…‘must not push during labour’
After nine months of every wedding in Nigeria and some other countries in Africa, there is always high expectation from the couple’s families of the arrival of a newborn baby. When this happens, there is always joy and excitement in both families. But if the reverse becomes the case, there will be panic and fear of infertility in the union.
While a lot of couples, themselves, particularly the women, are eager to have children after nine months of marriage, many are not aware of certain health conditions that must be evaluated and addressed by medical experts before pregnancy.
For anyone with a heart problem, this extra work is a risk. The message is clear – maternal health is the priority in all types of heart disease. If you have a sick mother, you will have a sick baby. If you have a sick mother, you may have a motherless child
One of such health problems is heart disease. Consequently, women in Nigeria with heart problems have been warned not to get pregnant except on the advice of specialists in heart related matters – cardiologists.
This is because indications have emerged that pregnant women with heart related-problems are at risk of life-threatening complications.
This revelation, no doubt, calls for caution among the women, particularly those in disparate need of children as a result of their age and in the name of protecting their marriages.
Speaking in an exclusive interview with The Point, Medical Director and Chief of Cardiology, Euracare Multi-Specialist Hospital, Victoria Island, Lagos, Dr. Tosin Majekodunmi, warned Nigerian women with heart related problems not to think of getting pregnant until they had their hearts evaluated and fixed by a cardiologist.
Failure to do so, Majekodunmi cautioned, could lead to severe complications during and after pregnancy and possible death of the woman.
Majekodunmi, a United Kingdom trained Adult Congenital and Structural Interventional Cardiologist, said the risk involved with heart problem during pregnancy was very obvious as the ailing heart had to work a lot harder and double its output, which in turn put the woman’s health at risk.
He explained, “When a woman gets pregnant, the heart works twice as it normally works before she got pregnant. So, the cardiac output doubles when a woman gets pregnant. If you have a heart that is just working on the edge and it could not cope with pressure when she was not pregnant, now, if she becomes pregnant, and her cardiac output doubles, it becomes a problem. This is because the heart might fail if not properly managed.
“Now, if she manages to survive the double cardiac output, during labour, which requires more cardiac output, the woman can have heart failure and pass away. When that happens, the doctors will come out to say, Oh! sorry, we didn’t know what happened, the woman could not make it. The reason being that the woman had untreated heart problem.”
“Some undiagnosed and untreated cardiovascular problems have been found in studies carried out in Canada and Toronto to be some reasons why women die during labour and a few weeks after birth. They identified that women with cardiovascular issues had adverse outcome during pregnancy,” he added.
Besides losing their lives during and after delivery, Majekodunmi also revealed that such women also faced the risk of miscarriage, preterm birth and breathing problem, insisting that women with heart problems and severe hypertension must be properly counseled by a specialist not to get pregnant until their heart is fixed.
Signs of heart problem
The consultant listed some signs of heart problem to include undue tiredness, breathlessness, chest pain, palpitation, leg swelling and fainting.
“Women experiencing such signs should seek medical advice before getting pregnant and if they are pregnant already, they need to see a doctor urgently as it could be a risk to their lives,” he cautioned.
Already in Nigeria, maternal mortality is high while many pregnant women, even in this age and time, prefer to deliver their babies in religious and traditional homes, where skilled attendants are massively lacking.
According to UNICEF, every single day, Nigeria loses about 145 women of childbearing age, making her the second largest contributor to the maternal mortality rate in the world.
Corroborating Majekudunmi’s views, Head of Maternal Cardiology Programme at the University College London Hospitals, Dr. Fiona Walker, said pregnancy was an issue for women with heart problems.
He explained, “During pregnancy, the heart has to work a lot harder. The output from the heart doubles and heart rate goes up by 15 per cent. The physiological changes have been likened to running a marathon; the difference, of course, is that you are doing it for nine months.
“For anyone with a heart problem, this extra work is a risk. The message is clear, maternal health is the priority in all types of heart disease. If you have a sick mother, you will have a sick baby. If you have a sick mother, you may have a motherless child,” he said.
Giving further insight into the issue , a professor of Obstetrics and Gynaecology, Prof. Innocent Ujah, advised women with heart problem not to have more than two children even if they had been properly treated to avoid over-working the heart, affirming that if the heart was over stressed by too many pregnancies, it could lead to failure.
Ujah, the immediate past Director-General, Nigerian Institute of Medical Research, Yaba, Lagos, told our correspondent that women with heart issues should not allow their hearts to be subjected to recurring overload because it would fail.
What should be done to avoid risk?
He said, “Now, when the heart fails, that is the end of life and then the woman will die. To avoid such a risk, women with heart problems must be well treated and counseled before getting pregnant. And when they become pregnant, they must be monitored in a specialist hospital by cardiologists and obstetricians. Every woman with a heart problem must also deliver in a hospital where there are competencies –experts and where delivery process would be used to avoid pushing by the woman during labour.”
The consultant obstetrician and gynaecological surgeon, emphasises that “if a woman with a heart problem becomes pregnant without knowing that she has issues and fails to use a hospital where there are experts during antenatal care, such a woman stands the risk of dying during the pregnancy.”
To reduce maternal deaths in Nigeria, the former NIMR boss called for the education and empowerment of women and girls, maintaining that information is power.
Another consultant gynaecologist and family planning expert, Dr. Ejike Orji, in his submission, said Nigeria’s healthcare system must be properly funded to reduce the risk of women dying from pregnancy related causes, adding that the degree of the heart problem would determine whether the woman would carry the pregnancy to full term or not.
Disclosing that cardiovascular disease was not a major cause of maternal deaths in Nigeria, Orji, who is the Chairman, Association for Advancement of Family Planning, however, listed the five major causes of maternal mortality in the country to include: post partum hemorrhage – severe bleeding, abortion complications, obstructed labour, eclampsia -hypertension in pregnancy and infection.
Identifying funding as key in reducing maternal deaths in Nigeria, he urged the government to ensure that every woman was provided antenatal care services as well as skilled facilities to deliver their
babies.
Calling for the revamping of the Midwives Service Scheme, the gynaecologist said the current rate of maternal deaths in Nigeria – 572/100,000 live births – was totally unacceptable, revealing that when the Midwives Service Scheme was optimally running, it saved the lives of 20,000 women, out of the 54,000 maternal deaths that were recorded
annually.
