A mother's joy turns to peril when doctors battle childbirth bleeding

The maternity unit at Siaya County Referral Hospital is a world of contrasts hope, pain, and resilience unfolding in real time. Outside the delivery room, a mother paces in agony, her face tightening with every contraction. She leans on a student nurse for support, the young trainee firmly holding her hand, rubbing her back, and whispering comfort as the woman reels through the waves of labour.

Inside the cubicles, the silence is striking. In the first stage of labour, women lie quietly on their beds, conserving their strength. In the second stage, some sit upright, waiting for the next push that will bring life into the world.

In the mother’s nursery, others cradle their newborns, breast feeding with a mix of exhaustion and tenderness. Nearby, in the Kangaroo Mother Care ward, mothers shuffle slowly out of their rooms.

Beyond maternity, the corridors of the hospital thrum with urgency. Student nurses from Kenya Medical Training College in white coats brush past doctors, patients, and anxious relatives. Pain and worry are etched across the faces of the elderly, children, women, and schoolgirls who crowd the benches and even the sidewalks outside.

Once known as Siaya District Hospital, this facility has become a beehive of activity a place where suffering and healing coexist, and where every step, every cry, and every sigh tells a story of life hanging in the balance.

In this hospital, men and women walk in and out some cradling newborns wrapped in blankets, others carrying basins and baby supplies. Life begins here, but not without its struggles. Behind the joy of childbirth, doctors continue to battle one of the deadliest maternal threats postpartum haemorrhage.

Despite their relentless efforts, this silent monster still haunts the county’s maternity wards.

At the hospital, life and death often meet in the same ward. Doctors, midwives, and nurses move swiftly, sometimes against time itself.

For Dr Michael Oduor, a obstetrician- gynaecologist this fight is deeply personal.

“Postpartum hemorrhage (PPH) is fairly common,” he says “In a week, we attend to about six cases PPH. Out of these, two or three are severe, what we call massive obstetric haemorrhage requiring interventions in theatre. PPH is one of the biggest emergencies we deal with.”

PPH is not just Siaya’s threat; it is the leading cause of maternal death worldwide. According to UNICEF, severe bleeding after childbirth remains the largest direct cause of maternal mortality globally, and in 2020 there were an estimated 287,000 maternal deaths worldwide, about 70 per cent of them in sub-Saharan Africa. UNICEF also notes that 14 million women experience PPH each year, and these hemorrhages result in roughly 70,000 maternal deaths annually.

The World Health Organisation has stated that PPH affects millions of women each year, is the leading cause of maternal mortality, and accounts for over 20 per cent of all maternal deaths globally. For Kenya specifically, national data cited by health sources show PPH contributes 25 to 45 per cent of maternal deaths and that many of Kenya’s 6,000 annual maternal deaths are due to complications arising from bleeding.

On the Siaya County Referral Hospital maternity unit’s wall, a white board stretches from corner to corner, its grid filled with handwritten figures of births, deaths, complications. The numbers, updated every month, tell a story of joy and tragedy intertwined. For every mother who walks through these doors, the board is both a record of life and a reminder of risk. Maternal complications remain every pregnant woman’s worst fear.

In January, the hospital recorded 248 normal deliveries and 86 Caesarean sections the highest of the year. There were nine breech deliveries, five stillbirths, and 344 live births. Out of these, 329 babies were discharged alive, while nine neonatal deaths and two maternal deaths were recorded. The same month, staff conducted 2 maternal death audits to understand what went wrong and prevent future loss.

January’s list of maternal complications was sobering, six cases of antepartum haemorrhage (APH), 16 of PPH, 1 of eclampsia, one ruptured uterus, 16 cases of obstructed labour, and 1 of sepsis.

February brought some relief. The hospital registered 199 normal deliveries and 68 C-sections with no maternal deaths reported that month. However, eight stillbirths and 260 live births reminded staff that safe delivery remains fragile. The month there were three APH, two PPH, one eclampsia, and two cases of obstructed labour.

