Use of the anti-shock garment childbirth deaths

(WOMENSENEWS)–When a woman named Olanna gave birth to a healthy baby boy at her home in southwestern Nigeria last year, she and her family celebrated–until she began bleeding heavily after the delivery.

Rushed to the emergency room in the city of Ibadan, Olanna had no pulse and no blood pressure. Her relatives gathered at the hospital to mourn her death. Then doctors wrapped the 30-year-old mother in a new "anti-shock garment" that revived her and saved her life.

Like an estimated 125,000 women across the world each year, Olanna could have died of postpartum hemorrhaging.

But doctors intervened with a garment that they have given to 400 women in Nigeria and 100 women in India through a two-year-old program. This initiative is run by Pathfinder International, a Watertown, Mass., nonprofit that promotes global reproductive health and is the source of Olanna’s story.

Mostly Preventable Deaths

The anti-shock device that saved Olanna fits tightly around the abdomen and legs. It stems the flow of blood from the body parts compressed under it, which alleviates postpartum hemorrhaging. It also reverses shock, during which the heart, lungs and brain are deprived of oxygen because blood accumulates in the lower abdomen and legs. The garment returns blood to the vital organs, counteracting shock and restoring the pulse and blood pressure.

Postpartum hemorrhaging, also known as PPH, is defined as the loss of more than 17 ounces of blood following vaginal delivery or more than 34 ounces after Cesarean delivery.

"The vast majority of deaths from PPH are completely preventable," said Dan Pellegrom, Pathfinder’s chief executive officer. "And it is within our capacity to make maternal deaths as rare in developing countries as they are in the United States."

Postpartum hemorrhaging can occur when there is an infection, when a woman is fatigued after prolonged labor, when her uterus fails to contract after delivery, or when part of the placenta remains in the womb.

It is typically treated with blood transfusions and surgery; two remedies that, combined with six hours in the garment, saved Olanna’s life.

While 1 in 100,000 pregnant women die of postpartum hemorrhaging in high-income countries, 1 in 1,000 do so in low-income nations, according to a 2003 British study.

Inadequate nutrition makes many women more vulnerable to anemia and heavy bleeding, and geographic isolation means that they are more apt to give birth without the help of a skilled attendant. Failure to recognize when bleeding is severe, delays in getting treatment and substandard care when clinics and hospitals are accessible also increase the likelihood of postpartum hemorrhaging.

Targeting Nigeria, India

Anti-shock garments were first developed to treat wounded American soldiers in the Vietnam War. Tightened with five Velcro closures, the garment is made of neoprene, the same substance used for wet suits.

Health advocates say the garment is particularly needed in the two countries that Pathfinder is targeting.

Women in India and Nigeria suffer more than one-third of all maternal deaths worldwide–with one quarter of those deaths stemming from postpartum hemorrhaging, reports the Geneva-based World Health Organization.

"In India, an estimated 50 percent of women give birth at home, while in remote parts of northern Nigeria up to 80 percent of women do," said Susan Collins, a senior program officer for Pathfinder. "When a hemorrhaging woman can get the anti-shock garment, wearing it for up to three days can buy her time while she is transported to a facility where doctors can treat her."

In November 2007, after researchers had worked for four years to test the anti-shock garment on 2,000 women in Nigeria, Egypt and Mexico, the Chicago-based John D. and Catherine T. MacArthur Foundation offered a $10.7 million grant to help Pathfinder create a "Continuum of Care" project around the garment’s use.

Run in collaboration with Dr. Suellen Miller of the University of California, San Francisco; Dr. Stacie Geller of the University of Illinois at Chicago; and Dr. Oladosu Ojengbede of the University of Ibadan in Nigeria, the project is funded through October 2010.

Other Methods Address Problem

In addition to using the anti-shock garment, the "continuum of care" model relies on two other means to address postpartum hemorrhaging. The first element is a blood collection drape that helps providers diagnose the severe bleeding more readily and measure the amount of fluid lost. The second element is "uterotonic" drugs, such as oxytocin and misoprostol, which can stem excess bleeding by causing the uterus to contract.

In eight states in Nigeria and eight states in India, Pathfinder researchers are not only employing these technologies, but lobbying for their widespread use. They are training medical providers to supervise a woman while she is in the garment and to remove it slowly to prevent excess blood loss.

"We’re doing advocacy and education so government agencies and communities know about the need to improve all aspects of postpartum care," said Cathy Solter, Pathfinder’s director of technical services.

Over the next several years, Pathfinder affiliates hope to prevent tens of thousands of deaths from postpartum hemorrhaging in India and Nigeria.

Widespread adoption of the continuum of care model could prevent 80 percent of the 125,000 deaths caused by this type of bleeding and 25 percent of maternal deaths from all causes, according to ongoing research at the University of California, San Francisco.

Molly M. Ginty is a freelance writer based in New York City.