By Dr Peter Martin Nguech, Ganyiel CEmONC Centre

Globally, maternal mortality remains one of the main public health challenges affecting quality of life for mothers and children. This is more evident in developing countries with weak health systems. Half of these maternal deaths occur in sub-Saharan Africa.

As much as efforts have been made to improve the accessibility and quality of healthcare in South Sudan, maternal mortality rates remain alarmingly high. The majority of women still prefer to deliver at home without a skilled birth attendant present. This has significantly contributed to South Sudan having the highest maternal mortality rates in the world, with 2,054 deaths per 100,000 live births.

In South Sudan, two out of 100 women die while giving birth. This can be attributed to several factors including long distances between communities and hospitals, socio-economic factors, and this year, flooding and insecurity which cut out access to facilities in certain areas. Limited skilled birth attendants further contribute to maternal mortality numbers.

In November 2020, Nyatiem Deng was brought to Ganyiel Primary Health Care Centre (PHCC). She was expectant with twins and went into labour at home. She managed to deliver one of her babies at home, but the second baby was retained. Realising that the mother and the unborn child were in danger, Nyatiem’s family took her to the PHCC, but because of the flooding this took the family 10 hours by boat.

By the time Nyatiem was presented at the CEmONC Centre, she had lost a lot of blood, was weak and unconscious. The midwife immediately performed obstetric history, examination and critical laboratory investigations to establish what to do next. Nyatiem was admitted, resuscitated and given antibiotic prophylaxis. Her caregivers consented without hesitation to Dr Peter Martin Nguech’s recommendation for a caesarean section as an immediate intervention to save the mother and baby’s lives.

“She was weak and had lost a lot of blood. If we did not operate, we were going to lose both the mother and the child. The operation was successful with the delivery of a baby boy weighing 2.3kg. The mother was in good condition in post-operative management,” said Dr Nguech.

After the birth, the family realised the benefits of institutional deliveries at a facility where there are qualified medical doctors and midwives able to recognise danger signs and risks associated with the delivery of twins. Nyatiem has managed to educate her husband on what the midwife shared with her as a way of successfully ensuring delivery while saving the lives of mother and newborn.

Nyatiem’s brother-in-law said: “I am so glad to have made it to Ganyiel PHCC after a long journey by canoe with my brother’s wife. I couldn’t believe Nyatiem and her second retained child would survive. Thanks be to God and may God reward the work of the service provider. Because of this I named our second twin Ganyiel.”

The twin delivered by emergency caesarean can be seen in the green shawl (top of picture)
Photo © Health Pooled Fund South Sudan

This story is one of a series of case studies written by partners working with Health Pooled Fund South Sudan (HPF), a multi-donor fund improving the quality of health care and hospital referral services in eight out of South Sudan’s 10 former states