A missionary-run hospital in Nairobi has been reprimanded by the Kenya Medical Practitioners and Dentists Council (KMPDC) for mismanaging a childbirth that led to the mother suffering a fistula and the baby with a dysfunctional left arm.
St Scholastica Uzima Hospital, located along the Thika highway on the Survey of Kenya area, has been ordered to pay Sh250,000 to the board within 30 days counting from September 28 as fine for the blunder.
The board also ordered the hospital to have talks with the mother to discuss how much she should be compensated. It should brief the KMPDC chairman about the progress of the compensation talks within 90 days starting September 28. Failure to pay the fine and compensate the mother will lead to further punitive measures.
“In the event of non-compliance with the directions … KMPDC shall be at liberty to suspend, withdraw or cancel the operating licence of St Scholastica Uzima Hospital,” says a ruling by Dr Abdi Mohamed, the chair of the board’s disciplinary and ethics committee that handled the case.
Little incident
The committee’s action will offer some respite to Ms Ann Waithira Wamaitha, a mother of three. Her two earlier deliveries happened with little incident. But this one in February last year showed her a side of childbirth she could have hardly imagined. She told the committee that her delivery of a boy with a “paralysed” arm and her fistula led to the collapse of her marriage.
Ms Waithira actually never went to the facility, run by the Missionary Benedictine Sisters Ruaraka, for delivery. All she wanted was an ultrasound scan.
“Upon examination, she was informed that she was in labour because her cervix was open at 5cm, and she required immediate admission,” reads Dr Mohamed’s ruling.
It is a decision that shocked Ms Waithira because she did not feel any sign of being in labour. The committee heard from the hospital that Ms Wamaitha’s pregnancy was 41 weeks and six days old. Delivery typically happens by the 40th week and medics at the facility adjudged this to be an “impeding post-term pregnancy”.
In her case before the board, presented by the firm of Chege Kibathi and Company Advocates, Ms Waithira claimed that the hospital advised her that she was in labour while she was not.
She also claimed that the labour was induced prematurely, adding that she was not given other options like caesarean section.
Ms Wamaitha also alleged that the hospital improperly pulled the baby, causing severe tears to her private parts that caused a fistula.
The hospital responded through its director, Sister Rosa Pascal. Sr Pascal said Ms Wamaitha was admitted at 11am on February 26, 2020 and that she had “self-referred” from Kiambu Level 5 Hospital “for reasons not disclosed to the caregivers”.
Sr Pascal further told the board that because Ms Wamaitha’s pregnancy had gone beyond the ideal term, she was given medical advice.
“She was counselled on the likely risk attendant to such a pregnancy and mitigations available at the facility. She had had two successful vaginal deliveries with no complication during labour and delivery,” says the ruling of the hospital’s response.
At the end, the committee found that the hospital failed to conduct an ultrasound scan to check on the status of the baby.
Had they checked, they would have realised that the baby was not properly positioned for birth, as he was relatively big (4.06kg at birth), had the face directly facing the exit rather than the top of the head and that the umbilical cord had wound around the baby’s neck three times.
“The committee notes that the use of ultrasound is of crucial importance in performing a safe delivery and can help in the prediction of whether a vaginal delivery would be successful. In this case, the ultrasound would have helped in estimating the foetal weight, especially given that it was a post-date pregnancy,” the ruling says.
Shoulder dystocia
The complication that caused the malfunction of the baby’s left arm was due to the fact that the way he lay in the womb, his shoulders were too big for the exit even after the head had gone through. This is called shoulder dystocia in medical terms.
The dystocia and the way the baby was extracted, the committee said, caused a rare disorder on the baby called the brachial plexus injury, where the nerves that serve an arm are tampered with.
The committee also found that the hospital failed to realise that it had caused a fistula on Ms Wamaitha.
“The committee finds that midwife Diana A Kalwara failed to recognise that the perineal tear that she examined was a fourth-degree perineal tear,” says the ruling.
Six months after the delivery Ms Wamaitha was admitted at the Kiambu Level 5 Hospital where the fistula was stitched up.
“St Scholastica Uzima Hospital is hereby reprimanded for failing to conduct an obstetric ultrasound before induction of labour,” the committee ruled.
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