Baby’s Healing
Kheema Devi, wife of Jatin Kumar, age 27 years, lives in a rural mountain village called Bhumka, located in Okhalkanda block, Nainital district in the central Himalayas. Seema was a mother of two children from her first marriage. Her third child from her present marriage died after a few months, and she was pregnant for the fourth time. With her husband in prison during her fourth pregnancy, she faced significant hardships, relying on her maternal family for food and care.
Kheema Devi’s pregnancy was marked by the absence of any antenatal check-ups or ultrasounds until the ninth month. During an ante natal care checkup home visit by Aarohi’s village health worker (VHW), her vitals were checked and found normal. However, the lack of institutional care posed a significant risk; therefore, she was advised to do institutional delivery. She was also suggested Amrit Clinic – Suni as an accessible option for delivery.
Home Delivery Process
Even when she got into labour, she was home alone. Kheema Devi had a home delivery without any medical assistance; no trained or untrained traditional birth attendant (TBA) was present at the time of delivery. In such situations, when a woman has a home delivery by herself, most commonly after birth, the umbilical cord is tied with a thread from both sides. A coin is placed below, and a blade is used to cut the umbilical cord.
On 29th August 2024, Kheema Devi got into labour and delivered a healthy baby. Kheema Devi tied the umbilical cord and cut it using the blade. Normally, in a few days, the remaining part of the umbilical cord falls off on its own. But here, because the thread was not tied properly, it opened up the umbilical cord attached to the baby and got infected. Infections like umbilical sepsis often arise from poor hygiene practices during delivery and postpartum care.
“Every newborn has the right to a healthy start in life, no matter where they are born.” – UNICEF
Postnatal Care And Early Risk Identification
Three days postpartum, Aarohi’s VHW from Bhumka went for a post natal care (PNC) visit to Seema’s house. VHW identified signs of umbilical sepsis during a PNC visit. The cord was infected with pus, redness, and swelling. Mother Kheema Devi was constantly applying powder to the infected area, which likely exacerbated the infection.
VHW immediately informed CHN (community health nurse) about the infection and symptoms. VHW also took some pictures of infected areas and shared them with CHN. The community health nurse immediately contacted Amrit Clinic Suni. With remote consultation from one of our consulting doctors remotely, an umbilical sepsis condition was identified. Sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its tissues and organs.
Sepsis Treatment And Follow-up
The newborn was prescribed a betadine solution and fusidic acid cream for infection, and Kheema Devi was then advised to maintain and take extra care in terms of hygiene around the infected area of the umbilical cord. Our VHW promptly delivered the prescribed medication to the newborn’s home. The community health program team ensured timely care and support for the newborn. VHW then regularly took follow-ups of the baby’s condition, and after 7 days when VHW went for a PNC visit, the infection was healed and the baby was in good health.
Infections like umbilical sepsis often arise from poor hygiene practices during delivery and postpartum care. The timely diagnosis of umbilical sepsis and rapid response by the community health worker and nurse played a crucial role in the early identification of risk and complications. This was made possible because of the well-trained and responsive frontline health team of Aarohi.
“Timely care and informed action are the cornerstones of saving lives in vulnerable communities.”
Dr. Abhay Bang, Founder of SEARCH in Gadchiroli
A Life Lost In Silence
Living in the village of Udiyari, Mamta Aarya, wife of Suresh Chandra, was pregnant for the first time after 2 years of marriage. Mamta was 29 years old, primigravida. Her last menstrual period (LMP) was on 30/04/2024, and she was registered for ANC on 12/07/2024. Her estimated delivery date (EDD) was 07/02/2025.
Mamta completed her first ANC check-up and ultrasound in Haldwani. She also received vaccinations at the local ANM centre. Shortly after her first check-up, Mamta developed jaundice, Despite treatment, her weight remained critically low, putting her at risk for fetal growth restriction and other pregnancy complications. She weighed only 34kg, at the time of registration. During an ANC follow-up visit, Mamta was prescribed iron and folic acid supplements to combat her anaemia. The VHW also counselled her on dietary practices to include calorie-dense and protein-rich foods.
High-risk Pregnancy: Diagnosis
On 5/11/2024 her ANC visit was done by VHW. She had no complaints. Mamta’s underweight condition identified her HRP (high-risk pregnancy). The VHW advised her to attend the Mobile Medical Unit (MMU) camp scheduled on 10/11/2024 in Bheerapani for a detailed check-up, including an ultrasound.
Mamta Aarya and her husband attended the MMU camp on 10/11/2024. During the doctor consultation, Concerned about the absence of fetal movements, the attending doctor ordered an ultrasound. The radiologist confirmed the absence of fetal heart sounds, indicating intrauterine fetal demise (IUFD). Later, Mamta disclosed that she had experienced a minor accident a few days prior while cutting grass. During the incident, she slipped and fell. Shortly after, she noticed a lack of fetal movements but did not report it earlier, assuming it was normal. This accident was considered a potential contributing factor, alongside maternal malnutrition and previous complications like jaundice.
Emergency Referral And Delivery
Mamta and her husband were informed about the urgency of the condition. If the deceased fetus is not removed promptly, it could lead to severe infections or complications such as sepsis. Mamta was then immediately referred to a higher centre, Haldwani. On the same day, on 10/11/2024 at 4:30, Mamta and her husband left for Haldwani from Ambulance. Mamta was then admitted to Sushila Tiwari, Government Hospital, Haldwani, from night. Mamta delivered the stillborn baby naturally within 24 hours of admission. There were no immediate postpartum complications such as excessive bleeding or infection.
Mamta received her postpartum care in Sushila Tiwari Hospital and returned home after nearly a week. During a PNC visit on the 9th day, the VHW advised Mamta to consider temporary family planning methods until her complete recovery. She was also advised to follow a nutritious diet and take proper care of her health.
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