Afghanistan: “A postpartum haemorrhage can happen to anyone”

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.

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 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 children in hospital so that she could be monitored in case of further complications with her heart.

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. Knowing that many complications related to delivery are unpredictable, MSF is pleased to see more and more women from the Dasht-e-Barchi community coming to give birth within its specialised facility. And because they are tending to come in time, any complications are easier to manage.

If Zainab is to have more babies, she will again need 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.

In 2015, of the 11,787 admissions in the Dasht-e-Barchi maternity service, over 28% 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.