Where Is
Mom?

There are direct and indirect medical reasons of maternal mortality. Direct reasons - appear during pregnancy, or in the process of giving birth. Chronicle diseases, which appear before pregnancy are regarded as indirect reasons.

Main direct reasons for maternity deaths are: eclampsia/preeclampsia (26%), Hemorrhage (bleeding) (25%), difficulties after cesarean section (17%) , sepsis (31%).

Indirect reasons are: tuberculosis (27%), vascular diseases (9%), suicide (14%), ©National Center of Disease Prevention in Georgia.

There are also the reasons, caused by social environment. Issues connected with reproductive system, family planning and sex stays as taboo. It causes marriage at young age and then - pregnancy. 16% of maternal death are those of underaged girls. According to World Bank, UNICEF and UNFPA data, in Georgia, 41 pregnant women out of 1000 is underaged.

Adolescent birth rate per 1000 women:

France - 6.2

Finland - 7.3

Estonia - 15.6

Fiji - 27.5

Georgia - 41.5

Armenia - 22

Turkey - 27

According to National Center of Disease Control, a very low number of women know about reproductive health, which explained by low level of education and non-existent governmental policy about sexual and reproductive rights. As in UNFPA report stated, that 67% of boys and 82% of girls aged 18-24 state that their parents did not talk to them about contraception. According to UNFPA data, 53% of population uses family planning methods.

As head of NGO “Association Hera XXI” Nino Tsuleiskiri states, social pressure and lack of knowledge between women plays a big role in this issue. Fear of conviction and stigmatization exists in teenage girls, when they come to the doctor. Before explaining their problems, they constantly asking the questions “Will you keep my name secret?” “Will you say this to my parents?”.

“There is no teenage friendly services in Georgia, - Tsuleiskiri explains, - because medical workers are still part of the society, so they often discriminate young girls, saying that 15-17 girls have no right to be sexually active, have personal life or possibility to get pregnant. It prevents teenagers from using medical services they need.”

1

I arrived to the maternity house with aches already started. I’ve been waiting for 12 hours for my uterus to “open”. Then injection of “solvent” was made in my vein and my child was born. The child born had no problem and taken by the father because I needed an intervention with post-partum bleeding. I expressed my emotions, would it be pain or happiness (that is what I felt) and I said that I would like to sleep because the intervention of the doctor seemed to be eternal, and I wanted to end my torture. The desire for my sleep has been caused by the loss of so much blood.

The baby was born at 18 o'clock and at 22 o’clock I was still fighting. Then the decision was made to cut the uterus, I was explained that the uterus did not regain its initial condition and there was no other way. The doctors informed me that I was taken to another service and that's why we had to wait. This phrase was an electric shock for me. I was taken to reanimation where I have been for 3 days when I felt like a real furniture. The nurses did not even ask me how I was, they just cleansed me, made injections and that’s it. I do not forget the needle of one student, who tried to inject it in my vein for 4 times and after my complaints said, “What can I do?”. I replied that taking into consideration my condition he could study to find a vein on me, because there was so much pain and it didn’t matter anymore. Maybe my gesture would be useful (I had no place on both hands from the needles). During these 3 days only one nurse asked me why I cried so much. (I spent 2 days and night crying). My long-awaited baby was born, and I did not even have the right to see it, no one had the right to come and I could not have a phone for connecting my spouse and outside world. In the reanimation, I was placed as soulless t subject (this is my feeling). I replied the nurse why I cried so much - I did not even see my daughter. She was taken by the father and was left with him, and he had no idea what to do at all. During these three days my child was with the father and with midwives by night.

The nurse decided to give me the opportunity to give me and my child 5 minutes as an exception. After that I spent 10 days in maternity house, and my girl was with me by the day and with midwives by the night, in order to let me rest.

After that I decided to have a second child and I gave birth exactly in 2 hours. When we were sent to ward, and I met my husband, we thought it was a dream. On the next day of the delivery, I realized what hell I went through two years ago.

And then, perhaps, after 4 years of this ambition, I accidentally listened to the report where the situation very similar to mine was discussed by the specialists, why did you get a 27-year-old girl had such complication.

Later I got that this “solvent” was injected in a large dose in my vein which prevented uterus to return its initial form and caused bleeding. In 2007, the doctor told me that it was not clear why had a 27-year-old girl had a reaction on it as 40 years old woman.

