Fear and risk: How Kenyan women fight to survive in labour rooms

So naive about motherhood, Branice* was rushed to a private hospital when she experienced the first signs of labour—cramps and her water breaking at home.

Being her first pregnancy at 37 weeks, she was terrified. Fear and anxiety consumed her as she prepared to give birth.

At the hospital, doctors examined her to check cervical dilation and determine whether labour induction was necessary. Instead of easing the process, the induced labour proved excruciatingly painful. She underwent induction a second and third time, but the procedures still failed to enable a natural delivery. A nurse guided her through exercises, including walking up and down stairs, yet nothing helped.

After about 24 hours of waiting, she was wheeled to the theatre for a Caesarean section (CS) to save her life and her unborn baby.

“I was induced drip after drip, but nothing seemed to work. The pain was unbearable, yet I still ended up undergoing surgery,” Branice recalls of her 2016 experience.

Branice later delivered her two other children via Caesarean section as well.

In another case in Nyeri, a woman reportedly endured labour induction for 34 hours, a situation allegedly linked to her baby’s death. Reports suggest she initially declined a CS, prompting the private hospital to induce labour.

She is said to have waited about 22 hours after her water broke before being taken to the theatre. Doctors described the labour as unusually prolonged, noting that active labour typically progresses within about 12 hours before it becomes an emergency requiring surgery. Prolonged labour, they say, exposes the baby to infections after the protective amniotic fluid is lost, increasing the risk of complications such as breathing difficulties.

These cases are not isolated. They reflect the struggles many Kenyan women face in labour rooms, often accompanied by intense fear, even though labour is a critical stage that determines the survival of both mother and child.

Fear of labour is widespread in Kenya, where at least 21 women die daily from birth-related complications.

Dr Fredrick Kairithia, a gynaecologist, stresses that labour is the most critical stage of pregnancy. Induction is an intervention to start labour for women who do not go into labour naturally. He adds that the duration of labour must be carefully monitored to protect both mother and baby.

“As a rule of thumb, when you go into labour, you should not labour for more than 24 hours,” Kairithia emphasises.

Induced labour

Labour is divided into latent and active phases, with the active phase lasting six to eight hours. “In the active phase, the baby should be delivered promptly, as delays can result in death,” explains Dr Kairithia.

Many women experience early labour without realising it, says Nereah Ojanga, a Nairobi-based midwife and doula. “Often, eight hours are lost in the early stages. Labour lasting more than 18 hours requires expert attention,” she notes.

Monitoring during labour includes checking the baby’s head position, the lie in the womb, the maternal pelvis and cervical opening to ensure a safe delivery. First-time mothers typically go into labour between 36 and 40 weeks. Common symptoms include cramps, back pain, regular contractions and intensifying uterine pain leading up to birth.

Women may also urinate frequently and notice blood-streaked discharge, known as “the show.” These signs are normal and non-threatening, Ojanga adds. Doctors often recommend induction at 40 weeks, but not every case requires it; physicians follow Ministry of Health policies and guidelines.

Kairithia stresses: “Some patients feel tired of pregnancy, notice reduced fetal movement, or want delivery for other reasons. Doctors must examine each case carefully and proceed only if safety isn’t compromised. There must be a clear medical indication.”

Induced labour artificially starts contractions rather than waiting for them to begin naturally.

Triggers for labour induction include post-term pregnancy (post-datism), maternal complications such as high blood pressure, bleeding, or diabetes, and fetal distress to prevent complications or death.

“Induction means to initiate. The goal is to start labour instead of waiting for it naturally,” explains Dr Fredrick Kairithia.

Induced labour is common in Kenya, particularly in higher-level facilities (Level 5 and 6 hospitals). Methods include membrane sweeping to release prostaglandins, administering artificial prostaglandins vaginally, or intravenous drips such as oxytocin.

If the cervix isn’t ready, doctors first ripen it. A thorough assessment determines eligibility and the safest approach. Induction is avoided when vaginal delivery is impossible, the baby is too large, congenital issues exist, or the pregnancy is extremely premature.

It is also contraindicated after previous CS or fibroid surgery due to the risk of uterine rupture, which can be fatal for both mother and baby. Very ill women or those with a history of failed induction are also exempted.

“When you commit to induction, the aim is birth. There’s no luxury of time; it can be delicate if not handled swiftly,” Kairithia warns.

If induction fails, a Caesarean section is recommended to save lives. “Induction should only be done in facilities with obstetric services and operating theatres, to allow prompt CS if needed,” he adds.

Failed induction is determined using a 24-hour cut-off under continuous monitoring. Any signs of abnormal fetal heart rate, membrane rupture, or bleeding prompt immediate cessation of induction and a switch to surgery.

“Pre-induction evaluation is essential. If complications arise, we stop immediately. About 30–40 per cent of inductions fail,” the expert notes.

Unnecessary interference

Many women report induced labour as more painful, but Kairithia says this is a misconception. Induced contractions start abruptly and intensify faster than natural ones.

“Labour is labour, induced or spontaneous. Both follow the same process,” he maintains.

Antenatal Care (ANC) prepares women by teaching them to recognise labour signs and cope with pain. Contractions often begin as cramps in the upper uterus that radiate downward and to the back. After delivery, the placenta follows within about 30 minutes.

“Most feel back-radiating cramps that gradually dilate the cervix, sometimes accompanied by discharge. Some start with membrane rupture; others have intact membranes,” Kairithia explains.

Accurate due dates help distinguish preterm from post-term pregnancies. Induction always follows Ministry of Health guidelines.

“Pregnant mothers, don’t surrender your life entirely to professionals. Seek accurate information from experts,” urges Ojanga. “Don’t rely on ‘Doctor Google’ or friends, social media only shares personal stories, not verified facts.”

She warns that unnecessary interference can affect delivery outcomes and breastfeeding. “The uterus has ‘its own brain.’ Disrupting hormones can affect milk production. Natural labour often supports better flow,” Ojanga explains.

She also cautions against “set-up-to-fail” inductions, where labour is started only to declare failure quickly—sometimes to justify a scheduled CS if a woman prefers to avoid natural labour.

As a doula running a Nairobi childbirth centre, Ojanga supports women through pregnancy, birth and postpartum care. She teaches breathing techniques, back rubs, comfort measures and encourages natural labour progression. She also trains mothers on effective breastfeeding to ensure adequate milk supply.