In September 2013, a woman was recorded giving birth on a concrete floor at Bungoma District Hospital while nurses watched. After the painful delivery, the nurses were recorded slapping and abusing the woman for soiling the hospital floor.
While this may have looked like an isolated case, Newsday Kenya has found out that cases of women suffering abuse and battering in maternity wards or undergoing dangerously botched labour processes have become common in many hospitals.
Take Carolyne Kiptoo. She remembers her delivery process at a hospital in Nakuru with a chill. She arrived at the hospital on September 3, 2013 after her active labour stage started. That the hospital was a referral unit, doctor negligence in the labour room was the last of her worries. “Although I had been attending my antenatal clinics at Langa Langa Dispensary Clinic, I had resolved to have my baby at this hospital. I was confident that I’d be put under good care and assisted throughout my second and third stages of labour,” she says.
However, when she arrived at the hospital at 6am that Tuesday, the reception she had envisaged was far from reality. “The nurses looked at my clinic booklet and said that I should just walk back to Langa Langa Dispensary Clinic and deliver my baby there. Their maternity was not an open market where any pregnant woman could walk in as they wished.” After hurling insults at her for a few minutes, the nurses called on the doctor to examine her. “He was drunk and kept hurling insults at me,” says Carolyne. To her shock, the other expectant women in the ward did not seem too perturbed by the abuse. Carolyne would later learn from those who’d delivered at the hospital before that insults, battering and carelessness were a common occurrence at maternity wards.
After a brief examination, the doctor noticed that this was her first pregnancy and remarked that first time mothers were just stubborn time-wasters who liked to fake pain and contractions. “He instructed that I go back home because I didn’t look as pained as I claimed.” Carolyne protested against being sent home until she was admitted. “I had consulted widely and read about the labour stages. Moreover, I’d already broken my water,” she says. From her bed, she was told to stay put and only call the doctors when she saw blood. “They kept ignoring me saying that I looked too young to have a baby; that I was a promiscuous girl who’d stolen someone’s husband and who didn’t deserve to be cared after.”
A few hours later, Carolyne felt her baby coming. “I yelled for help. The nurses refused to come at first. I yelled again and they came and slapped me saying that I was a noise-maker. They pulled me from my bed and began to drag me towards the delivery room. I was too afraid to stand up and walk. I feared that my baby may drop to the ground.” In the delivery room, the nurses lay her on the delivery bed and left her at the mercies of three students who were in the hospital on attachment. Luckily, she delivered her baby safely at 9pm on September 4.
On June 30, 2013, Gladys Awino checked in at yet another maternity hospital in Nakuru ready to have her baby. She was the only expectant woman at the labour ward. At 7pm, a nurse passed by her bed and after checking her, she was told that she had dilated 8cm. “I was confident that by 10pm, I’d be ready to have my baby. At 10pm, she called on the nurse and told her that she felt dilated enough and her baby was on its way out. “I could feel that my baby was trying her way out,” she says. However, the nurses told her to shut up and stay put in the labour room while they had tea along the maternity corridor. “I could hear them talking and laughing while I screamed for help. By 10.20pm, they were still there laughing and talking. By 10.30, I could have it no more and I yelled with all my voice.” One of the nurses angrily stormed into the room and instead of helping her to the delivery room, she was told to get up and walk by herself. “I told her I couldn’t because the baby was coming out but she refused to listen,” says Gladys.
She crawled to the delivery room with the nurse walking behind her. Inside, the nurse told her to climb unto the delivery bed by herself. “By then, I was so tired and pained that I could hardly push. I was slapped several times as the nurse exclaimed, ‘Wewe mama; wacha kujifanya!’” The nurse injected her with oxytocin to induce labour and strengthen her contractions. Unfortunately, Gladys’ bladder was full. She slapped her again. “Immediately after the slaps, she received a phone call and talked for about five minutes. I could tell it was not an urgent call since she was laughing and cracking jokes.” A few minutes later, she delivered her son and sighed deeply. “The nurse slapped me again and rebuked me saying that I was breathing heavily and yet I might have been carrying diseases.” She was returned to her bed and discharged the following morning. In those two days, Gladys received no food or drinks from the hospital.
However, not all women at Nakuru hospitals have always been as lucky as Carolyne to deliver normal babies after surviving botched up labour processes. Take Monica Wangari, a mother of two. Whenever she looks at her eight-year-old son, Monica cannot help but imagine how different her son’s life would be had the doctors and nurses been more careful during her delivery. By the time she was admitted at the hospital on January 23 2006, her cervix had dilated by 1 cm. Twelve hours later, the cervix had not changed and was still at 1 cm dilation. A day later, it was still at the same position.
Despite sufficient cause for alarm, the doctors told her to stay put and wait for it to open up. They put a drip on her and injected medicine to induce labour and force the cervix to thin out but by the 18th hour her cervix was still at 1cm dilation. She requested for a cesarean section but instead, the doctor lined a second drip on her. “I was put in pain for 26 hours as they waited for the cervix to dilate.” Eventually, the doctors decided to operate her. “It was too late. My son had swallowed too much amniotic fluid and meconium,” she says. The doctors examined the baby and told her that he was alright. “They assured me that he was normal like any other baby and being a first-time mother, I had no cause for alarm,” says Monica. She was discharged from the hospital, without knowing that her baby had cerebral palsy (CP) due to lack of oxygen to the baby’s brain – known as asphyxia – during the prolonged labour and attempted normal delivery.