In March there were 201 normal deliveries, 74 C-sections, and three breech deliveries. Out of 270 live births, 268 babies were discharged alive, while two neonatal deaths occurred. There were no maternal deaths, but the unit recorded five APH, seven PPH, three eclampsia, and seven obstructed labour cases.

April, however, tested the hospital’s endurance again. Out of 171 normal deliveries and 68 C-sections, the hospital recorded 239 total deliveries and 337 live births, with three stillbirths and 11 neonatal deaths. There was one maternal death that month, followed by one death audit.

Maternal complications included four APH, six PPH, three eclampsia, one ruptured uterus, and 10 obstructed labour cases.

Between January and August 2025, the hospital recorded 1,419 normal deliveries with January being the busiest month with 527 Caesarean sections, 25 breech deliveries and 46 stillbirths, with March’s ten stillbirths marking the year’s highest. 52 neonatal deaths, with June alone accounting for 18. Six maternal deaths in total, all reviewed through five death audits. In those eight months, 57 cases of PPH were reported the most common and dangerous complication. APH followed with 27 cases, while ruptured uterus and obstructed labour tied at seven and 57 cases, respectively.

Eclampsia, a pregnancy-induced hypertensive disorder, was logged 11 times, while sepsis, though rare, appeared once a grim reminder of the infection risks mothers still face.

The hospital also recorded 1,946 live births, with 1,824 babies discharged alive. June saw the lowest survival rate, with only 78 babies discharged alive, pointing to resource strain and possible neonatal complications.

These numbers, according to the maternity team, aren’t just statistics they’re stories. Each line represents a woman who bled too much, a newborn who didn’t cry, a nurse who raced against time, a family that waited anxiously outside the ward.

“Sometimes, you think a delivery has gone perfectly,” Oduor says. “Then suddenly, the mother starts bleeding, her blood pressure drops, and everything changes in seconds. Those are the moments when you realise how fragile childbirth can be.”

When a mother arrives bleeding, time becomes a luxury no one can afford. Dr Oduor describes the urgency.

“Our first goal is to save life. We secure the airway, ensure she’s breathing, and get immediate intravenous access to replace lost blood. We must identify where the bleeding is coming from and stop it. You can’t keep pouring water into a leaking bucket you have to fix the leak first.”

Once the bleeding is controlled, the team provides supportive care blood transfusions, oxygen therapy, and, in severe cases, kidney support or ICU admission. “Every second counts,” he adds. “If a woman arrives too late, even our best efforts may not save her.”

“If you look at the last five years,” he notes, “there’s been a gradual decline in maternal mortality on average. But the trend fluctuates. Some years, we do well. Some years, we struggle. What’s encouraging is that overall, the numbers are going down.”

When asked how his team responds to such emergencies, Oduor breaks it down, “Response to obstetric emergencies follows the same pattern everywhere, but the priority is always to save life. The first thing is to support basic body functions make sure the airway is clear, the mother is breathing, and that we can replace lost blood volume. We immediately secure intravenous access for fluids or blood transfusion, because when someone is bleeding, every minute counts.”

He compares it to fixing a leaking tap. “If you’re trying to fill a bucket with water but the tap is leaking, it doesn’t matter how much water you add you’ll never fill it until you fix the leak. The same applies here. Once we stabilise the mother, we must find and stop the source of bleeding.”

After bleeding is controlled, the focus shifts to supportive care managing any damage caused by blood loss.

“When someone has lost a lot of blood, every organ in the body is affected because blood carries oxygen and nutrients. Some patients develop kidney failure and require dialysis; others need to be admitted to ICU for close monitoring. So, after we stop the bleeding, we evaluate what each patient needs to survive.”

On availability of lifesaving commodities, Oduor says Siaya County Referral Hospital has made notable strides.

“We’ve not had challenges with oxytocin availability or storage. We also have carbetocin, which is heat-stable and doesn’t require refrigeration, and misoprostol is readily available. In terms of uterotonics, we’re doing well.”

Blood supply, he says, is where challenges occasionally arise.

“The situation changes from time to time. Sometimes, the regional blood transfusion service runs out of reagents, which temporarily affects supply. But those cases are few, and our lab team has built strong networks with Kakamega and Moi Teaching and Referral Hospitals, which help us bridge shortages.”

