If only all parents could see their babies' first smiles

By CATHERINE MWESIGWA KIZZA

I had just been discharged from hospital with my new-born baby. Both of us were healthy and well. I made my short visit to the labour ward to thank the midwifery team that had been with me for the past four days. I was lucky to find the midwife who had been in the theatre to receive my baby at birth.

“Thank you so much,” I said pressing her small hands. I expected a bright smile, but all she could afford was a nod and sigh. Then she said, “No, don’t thank me, thank God. He saved your baby. I had lost him.” The news came to me as a surprise. I had not detected any problem.

“But I heard him cry,” I insisted. “Yes he did cry, but once. His nostrils were too small. He had failed to breathe.” Bewildered, I started to ask more questions but she continued, “Go home now. Do come back if you notice breathing problems.” Then she burst into a chuckle and joked, “It is your fault, why did you give him your small nose?” and with that disappeared into another new mother’s room.

I did not have enough time to continue the conversation, but it all came back to me. My baby had cried, but once. At that moment, during a cesarean section, I had not taken much note about it.

Thankfully, I was under a skilled theatre team, with two midwives – one to receive my baby and another one by me, just like the World Health Organisation recommends.

This is what every mother deserves, but not many in Uganda get this care. Many are lucky to have a trained midwife at their side to attend to 10 of them at a go. For the majority, there is an unskilled relative to receive the baby as the midwife tries to save the mother if there are complications.

It is no wonder that every day in Uganda, 41 new-born babies die without perhaps giving their mothers and fathers that first cherished baby smile. 40% of all deaths of children under the age of five in Uganda occur in the babies’ first month of life.
Uganda is among the world’s 50 riskiest places to be a mother. This is

Fifteen percent of under five deaths happen within the baby’s first 24 hours of life.

The causes of newborn deaths are largely preventable. 80% of the deaths are due to complications arising from babies being born prematurely, complications during childbirth and due to severe infections. The major infections include pneumonia, sepsis, meningitis and tetanus.

To prevent the deaths of babies born too soon, mothers prone to premature births are given an injection that helps the baby’s lungs to mature before it is born.  

“Only one or two injections of Dexamethazone can save the baby,” says Dr. Patrick Aliganyira, the programme specialist, Saving Newborn Lives.

According to online sources, the lungs of full term babies produce a lubricant in the lining of the air sacs in the lungs.

These prevent the air sacs from sticking together when the baby breathes, allowing the new-born to breath easily on its own. In premature babies, this is not the case. An injection given to the mother helps to produce this lubricant in the baby before its premature birth, thereby improving its chances of survival.

Corticosteroid drugs like Dexamethazone can lower the risk of breathing problems in a premature baby after it is born. The drug also prevents other conditions in premature babies like bleeding in the brain, intestinal infection and even death.

Also to ensure the premature baby survives, Kangaroo mother care, where the premature baby is strapped on its mother’s chest, with skin to skin contact, has been found to improve survival rates than the incubator.

“Kangaroo mother care position facilitates breastfeeding, is a natural incubator and reduces chances of infection,” Dr. Aliganyira says.

To prevent complications during childbirth, mothers are encouraged to deliver with skilled attendants. These are healthcare workers with midwifery skills.

“Traditional birth attendants are not able to detect complications the baby may suffer during labour while still in its mother’s womb. They cannot perform cesarean sections to save the baby or mother’s life when either one of them is in danger,” he says.

Unskilled attendants also do not have skills to help babies breathe at birth, yet newborn resuscitation helps babies who are unable to establish the first breath to breathe and live.

Dangerous cultural practices around the newborn’s cord and its care are also a cause of concern. According to Aliganyira, the baby’s skin and the cord are the biggest entry of infection to the newborn, leading to life-threatening infections.

Known interventions to save mothers from maternal death also save babies. There is need to train, recruit and retain health workers with midwifery skills and to support them with the tools and supplies they need to save mothers and babies. Nurses without midwifery skills do not have the ability and confidence to detect and handle complications.

Communities and fathers need to encourage mothers to attend antenatal care at least four times during pregnancy to receive necessary immunisation and monitoring for themselves and the babies.

With this done, perhaps we shall be able to see every mother and family in Uganda smile, at not only each baby’s first birthday, but through the fifth birthday and for life.