'Zuri died in the Neonatal Intensive Care Unit': Ashley Muteti's battle with pre-eclampsia

When Ashley Muteti first learnt she was pregnant in 2017, she was 25 and glowing with the joy, anticipation and excitement that many first-time mothers know so well. She imagined pregnancy would be blissful, an easy journey like those of her friends, soft kicks, baby shopping and excited countdowns to delivery.

She looked forward to the day she would hold her baby in her arms. It never occurred to her that something as common as high blood pressure could turn that joy into tragedy.

“I had never seen anyone close to me go through a difficult pregnancy,” she says quietly. “My best friend had just delivered smoothly, so I thought that’s how it would be for me.”

Around her fifth month, things began to change. Her face puffed up. Her hands and feet felt heavy, her head throbbed and her vision blurred. At her local clinic, she was told the swelling was normal and part of pregnancy. No one checked her blood pressure or urine. She went home with painkillers and reassurance that “first pregnancies are usually hard.”

Unknowingly, Ashley was living with a life-threatening condition. According to Dr Felix Oindi, a consultant obstetrician and gynaecologist at Aga Khan University Hospital, pre-eclampsia occurs when a woman develops high blood pressure after 20 weeks of pregnancy, usually accompanied by protein in urine or changes in liver and kidney function.

“It can start mildly and silently,” he says. “If not detected, it can lead to seizures, stroke or even death for both mother and baby.”

By 26 weeks, Ashley’s headaches had intensified. Her body ballooned overnight. One morning, her mother insisted she seek a second opinion at a bigger hospital. The readings shocked everyone. Her blood pressure was 160 over 100, nearly double the healthy range.

“I didn’t even know that high blood pressure in pregnancy was dangerous. Nobody had explained the risks to me during antenatal visits,” she says.

Emergency CS

Her urine was full of protein, a classic marker of pre-eclampsia. She was admitted immediately. “I remember the doctor saying my organs were starting to shut down,” she recalls. “My liver was strained, my kidneys weren’t filtering well and they feared I could get a seizure at any time.”

Doctors tried to stabilise her, but the only definitive treatment for pre-eclampsia is delivery. At just 30 weeks, they made the difficult decision to perform an emergency caesarean section to save her life.

Her baby, Zuri Nzilani, was born weighing 1.2 kilogrammes. She was tiny, fragile and rushed to the Neonatal Intensive Care Unit (NICU). Ashley remembers waking up from surgery to see her daughter’s incubator surrounded by tubes. “She was so small I could hold her in one hand,” she says.

Zuri fought bravely for weeks. “I had just gone through a caesarean section, and yet every day I had to travel to the hospital to express milk and sit by her side. It was exhausting and heartbreaking.”

She developed complications of prematurity including swelling, high blood pressure, necrotising enterocolitis (a serious intestinal infection) and a brain bleed. “One day, I watched the monitor go from 100 per cent oxygen to zero,” Ashley says. “The nurses performed CPR, and she came back, but from that day I lived in fear.”

After weeks of struggling, Ashley’s worst fears came true. Zuri died in the NICU. “The nurses gave me a chance to hold her for six hours, until her skin began to change colour,” she recalls softly. “My family took turns holding her. That was the hardest day of my life.”

The grief was suffocating. Ashley and her husband had not only lost their baby but were also staring at a hospital bill of nearly Sh7 million. She stopped leaving the house for weeks. “Everything reminded me of Zuri,” she says. “The sound of a baby crying, the smell of milk, everything.”

Six months later, life took another unexpected turn. Ashley was on an intrauterine device (IUD) and believed she could not conceive so soon. When she missed her period, she thought it was hormonal imbalance. “When I tested positive, I cried. I wasn’t ready, not emotionally or physically,” she says.

Doctors warned that her body had not healed enough and that her second pregnancy was automatically high-risk. She was placed on low-dose aspirin to help prevent pre-eclampsia and advised to monitor her blood pressure every few days.

Close follow-up

Still, anxiety became her constant companion. “I would panic whenever I felt dizzy or swollen. I was even on anxiety medication,” she says. “I kept thinking I would die or my baby is going to die.” Her pressure began to creep up again around the seventh month, at 150 over 100. The symptoms were familiar; headaches, nausea and swelling. Once again, doctors decided to deliver early to save her life.