Still, Oduor admits that delays in referral remain a stubborn challenge.

“We have ambulances in the county, but running ambulance services is not easy, fuel is often the biggest problem. In cases of massive postpartum haemorrhage, time is everything. A woman should be at a specialised care centre within 30 minutes. For far-flung areas, by the time we receive them, so much damage has already been done that recovery becomes difficult despite our best efforts.”

Ezekiel Ojwang’, the reproductive health coordinator for Alego Usonga sub-County, the fight against postpartum haemorrhage has been a lifelong mission.

“When I started to practice in 2004, postpartum haemorrhage was the single biggest complication women faced during labour and delivery,” he recalls. “It contributed to nearly 80 per cent of maternal complications within the county.”

Over the past 20 years, Ojwang’ has witnessed when most women delivered at home data on maternal deaths was scarce, to today, when nearly all deliveries occur in health facilities.

“Earlier, few women come to hospitals because delivery services were paid for,” he explains. “But after free maternity care was introduced, hospital deliveries rose to nearly 100 per cent. That shift alone has helped us identify and manage PPH cases faster.”

At the Siaya County Referral Hospital, about 500 deliveries take place every month, both normal and caesarean. Of these, roughly 10 per cent develop postpartum haemorrhage, and another 10 per cent of those cases progress to severe levels.

While the county still records maternal deaths around two per quarter Ojwang’ says that’s a sharp decline from past years when they would lose up to five mothers in the same period.

“The maternal deaths that occur, on average, in our setup currently are around two in a span of three months in a quarter,” he says. “That is a very good indicator for us, although we are not where we need to be, realising that a woman should not die while delivering. In previous years, we would record up to four or five maternal deaths in the same period. But this has decreased because a lot of effort has been put into managing maternal cases more effectively.

“The healthcare system in Kenya is structured in levels from the community (level one) to dispensaries (level two), health centres (level three), sub-county hospitals (level four), and the county referral hospital (level five). These levels deal with clients differently. Before, if a woman developed complications at a level three facility, there was often no way for her to reach the referral point on time for care.”

That changed when the county government rolled out a free maternal referral system.

Ojwang’ is clear that timely recognition of danger signs remains a life-saving skill both for health providers and expectant mothers.

“I always tell my colleagues and community members that pregnancy can complicate anywhere, anytime. It’s not a sure bet. So the most important thing is to recognise danger signs early. We’ve done a lot of training for healthcare providers so that they can identify complications early, such as uterine atony, retained tissues, or poor clotting.”

He adds that the county has significantly increased ambulance coverage.

“Earlier on, we didn’t have ambulances stationed all around. Now, each sub-county has one from Ukwala to Ambira to Siaya Referral Hospital. At a stroke of a button, a woman can be transferred. These ambulances act like mobile hospitals they’re equipped to continue care even during transit. Currently, the system prioritises mothers and newborns, though the goal is to expand it to all patients. It’s just too costly at the moment.”

When asked about the main contributors of maternal deaths, Ojwang’ is candid.

“Teenage mothers between 10 and 19 years are still a significant group, though most of our deliveries are among young women aged 20 to 30. These younger mothers, up to age 35, contribute the most to maternal complications and deaths.

“Within 30 minutes, a woman can lose her life. That’s why when PPH occurs, everything stops in the delivery room. Every facility conducting deliveries should have a postpartum haemorrhage kit.”

Ojwang’ and Oduor agree that human resource constrains remain a challenge.

Oduor explains, “When staff are overstretched, burnout sets in, and the quality of service suffers.”

He also points out that infrastructure plays a role in service delivery. “At times, we have emergencies lining up for theatre, there is need more investment in equipment.”

When asked if social or cultural beliefs contribute to poor outcomes, Oduor says the problem is smaller than before thanks to the county’s community health strategy. “We have community health promoters who visit mothers during pregnancy, so awareness is improving. But we still have a few cases where women first seek help from traditional healers or herbalists before coming to the hospital. By the time they arrive, it’s often too late.”