2

Normally, 2 months before I came, and I fixed as a patient in Chachava clinic. On August 11, amniotic waters begun to drain, I arrived to Chachava. I had the pain already started, but I walked in the ward and somehow endured this pain. But suddenly, I was told that I needed epidural anesthesia and that I wouldn’t be able to endure that pain. I couldn’t understand why. I just said that I do not want it, I to just walk. But I was told that had no other way, but anesthesia. At this time my uterus was open at some level. Ans as I got later, no one does epidural anesthesia in this condition. After anesthesia all pain disappeared. Shortly afterward, the maternity pain started, and I was taken to the maternity block immediately and my torture began. Because I had an epidural, I had no forces at all to let the child out. My doctor instead of explaining how to breathe in a right away, how should I concentrate my forces – he was shouting and threatening to bring the child forceps and my child be retarded. I was completely alone in the block, I was going mad from these pains (and imagine that I shouldn’t feel anything during the epidural, but I felt everything at this time). And suddenly this man, on whose you can count, is shouting and fighting with you. So, my parturition continues, and finally child is born, but the main gynecologist, whose hope I had and whose I specially chose, just stood at the distance, issued orders and shouted. Moreover, he was saying that I should be silent, because it’s shame to shout like I did. I almost climbed on the walls, my skull was exploding from pain, and I just moaned in low voice, which is also shame! I briefly saw this baby - the midwife showed me - and then when I was taken to the ward, where my child was brought – not washed at all. And the young nurse who brought the baby told me to “save” the left hand. What do you mean? – I asked. I know to save money or nerves, but hand? She answered me that she cannot say and called and old nurse. And this nurse said to me - (newborns and I had a really terrible delivery) –“I have 25 years in pediatricы and your child's left hand will never move and never expect that”. That's how it got up and it's bad. I had no voice to answer. The next day, the child has a problem. I called to my relative and quarrel with the whole clinic. And they started to move. They washed a child and ma an x-ray screening. But finally, it turned out that my child had a paresis - nervous injury that prevents normal development of the limb. That's what happened: I have narrow pelvis and my gynecologist didn’t pay attention to this fact. I asked for caesarean section, but he forced me to give birth physically. The epidural anesthesia was made late and that’s why I had no strength and I wasn’t explained how to push child properly and that’s why childbearing was complicated. In the meantime, midwife took Keso wrongly, so the nerves of the left part of the body were injured. Now she’s 10 years old and she plays piano, but I went through hell in order to make her left hand move. I’ve been making massages every night, then I've bought special boob for hand, controlled her during the sleep – she shouldn’t sleep on her left side. As a result, her left hand is not the same length as the right one, but except me no one sees that, and it gets tired too quick.

UNFPA/Healthcare system

In order to prevent maternal mortality, Ministry of Healthcare and UNFPA are working together for a last few years. With their technical support Ministry of Healthcare are working on different guidelines and protocols for medicine workers in different fields of reproductive health – guidelines for prenatal monitoring – which has a huge importance – because a lot of mistakes are made during this period, which can lead to mother’s death in the future. Also, there were some training included, because most of the women don’t know that there should be 8 visits to the doctor, which can ensure safe pregnancy. For most women it’s not priority, they usually go to the echoscope for revealing sex of child, etc.

We made guidelines for eclampsia, bleeding which gives medicine workers constant update of their knowledge and skills. UNFPA monitors and updates information concerning this issue.

Also, UNFPA collaborates with the Ministry in the “Council of a Mother and Child”, where different specialists are gathering – gynecologists, neonatologists, pediatrists, ministry workers, NGO representors, etc. where discussions and problem solutions are usually held.

One of the most important thing, implemented by UNFPA – implementation of WHO’s methodology called Beyond the Numbers. In this methodology includes review of the death cases – in Georgia, review of the cases, closed to death. We took 6 maternity houses, 3 in Tbilisi and 3 in regions, where we had training for medicine workers in order to implement this project. So, this methodology has its own criteria’s – in order the case to be reviewed. For instance, in the case of bleeding, how much blood women must have lost, in order her case can be reviews in the framework of this project. So, the case review represent meeting and monitoring all the details concerning case – everyone is asked, whom hands pregnant woman went through – from radiologist to midwife. So, discussions are held around this case in order to find a mistake somewhere in the whole pregnancy period. And when they found some flaws, they start to work on it. First, this methodology was implemented by WHO in Great Britain, where they were able to reduce maternal mortality. After that UNFPA decided to implement this in Georgia.