Yesterday afternoon social media went crazy about the Nairobi Governor Mike Sonko’s impromptu visit to Pumwani Hospitals where he found bodies of 12 infants hidden away. It was reported that these babies had died after an incubator incident. While I cannot comment on the cause of death as I have no proof, the fact that the governor found the bodies wrapped together in polythene bags and stuffed in three boxes inside a store is extremely heartbreaking. This issue immediately raised a debate on social media about the lack of respectful bereavement care in hospitals in Kenya.
In the 4 years I have run Still A Mum I have seen firsthand how babies are treated in our hospitals especially when they die. I have heard horrible stories from the parents we support on how they were handled after the loss of their baby. The Pumwani Hospital story is just a tip of the iceberg and I dare say it caused an uproar because it went public and was unearthed by the governor. Parents are having bad experiences in our hospitals and the public never gets to here about it. How a mom or dad is treated after the loss of their baby determines how their grieving journey will be. A lot of parents start off this journey with bitterness at the hospital staff and this greatly delays the healing process.
Still A Mum has been doing Respectful Bereavement Care training in a couple of hospitals. In the process we have encountered very good response from medical staff. We have also encountered hospital staff that feel what we are asking them to do is too “Westernized”. Why would a mother want to see her dead baby? They ask.
Allow me to explain what Respectful bereavement care entails and why it is so important.
Breaking of news:
This is a big deal. This is the first time a mother hears that her baby is no more. How she is told the news will replay in her head for years. In the case of a miscarriage most times it is the sonographer who notices there is no heartbeat during the ultrasound. I have experienced this myself and I’ve heard it countless times from moms. The sonographer usually frowns at the monitor. Leaves the room and comes with a doctor – someone who looks senior. They both stare at the monitor with worried looks. Another doctor is brought in. Meanwhile no one is talking to the mother who is lying on the table with her top up and ultrasound jelly still on her tummy! Eventually someone says, “madam hapa hakuna heartbeat”. And they all leave. Sometimes you will be told that you should take the results to your doctor who will then explain the results! For stillbirths and infant death, the breaking of news is downright horrible. I have met a mom whose daughter passed on when in the incubator and when she came in she found a different baby. When she asked where her daughter was she was told “mtoto wako amekufa ako pale kwa store ukitaka kumuona”. That is just downright cold! I know breaking of news of a death is a tough thing to do. And most people even avoid facing the mom. So they tell your partner. Or your parents. But no one tells you until you press hard!!
So, how should it be done? Break the news clearly and with compassion. Don’t say “mtoto wako hayuko” that is very vague. You are forcing the parent to starting asking for clarity. Instead say, “I am so sorry but your son/daughter has passed away. I am terribly sorry.” Even in Swahili “Pole sana mama mtoto wako amefariki.” That is clear but it also compassionate. I know midwives also feel bad when a baby does not make it. They are human too. And maybe they even tried to resuscitate. So, as a midwife let your compassion show. Remember, this is the worst news these parents will ever receive so try and make it as compassionate as you can.
Giving “what next” information
It is not enough to just say the baby has passed away. Tell the parents what the next steps will be. For example, if the baby passed on while in the womb, explain that you will need to induce the mother for delivery to happen. Don’t just start bringing the drip and injecting her hand! Tell her – preferably in the presence of her partner, friend or family member – what will happen once the baby is born. Ask if they’d like a post-mortem. Explain that they can have a burial should they desire. Tell them if they don’t want a burial the hospital can take care of the baby. I know hospitals like Mater and Kijabe have an option for the family to have a memorial service in the hospital even if they will not bury the baby! Give these people options!! This will help them make very crucial decisions. Don’t wait until the parents are the ones asking questions. Kijabe hospital noted that when they asked moms if they would like to see their baby once they delivered -even knowing they were already dead – 98% said yes. When talking about burial and such avoid the use of the word “disposal”. Yes I know that is the medical term used but a mom doesn’t to hear that you will dispose off her baby. It is not a glass that broke and you need to sweep it and dispose it in the dustbin. This is a human being that died! And yes even if it was an 18 week pregnancy, they are still a human being!
Time with the baby and mementos
Let the parents know that they can see their baby and even spend time with them. A big shout out to Kijabe Hospital who take Respectful Bereavement Care for parents to a whole new level. They have a bereavement room where parents can sit and hold their baby. Nothing fancy. Just a small room that is nicely painted with a bench to sit on and a surface to lay the baby on. They clean up the baby, dress them and wrap them in a nice blanket or shawl and leave the parents to spend time with their child. Parents are allowed to take photos too. They even go ahead and give the mom footprints of their baby to take home. Again, nothing fancy – just an inkpad and nice paper. Some of you reading this are feeling like it not necessary or its too “mzungu”. Let me assure you it is extremely beneficial to the parents. They are getting a chance to make memories with their baby. That one hour is the last they will spend with their child. And those photos and footprints are the only things they have to remember their baby by. And this is not something that is expensive for hospitals to implement. It just needs passion. I remember seeing my daughter after delivery (she was stillborn) and I am grateful I got that chance. However, I wish someone had encouraged me to take photos or given us footprints. I wish someone would have mentioned having a burial. I literally have nothing physical to remember her by. And I regret that.
Stay at the hospital
At times, the mom has to stay in hospital for a while until she fully recovers. Try and minimize her stress while there. Move her out of maternity ward. Staying in a ward with babies crying and yours didn’t make it is extremely traumatic. Have a way to inform your staff of the women’s situation. It is hurtful when the kitchen staff come to bring you lunch and they’re like “mama, kwani mtoto wako ako wapi?” Let the guards at the gate know so they can allow her visitors past visiting hours. These are things that feel small (and don’t demand a lot of logistics) but are extremely important to the bereaved parents. Remember, this is the start of their journey grieving their baby. They will be in mourning for months, sometimes years. Don’t let this journey start with bitterness and anger.
Counseling before and after discharge
It is important for someone -preferably a counselor – to speak to the parent(s) before discharge. I remember the counselor who spoke to my husband and I. She was very kind. She let us know the emotional rollercoaster that awaited us and how to navigate the complex feelings that come with grief. She was an instrumental part of my healing. Thanks Nairobi hospital for that! Now, I know that it not possible to follow up after discharge. Hospitals are already stretched so thin. But we can help. Still A Mum does one on one counseling as well as support group sessions for the parents. For some hospitals, we do in-house support groups. You can reach us on firstname.lastname@example.org and we will help support your patients who have lost a baby.
I hope that this Pumwani Hospital story is not going to just fizzle out without us learning from it. Great strides have been made in medicine and specifically in maternal and newborn care but we still have a lot of work to do. Even as we strive for Universal Health Coverage (UHC) which is in the government’s top 4 agenda, we need to also work on respectful bereavement care for parents who lose a baby to a miscarriage, stillbirth or infant death.