae and hang up fluids. You, take blood samples, and get blood for her.”
Someone else had lifted her hospital gown and pressed on her lower abdomen. Clots splashed out of her like water from a hosepipe. “Her bladder is full. We need to catheterise her.”
‘What? No!’ Eva thought. ‘Not a catheter.’ But there was no way her voice could be heard above this organised chaos.
When they fixed the catheter, her breath was caught halfway to her mouth. It felt like a searing rod was being pushed into her urethra. Before she could register this pain, one nurse said,
“Eva I am going to evacuate the clots.” She knew what this meant but she wasn’t ready for the visceral reaction it gave her when the nurse inserted her hand into her vagina and pushed all the way up to her elbow.
Eva lunged forward in agony and gave out a blood curdling scream. Everyone in the room turned to her and Mau jumped backwards and fell into a chair, dizzy with worry.
Mau had always known he would marry Eva. He can’t remember how he knew, he just did. Back when they were just 17, in french school, he had asked to meet her dad who knew him as the boy who liked to call his daughter on his mobile phone. So on a random day Eva asked her dad, “Dad, you know that guy who usually calls me on your phone? The one I am with in French school? He wants to say hi.”
“Ok.” Because her dad was that guy. The guy you could talk to about anything. The guy who would say ‘ok’ to meeting your friend, who was a boy, at a supermarket on Langata road.
They met and spoke for 30 minutes about everything and nothing in particular. Her dad did all the forensics, and Mau answered each of his questions politely. Her dad later told her mom, “I met Njeri’s friend today. A nice chap.” What no one knew on that day, was a few years later, Eva’s dad would be deceased and that conversation Mau had with him, when he was just 17 would be the only time they ever spoke.
When he looked back on that memory, it jolted him. How someone can be so full of life, then gone. He recalled the conversations he had had with Eva just that afternoon as they weaved in and out of traffic doing their last minute shopping for the baby. They drove around chatting, enjoying each others company not knowing that a few hours later, she would be warring with God for her soul.
“Give her pethidine!” He heard her doctor shout after he arrived and saw the kind of pain she was in. Once the drug was pushed in, she lay back like a puppet. Semi-conscious and floppy. Dead weight. “Squeeze those fluids sister.” He said to one nurse who took the bag of clear fluid and flattened it in between her hands. Someone ran in with a pint of blood that was hung up and attached to her other arm. Despite all these measures, when they checked her, she was still gushing blood like a stream.
“BP?” her doc asked.
“Have you given Tranexamic?” And he went on to list several other drugs which were part of the protocol of management. And the answer was yes to each one. The doctor looked at the monitor and her BP was still dropping.
“Call theatre.” Then he turned to Mau. “I will need you to give consent. Depending on what we find, we may have to remove her uterus to save her life.”
His body stiffened as something inside him clenched up hard. He looked at her tiny frame and thought, ‘Not today Eva. Not today.’ Not after dating, then breaking up, then finding each other again when he came back in to the country. In the period of their break up, when he was away, they had each seen other people yet had still found their way back to each other. It hadn’t been easy. Eva was as stubborn as the smell of a dead rat refusing to clear, and even if when he got back they were both single, she refused to entertain the thought of dating him or anyone for that matter. It took an insurmountable amount of patience to win her over. The first time he took her on a date after his return, he told her, “I hope you will stop being so stubborn and accept to be my girlfriend again. Then I will marry you.”
He saw her face fall by just a tiny degree and knew she was mentally flipping through her list of polite let downs. Her response was, “Take me home.”
That month, he took her out every weekend and she remained cold as a block of ice. She only thawed much later and before she had a chance to change her mind, he had proposed.
‘Be stubborn today Eva.’ He begged her. ‘Be stubborn and don’t die.’ And he prayed. He prayed because she was the only girl he had ever loved. Prayed because they had two other little boys at home waiting for their mom. Prayed because if he lost her, he would miss her terribly. By now an hour had passed since they started resuscitating her.
Her doctor examined her again and said, “The bleeding seems to be less. Her BP is now stable. Let’s give it a bit more time.”
And that is all Mau needed to hear.
As narrated to me by Dr Eva Njeri Njagua — who is alive and well and a mother to three boys.
Postpartum hemorrhage (PPH): is a condition in which a woman loses a very large amount of blood after childbirth. This can happen after a woman gives birth through the vagina or after a cesarean delivery.
Causes: Almost always, PPH happens because the uterus does not contract well after birth. Others causes include: ●Tears of the vagina or the cervix ●Small pieces of the placenta remain retained .Disorders of the clotting system
Symptoms: Bleeding is the main symptom. And if the woman loses a lot of blood she ends up weak, lightheaded and can go into shock.
Treatment: Depending on the cause, some of the measures taken include: ●Massaging the uterus — The nurse or doctor will use his or her hands to press down on the woman’s lower belly and massage the uterus. This helps the uterus contract. ●Medicines that help the uterus contract and slow down bleeding ●Checking to see if there are bits of the placenta stuck in the uterus. If so, the doctor/ nurse will remove them.
If the hemorrhage happens because of injuries or tears, the doctor/nurse will stitch up any tears.
If the bleeding is very severe, a woman might need a blood transfusion.
If these treatments don’t stop the bleeding, there are other treatments the doctor can try.
If none of the treatments work, the doctor might have to take out the woman’s uterus.
Moving forward: — Make sure your doctor/nurse knows about your past postpartum hemorrhage.
Compared with women who have not had a postpartum hemorrhage, you have a higher chance of having the problem again.