Although mothers like Carolyne, Monica and Gladys can seek justice either through the courts or the doctor’s disciplinary board, many women prefer not to pursue such cases. On one hand, many fear that regulatory bodies charged with the task of investigating and disciplining negligent doctors hardly rule in their favour. Similarly, cases such as Charity Wanjiku’s only add to the perception that the doctors’ board is an umbrella chaired by doctors to protect their colleagues. On January 16, 2014, 27-year-old Charity lost her new born after her baby died minutes after birth at the Nyeri Provincial Hospital. The baby dropped and hit his head on the ground and efforts by nurses – who were not present at the time of birth – to resuscitate him were futile. Charity had arrived at the hospital at around midnight with sharp labour pains. “I alerted the nurses that the baby was due but they ignored me. I stood up due to the pain and that was when the baby came out and fell head first to the ground,” she says. In search for justice, the baby’s death was taken up for investigation by the Nyeri County Government, the Kenya Medical Practitioners and Dentists Board (KMPDB) and the Nursing Council of Kenya.
In an investigation report released by the three, the death of the baby boy was blamed on his mother. According to the report, Ms. Wanjiku had been attending antenatal clinic at Kiganjo Health Centre in Nyeri County until later in her pregnancy when she was referred to Nyeri PGH due to a recurrent blood pressure. She reported at the Nyeri PGH on January 15, 2004, hours to her delivery for a check-up and she was advised to go back home and only return when her labour fully established. After reporting to the hospital in pain at around midnight, Ms. Charity was closely monitored until shortly before she delivered, the report said.
On the other hand, aggrieved mothers may find themselves unable to meet the costs of hiring a lawyer to represent them. “A mother may go to court to seek damages for the loss suffered. However, the cost of filing the case will depend on the amount claimed as damages and the advocates retained to pursue the matter. The minimum such a claim can ordinarily cost is about Sh. 50,000,” says Mr. Murigi Kamande, an advocate of the High Court of Kenya. This is what prevented Monica from reporting her case. “I would have wished to sue the hospital but I didn’t have the funds with which to support my case.”
Eight years down the line, Monica has been left reeling from the pain of raising her child alone. “He does not speak or move. I cannot be too far from him. I have tried to take him to a special school but they won’t take him in,” she says. “But what pains me most is to know that he would be a normal jovial child had the doctors at the delivery room been more careful and quick to take action.”
According to Mr. Kamande, Monica would be time barred were she to decide to pursue the case today. Says he: “The statutory limitation period for torts, including negligence, is 3 years.” Nonetheless, there are exceptions where one can file leave to file out of time.
The medical regulatory bodies in the country include the Medical Practitioners and Dentists Board (KPMDB), the Nursing Council of Kenya and the Clinical Officers Council. KPMDB is created under the provisions of Section 4 of the Medical Practitioners and Dentists Act, Cap 253 of the Laws of Kenya with among other, disciplinary powers.
Subsequently, all medical practitioners are registered under this Act. On the other hand, the Nurses Act, Cap 253 of the Laws of Kenya provides for the registration of nurses, midwives, community health nurses and psychiatric nurses. According to Mr. Kamande, aggrieved mothers should first register their complaints with both the Nursing Council of Kenya (NCK) and the Medical board (KMPDB) to facilitate investigations and possible disciplinary actions.
According to Eunice Muriithi, the Kenya Medical Board’s Legal Officer, many of the cases that are reported to the medical board are obstetric and gynecological related. “Though one may complain against a doctor, we often find that the person being referred to as doctor is actually a clinical officer.” She singles out the Bungoma case.
Says she: “The Bungoma incident did not fall under the jurisdiction of the medical board. Any disciplinary ought to have been taken by the Nursing Council of Kenya and the Ministry of health since the medical facility was a government hospital.” To file a complaint against an institution or medical practitioner licensed by the medical board, aggrieved mothers are required to fill the official complaint form. But this is a route that many mothers will rarely take.
“The fear to report to the boards is caused by the fear that that since the board is composed of mainly medical practitioners, the board members will not be impartial, will be biased towards their colleagues or will cover up the incident,” says Mr. Kamande. Currently, KMPDB is not legally bound by a time limit during investigations to alleged misconduct by doctors or cases of doctor negligence. Subsequently, such cases take months, even years before a verdict is returned, putting off patients looking to seek justice after botched labour processes.
According to Carolyne, expectant mothers accept to be humiliated, battered and abused at the maternity wards because they feel inferior and fear the wrath of the maternity staff being unleashed on their babies. “No matter how you’d react to them, they don’t fear you or act caring. They know and believe that you need them and therefore can’t do anything.
In numerous cases, mothers have only come to realize that they suffered botched deliveries after seeing their children miss certain childhood milestones like sitting on their own or crawling. This has been common in cases of delivery-related cerebral palsy. Take Monica for instance. She only realized that her child had cerebral palsy five months after delivery. “I only knew about my child’s ailment five months later. He didn’t cry or make noises like other children his age. He also had problems suckling and couldn’t seem to reach any of the motor milestones like his age-mates,” she says.
In many cases, if a child loses oxygen during delivery, the injuries associated with asphyxia may not be apparent until the baby begins to miss his or her motor milestones like sitting up or crawling. Similarly, complications from meconium aspiration are common in cases of asphyxia.
Signs that your baby may have suffered from botched delivery during birth may include the baby’s heart rate dropping, persistent late decelerations of the heart rate, bowel movement or passing of meconium during birth, presence of meconium in the breaking of water, immediate insertion of a tube to aid breathing after birth, floppy, flaccid or limp baby at birth, a swelling filled with blood caused by a break in the wall of a blood vessel on the baby, a stuck baby’s head or shoulder, low cord blood gases.
