Every year around Mother's Day, I find myself caught in two main reflections. First and foremost, of course, is gratitude for my own mother, and the growing appreciation I have for her as I realize how difficult it is to be a mother, especially of an independent and strong-willed child!
The second reflection is about my patients. As an OB/Gyn, so much of my work circles around the idea of motherhood. Women who aren't pregnant and want to be. Women who want help with family planning methods so that they can time their next pregnancy when their family is ready for another child. Women who have been pregnant, sometimes over and over, but have never brought a child home with them due to what is know here as "Bad Obstetric History."
A few weeks before Mother's Day, I got a call from one of our visiting physicians. "I have your patient Faith here" (name changed, of course). The patient's name was an incredibly common one, and I wasn't sure who he meant. I waited for more information. "She's had two stillbirths at term; this is her third pregnancy."
As an general OB/Gyn, I'm fully trained to see routine pregnancies and manage some high-risk conditions in pregnancy as well. A general OB/Gyn in the US might very reasonably see a patient in his/her clinic with a history of one prior stillbirth. However, to have a patient with two prior stillbirths would be quite uncommon, and most likely a general OB/Gyn would at least get a consultation from a high-risk Obstetrics physician (we call them "Maternal Fetal Medicine" trained OB/Gyns).
What made this conversation stick out in my mind was not the fact that this woman had two prior stillbirths. It was that even after receiving her name and history from the visiting physician - I still couldn't recall who this patient was. Not because I'm a heartless provider, or I have a terrible memory - but because we have so many patients with a similar story. Being a referral center for high-risk pregnancies, of course, we have much higher rates of "Bad Obstetric History" than most antenatal clinics would see. But still, the number of patients we see with potentially avoidable pregnancy losses is at times heartbreaking, and it is staggering to think that Kenya is much much better at maternal-child health than other countries in the world.
Some people tell me that the women in Kenya are so strong, to be able to deal with these pregnancy losses and still carry on. I can tell you on the one hand - yes, they are incredibly strong. And on the other hand - many have no option but to carry on. Others aren't able to. I've met women in my practice who have lost their marriages, families, and communities due to their difficulty conceiving or carrying a pregnancy. I've met women with suicidal thoughts and profound grief, depression, or anxiety due to the loss of a current or past pregnancy. The fact that these women may have a sister, mother, or friend who has also lost a baby "normalizes" the experience a little, but it doesn't make the loss any easier for any particular mother.
I'd love to end this post with some profound insight or great plan of how we're going to end "Bad Obstetric History" in Kapsowar, or a moving call to action. I guess I'm clean out of pithy summaries. Maybe as you reflect on motherhood in your culture or context, think about the women and mothers who might be struggling within your sphere of influence, and send them a kind or encouraging word to let them know that they are valued, no matter what they have been through.
