Michael Abrahams | Advice to women for a safe pregnancy and delivery

Many assume that when a woman conceives it is a given that she will carry the pregnancy to nine months and deliver a live baby. And in most instances, this is the case.

However, pregnancy is unpredictable and not without risk. According to statistics from the World Health Organization (WHO), about 287,000 women died during and following pregnancy and childbirth in 2020. That is approximately 800 women per day. Here in Jamaica, our maternal mortality statistics are cause for concern. According to data from our Ministry of Health and Wellness (MOHW), in 2022, our maternal mortality rate (deaths per 100,000 live births) was 156.7. In 2000, it was 90.8.

The reasons for this significant rise are multifactorial and include issues with provider care such as delays in management, diagnostic errors, transportation issues, and deficiencies at facilities such as reduced availability of blood and drugs and inadequate medical supplies. These are beyond the control of pregnant women. However, there are steps you can take to enhance the likelihood of a safe delivery and minimise your risk of complications that can place your life at risk. One of the first steps you can take is to plan your pregnancies. Most pregnancies in this country are unplanned. It is best to be physically, mentally, socially, and financially prepared, and part of being prepared is to be as healthy as possible.

For example, if you have anaemia (a low blood count), it is best to correct it if possible. Some types of anaemia, such as sickle cell anaemia, are permanent. However, others, such as iron-deficiency anaemia, the most common type, can be corrected. Obstetric haemorrhage is unpredictable. But the higher your blood count, the better you will be able to tolerate massive blood loss should it occur.

OTHER FACTORS

Other factors and conditions can also increase maternal morbidity and mortality. Some of the main ones are increased maternal age, obesity, hypertension, and diabetes. The older you are at conception, especially if you are over the age of 34, the greater the risk of complications. This is not surprising because as we get older, the more likely we are to develop co-morbidities that can complicate pregnancy. If possible, it would be in your best interest to conceive at a younger age.

Regardless of age, if you plan to conceive or are in a position where you can, it is imperative that you control chronic diseases and try to be in your ideal weight range. If you have certain conditions such as sickle cell disease and certain types of heart, kidney, and thyroid disease, and you plan to conceive, it is important to consult a physician to discuss the risks involved. In some instances, it may be advisable to avoid pregnancy altogether.

Once you conceive, it is essential to see a health professional shortly after you realise you are pregnant. Early assessment is necessary to optimise management and decrease risk. For example, an early ultrasound examination will not only confirm the pregnancy and its age, but also its location. A pregnancy outside of the uterus is known as an ectopic pregnancy and its most common location is in one of the fallopian tubes. A pregnancy at this site is extremely unlikely to make it to viability, and if the tube ruptures, the resulting bleeding can be catastrophic. An early ultrasound examination can assist with diagnosing the condition, facilitating prompt management.

The importance of proper antenatal care cannot be overstated. There is no room for complacency. Some complications can be silent and only detected by clinical examination or investigations. For example, with some foetal positions, such as if the head is pointing to the left or right instead of downwards, vaginal delivery is not possible. Labour in this position will not only fail to progress to a vaginal delivery but can result in a ruptured uterus. Or if a foetus is too big, it can not only get injured during delivery, but can also cause significant genital tract trauma to the mother. Examinations at antenatal visits can detect these anomalies, and if found, an elective (scheduled) Caesarean section can be planned, which is ideal, as the complication risk with elective surgery is less than with emergency intervention.

LOW-LYING PLACENTA

Another issue you may be unaware of is a low-lying placenta, a condition known as placenta praevia. The placenta is also known as the afterbirth because it departs the uterus after the birth of the child. However, if it is too close to or covering the cervix, the lowermost part of the uterus, it may not only obstruct the delivery of the baby, but also cause massive haemorrhage when contractions commence and the cervix begins to dilate. An ultrasound examination in the antenatal period will detect this condition and facilitate the planning of delivery by elective Caesarean section, in some cases, to minimise maternal blood loss.

Another example is that you can be anaemic and be unaware. However, a blood test in early pregnancy can detect it, facilitating its appropriate management. Getting blood donors in case you need to be transfused is also a good idea.

Present yourself for your antenatal visits, be compliant, and do not delay in seeking treatment if you notice symptoms that require attention. As your due date approaches, the intervals between visits become shorter, and there is a good reason for that. Some conditions may occur suddenly in the latter part of pregnancy and require swift management. One of these is pre-eclampsia, a hypertensive disorder that occurs during pregnancy that will only resolve after the baby and placenta are delivered. If untreated, pre-eclampsia can progress to seizures (eclampsia) and life-threatening blood-clotting abnormalities.

The aim is to reduce the global maternal mortality rate to less than 70 by 2030. Is this possible in Jamaica? Yes, it is, but it will require a multidisciplinary approach involving the actions of not only health professionals, but also fertile females.

Michael Abrahams is an obstetrician and gynaecologist, social commentator and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on X , formerly Twitter, @mikeyabrahams.