Data from the hospital’s maternal unit board indicate that Siaya has lost six mothers this year. Oduor says while the numbers are worrying, the trend is not isolated. “Reducing maternal deaths requires a system-wide approach. Even if the referral hospital works perfectly, if lower facilities are weak, we’ll still have challenges. That’s why our model is hub-and-spoke the hospital acts as the hub, providing 24-hour support to all facilities in the county. We’re always on standby for emergencies.”

He says strengthening capacity at lower levels is crucial. “We hold continuous medical education sessions and invite staff from other facilities to learn how to manage obstetric emergencies better. Feedback and training are key.”

Blood availability, however, can still be a challenge. “We have a satellite blood bank in Siaya, which maintains a constant supply to transfusing facilities. But most of our donors are school children, and during long school holidays, blood shortages occur. That’s a real gap.’’

Despite improvements, Ojwang’ admits that some systemic weaknesses remain.

“We’ve improved accessibility, equipment, and human resource, but all still have gaps. For instance, are the ambulances always fueled? Are they adequate? Are we reaching every woman who needs us? Those are questions we still grapple with.”

Another challenge is access to the Social Health Authority (SHA) system.

“Currently, mothers must be enrolled in SHA to access free delivery services. The problem is that many young mothers lack national ID cards a requirement for registration. About 60 per cent of the women who come to this hospital don’t have IDs. Under the previous Linda Mama program, we could enroll them using a guardian’s ID. Now, that’s impossible. We still attend to them health is a constitutional right but payment and discharge become complicated.”

Even with these obstacles, Ojwang’ insists the county has made strides.

“We also have what we call ‘near misses’ women who come with severe complications but survive due to timely intervention. Around 20 per cent of deliveries fall under this category. These are women who could have died but were saved because of improved systems.”

Siaya’s progress is echoed by Pamela Josephine, the County Reproductive Health Coordinator, a seasoned midwife with 24 years of experience and five years steering reproductive health programs at the county level.

Pamela has been in the trenches literally from the labor wards to the county boardrooms. “Working as a midwife, I’ve witnessed many cases of PPH. A number of them were managed successfully, but it was always depressing. From the early 2000s, I have seen devastating cases and mothers in pain,” she recalls softly, her tone carrying both fatigue and pride.

According to the 2022 Kenya Demographic and Health Survey (KDHS) Fact Sheet, 65 per cent of women in Siaya aged 15–49 attended at least four antenatal visits, while 86 per cent received a postnatal check within two days after birth.

Neonatal mortality stood at 24 deaths per 1,000 live births, slightly above the national average. The 2022 KDHS further reported approximately 362 maternal deaths per 100,000 live births, while a 2025 Maternal and Perinatal Death Surveillance and Response (MPDSR report shows Siaya’s facility maternal mortality rate has declined to 336 per 100,000.

“These numbers tell us that while we are not yet at the global targets, we are moving in the right direction,” Pamela says.

Teenage pregnancy remains one of the most stubborn challenges in the county. “From January to June 2022, we recorded about 22 per cent teenage pregnancy,” Pamela notes. “When you break it down, girls aged 10 to 14 accounted for 0.27 per cent, while those between 15 and 19 were at 20 percent. So there’s a reduction from what was reported earlier.”

While progress has been made, she cautions that adolescent pregnancies continue to put many young mothers at risk. “Among girls aged 15 to 19, we’ve had a few cases contributing to maternal deaths about two in 2022, one in 2023, and one in 2024. Each life lost is one too many,” she adds.

Approximately 21 per cent of adolescent girls aged 15–19 in Siaya have started childbearing, placing them at higher risk of complications like eclampsia, obstructed labor, and PPH.

Still, Pamela insists, Siaya has reason to be hopeful: “The county now ranks 41st out of 47 counties for child mortality meaning we are among the top ten counties where the likelihood of a mother dying in childbirth is lowest. That’s something to build on.”

Pamela credits Siaya’s decline in maternal deaths to a series of deliberate interventions by the county government.