Her second daughter, Amani, was born weighing 975 grammes at 31 weeks. This time, Ashley and her husband were emotionally guarded. “We were scared to love her too much,” she admits. “We didn’t even want to bond because we thought we would lose her like we lost Zuri.”

The NICU days were long and draining. Amani lost more weight, dropping below 900 grammes, but she was strong enough to breathe on her own. After three months in hospital, she was finally discharged, frail, but alive. Today, Amani is a bright six-year-old girl with a radiant smile. For Ashley, Amani’s survival became a turning point.

According to Dr Oindi, recurrence of pre-eclampsia is common but not inevitable. “If managed early, most women can safely carry another pregnancy. Close follow-up, medication like aspirin and lifestyle monitoring make a huge difference.”

Ashley began counselling and therapy to cope with the trauma. Still, she struggled with fear, anxiety and depression. Her doctors advised her to give her body time before another pregnancy. For three years, she focused on recovery and on Amani’s care.

In 2021, Ashley conceived again. This time, the experience was markedly different. Her obstetrician prepared a detailed plan from the start. She underwent regular scans, kept a daily blood pressure log, and followed a balanced, low-salt diet. Her readings stayed stable around 120 over 80, within normal range. “It was the calmest pregnancy I had ever had,” she says.

For the first time, Ashley allowed herself to celebrate. Her friends threw her a baby shower, something she never imagined she would live to experience. “I finally felt joy instead of fear,” she says.

Her third daughter, Nia, was born at 35 weeks, weighing 2.3 kilogrammes. Small, but healthy and breathing on her own. “When they placed her on my chest, I couldn’t stop crying,” Ashley says. “It felt like healing. Like I could finally breathe.”

According to Dr Sikolia Wanyonyi, a foetal medicine specialist at Aga Khan University Hospital, Ashley’s experience reflects what many women face when pre-eclampsia is well managed. “With proper antenatal care and timely intervention, outcomes improve dramatically,” he explains. “Frequent visits, urine and blood pressure checks and good nutrition are vital.”

Family history

Ashley’s story has another layer of irony. She later learned from her mother that she herself had been born prematurely due to pre-eclampsia. “I am a pre-eclampsia baby,” she says. “My mother nearly died giving birth to me. I guess it runs in our bloodline.”

Experts confirm that genetics can play a role. “Family history is a known risk factor,” says Dr Wanyonyi. “A woman whose mother or sister had pre-eclampsia is more likely to develop it.”

Now a mother of three, counting Zuri, whom she still lovingly includes, Ashley has found healing through advocacy. The loss of Zuri left Ashley broken, but it also planted a seed. Out of her grief, she founded the Zuri Nzilani Foundation, named after her firstborn. The foundation raises awareness about pre-eclampsia, supports mothers in NICU wards and trains health workers in compassionate maternal and bereavement care.

“Zuri gave me purpose,” Ashley says, her voice firm. “Her life has impacted so many women. I get messages from mothers saying, ‘My life was saved because I knew the signs.’ That is her legacy.”

Through the foundation, Ashley has reached hundreds of women, speaking at hospitals and community events. She educates them on recognising warning signs: headaches, swelling, blurred vision and sudden weight gain. She also advocates for respectful maternity care, something she wishes she had received during her first pregnancy.

“I was dismissed because I looked too young and healthy,” she says. “If someone had taken my symptoms seriously, maybe Zuri would be here today.”

Her experience reflects a wider crisis facing thousands of women. Pre-eclampsia affects between two and eight per cent of pregnancies worldwide, and according to the World Health Organization (WHO), it accounts for around 46,000 maternal deaths and 500,000 infant deaths each year. In Kenya, it is estimated to affect about six per cent of expectant mothers, making it the second leading cause of maternal mortality after bleeding.

“Many of these deaths are preventable,” says Dr Oindi. “All it takes is consistent blood pressure checks and awareness. High blood pressure in pregnancy is not just a number. It can be a warning of something deadly.”

Ashley knows that too well. From nearly losing her own life to watching her daughters fight for theirs, her journey is one of pain, faith and transformation. She continues to live with the scars of pre-eclampsia, but she has transformed her grief into a mission to save others.

“Pregnancy can kill you if you don’t know the signs,” she says. “But with the right care, it can also be beautiful. I survived pre-eclampsia, and now I help others survive it too.”