A mother’s death under COVID-19’s shadow

The story of Katherine Bulatao is, in the words of women’s health pioneer and champion Dr. Florence Tadiar, “horrible, inexcusable, criminally liable.” It is also, tragically, all-too-common and real.

Katherine’s story is quick and simple enough to tell. She had given birth five hours previously at home with the help of a midwife. The home birth was decided upon by Katherine and husband Jan Christian out of fear of infection from COVID-19, even if home births are still fairly common here. After the birth, though, the midwife advised Jan Christian to bring his wife to a hospital because she could not stop the postpartum bleeding, a fairly common aftermath of childbirth.

What followed, though, is hardly common or routine—or should not be—had the 26-year-old Katherine’s pregnancy and delivery not taken place in a poor country like ours, to a couple as poor as them, at a time of a deadly pandemic. News reports say Katherine passed away five hours later after six hospitals—government and private—refused her admission.

The reasons given by the hospitals range from a lack of facilities, including a ready blood supply, to the absence of an obstetrician/gynecologist, and the family’s lack of money for a down payment.

But, writes Dr. Tadiar, it would have been fairly easy for any of the hospitals to administer emergency measures to save Katherine’s life.

“From what I know, postpartum hemorrhage would likely be due to retained placenta,” writes Dr. Tadiar. “Did someone do any abdominal/uterine massage throughout the four hours Katherine was hovering between life and death? Her husband could have been taught to do this, to help the uterus contract and perhaps expel the retained placenta.”

One simple way of helping the uterus to contract, continues Dr. Tadiar, would have been to put the newborn infant to suck from Katherine’s breast that would have helped spur contractions. “And did any hospital insert IV fluid if there was not available blood or no time to have (a transfusion) done?”

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The young mother could also have been saved if any of the hospitals had Misoprostol on hand. The drug, which is on the WHO Model List of Essential Medicines, “has been found to be effective in the prevention and treatment of postpartum hemorrhage.”

Misoprostol is “inexpensive, has a long shelf life, and does not need refrigeration.” It should have been available, asserts Dr. Tadiar. Another “simple and inexpensive” method that could have saved Katherine’s life would have been the use of the manual vacuum aspirator.

“All hospitals,” asserts Dr. Tadiar, “particularly those in remote places or maybe in all LGU hospitals should be able to use any of these methods, to save women’s lives. After all, many mothers still deliver at home.” And during these days of enhanced community quarantine, perhaps many births have to be at home, says Dr. Tadiar.

The manual vacuum aspirator can be used by trained midwives or nurses, notes Dr. Tadiar. “It does not require general anesthesia or hospital admission, so the procedure is definitely cheaper. And it can be done in a few minutes.”

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One reason for the absence of Misoprostol and manual vacuum aspirators from delivery rooms is the fear that these could be used for abortions. But with proper safeguards, says Dr. Tadiar, the use of the drug and device can be strictly monitored while saving the lives of mothers.

The need for protection of girls and women against unplanned and unwanted pregnancy in these days of the COVID-19 peril is particularly acute. During the lockdown, says Dr. Tadiar, “women and girls can become pregnant inside their home or evacuation places, with or without their consent.” Which is why, says the doctor, apart from the needed drugs and devices to protect them from the risks of childbirth, women and girls need to be protected from forced, unwanted, and unplanned pregnancy mainly through access to contraceptives, including emergency contraception which, says Dr. Tadiar, “is actually legal in the Philippines but not really available.” It does not, she asserts, cause abortion.

Katherine’s death is certainly cause for sadness, frustration, and concern, embodying as it does the fragile state of women’s reproductive health and rights in the country under the shadow of COVID-19. It is not just the virus that is threatening the survival of our women.

rdavid@inquirer.com.ph