“The first was improving service delivery,” she explains. “We’ve promoted access to quality antenatal, delivery, and postnatal care across facilities. Initially, only Bondo, Yala, and the County Referral Hospital could handle emergencies. But now, we’ve upgraded Ambira and Madiany health centers to fully operational theaters.”

Between February and July 2025, Madiany alone conducted 406 emergency operations, while Ambira handled 25 cases since its upgrade in late 2024.

Another milestone, Pamela adds, is an enhanced health workforce.

“Initially, we only had two gynecologists in the entire county. Now we have four two at the referral hospital, one in Yala, and one in Bondo. In addition, we’ve employed around 180 healthcare workers in the 2024–2025 financial year to strengthen the workforce.”

Siaya has also improved its availability of essential health products and blood a crucial step in tackling postpartum hemorrhage, the leading cause of maternal deaths.

“Our mothers need blood,” Pamela says. “In 2022, we collected 7,185 pints of blood, rising to 7,321 in 2023, and 7,549 in 2024. By July 2025, we had already collected 2,378 pints. That’s a big achievement.”

On drug supply, she says, “We are trying as much as possible to ensure that we don’t run out of oxytocin or carbetocin key drugs in managing PPH. Once a mother delivers, she must receive these drugs immediately. If unavailable, the bleeding can be fatal.”

Pamela highlights leadership and governance as a backbone of this success.

“We have committees at facility, sub-county, and county levels to review maternal deaths and near misses,” she says. “Through these, we identify gaps whether they are knowledge-based, equipment shortages, or systemic delays and act fast.”

The county also uses data-driven decision-making. “We’ve strengthened our reporting systems so that every maternal death is documented, reviewed, and responded to. It’s no longer just numbers it’s lessons and accountability.”

Community engagement has been another game-changer. “We’ve trained Community Health Promoters (CHPs) to recognise danger signs in pregnancy. They go door to door teaching families how to identify risks early and encourage mothers to deliver in facilities,” she adds.

To motivate mothers, the county introduced Mother-Baby Packs small gifts with basins, baby shawls, and sanitary pads given to women who deliver in hospitals. “It may look small,” Pamela says, “but it goes a long way in encouraging facility births.”

Despite these improvements, Pamela admits that gaps remain.

“Evacuation of mothers during emergencies is still a challenge,” she says. “We need more ambulances and a stronger referral system. Funding is another issue allocation for maternal health are still low, and sometimes we can’t procure enough supplies or conduct refresher trainings for staff.”

To address this, Siaya has established the Siaya County RMNCAH Act (Reproductive Maternal Newborn Child and Adolescent Health) Act a local legislation meant to create a special health kitty for maternal health. Siaya County “Once fully operational, the Act will help fund emergency evacuations, sustain blood campaigns, and support high-dependency units for mothers in critical condition,” Pamela explains.

The county also hopes to revive the Mama Link program, which previously supported transportation of mothers from remote areas to health centers. “The contract with our private ambulance partners ended, and we can’t afford the millions needed to renew it,” she says.

Another gap is the shortage of pediatricians. “We only have two, supported by nurses and clinical officers. We need more specialists to handle newborn complications,” Pamela says.

Still, she remains hopeful. “We want to be the first county to conduct maternal death audits every two months instead of quarterly. This way, we can act faster,” she says confidently.

Inter-county collaboration is also helping. “We work closely with neighboring counties like Busia and Bungoma. When we run short of blood especially the rare O-negative type we coordinate transfers. This year alone, that coordination saved three mothers.”

Beyond hospitals, Siaya is investing in youth empowerment to curb early pregnancies.

“We have Youth Cafés, Technical Working Groups (TWGs), intergenerational dialogues, and Youth Advisory Boards where young people lead the conversation,” she says. “We’ve also developed an Adolescent and Youth Action Plan (2025–2028) targeting the ‘Triple Threat Plus’ teenage pregnancies, HIV, STIs, GBV, and mental health.”

For Pamela, the mission is personal and deeply human. “When I see a mother go home alive with her baby, I feel fulfilled,” she says, “Because behind every number is a woman, a family, a story of hope.”