Dangerous Deliveries: Ebola Leaves Moms And Babies Without Care
For more than two decades, Lucy Barh has been helping women deliver babies. Even during Liberia's violent civil war, when other midwives left, Barh stuck around.
But none of this prepared her for a patient she saw a few months ago.
"I was on duty that day when the patient came in," says Barh, at the headquarters of the Liberian Midwives' Association in Monrovia. "We did the examination. She was not in labor."
The woman didn't even seem close. So Barh sent her home and told her to return to the maternity ward when her contractions started. Barh was expecting her in a couple of days, maybe a week.
"But to our utmost surprise, the very next day," she says, "that woman was rushed on our ward, bleeding profusely."
The woman was in full labor. The midwives raced to deliver the baby.
"Right after the fetus came out, that woman started bleeding from all over," Barh says. "We did everything we could, just to save her life. But even with a blood transfusion, she ended up dying."
The baby died, too. And it was only then that Barh and her team learned the truth about the woman's medical history: Two of her relatives had died of Ebola.
A pregnant woman waits for help in a cab outside John F. Kennedy hospital in Monrovia, Liberia, in September. Then closed, the hospital's maternity ward reopened in October and is now one of the few places in Monrovia delivering babies.
If a person can get treatment, he or she has nearly a 40 percent chance of surviving Ebola. But for a pregnant woman and her fetus, Ebola is almost a death sentence. One small study found a fatality rate around 95 percent. The woman invariably passes the virus to the fetus. And the fetus dies before labor, or it's born and dies shortly after.
The devastation doesn't stop there.
Both the baby and the woman's amniotic fluid are flooded with Ebola virus — and are highly infectious.
The maternity ward at the Eternal Love Winning Africa, or ELWA, hospital is nestled in a tropical forest a few hundred yards from the Atlantic Ocean.
"After a few days, the midwife who did that delivery came down with Ebola," Barh says. "She spent 21 days in a treatment center. It was only by the grace of God that she recovered."
Many other midwives haven't been so lucky.
Right outside Barh's office is a whiteboard. There are about three-dozen photos taped on it. At the top, it says, "Nurses and midwives who have died during the Ebola crisis."
Not all of them caught the infection from pregnant women, but in Liberia, you hear the same story over and over again: Someone got Ebola while trying to help a pregnant woman in trouble.
When a woman is bleeding, minutes can mean the difference between life or death for the baby and mom, Barh says. "Sometimes it doesn't even give you ample time to put on your gloves. ... That alone is so dangerous for the midwives."
With so much blood and so much bodily fluid involved in deliveries, even doctors with access to protective gear are getting infected.
That's how the American doctor Rick Sacra got Ebola in August. Sacra, who is now recovering in Worcester, Mass., was helping pregnant women at a hospital outside Monrovia called Eternal Love Winning Africa, or ELWA.
"Sacra was being very cautious," says ELWA's assistant director, Dr. John Fankhauser. "But it's also just very risky. What we consider our two riskiest places are the OB ward and the operating room."
The problem, he says, is that women who are miscarrying often have bleeding and cramping, like someone with Ebola. So it's very difficult to tell the difference.
The risk to health care workers is so high that many clinics in Liberia refuse to treat pregnant women. Hospitals have closed their maternity wards.
Midwife Ester Kolleh and family doctor John Fankhauser say that, despite the risk of getting Ebola, they won't stop helping women deliver babies at the maternity ward of Eternal Love Winning Africa.
The ripple of effects of that breakdown in the health care system could be more catastrophic than Ebola itself.
ELWA is one of the few health facilities in Monrovia where a woman can deliver her baby. The midwives there now wear full Ebola suits — gown, gloves, face mask, goggles — during every delivery. And they get sprayed down with chlorine after a shift, just like in the Ebola clinic.
"So far, by the grace of God, we haven't had another infection," Fankhauser says. "But all we can do is take great precautions. We can't stop caring for patients."
Even as careful as Fankhouser was, he is now back in the U.S., under quarantine, after possible exposure to Ebola. So far, he's had no symptoms.
And many midwives across Liberia have stopped caring for patients, says Ester Kolleh, the lead midwife at ELWA. They've quit or stopped coming to work. "Everybody is afraid of catching Ebola," she says, "because most nurses who caught Ebola died."
Around that moment, a nurse walks by in the hallway of ELWA's OB ward. In her arms is a baby who isn't moving. Kolleh explains what happened.
"Last night we received three ladies," she says. "They had been in labor one week, two weeks. Nobody to help them."
The three women had gone from hospital to hospital in Monrovia. They were turned away at each one. By the time they made it to ELWA, it was too late for their babies.
"All of them had stillbirth," she says. "They couldn't get help from anyone. The babies died before they came. Now we have three dead babies in the delivery room."
The United Nations Population Fund says the problem is widespread across Liberia, Sierra Leone and Guinea. Maternal death rates are climbing. And tens of thousands of women — and their babies — could die in the region over the next year unless more maternity wards reopen and ERs start seeing pregnant women again, the agency predicts.
Kolleh says that's why she's not quitting, no matter the danger. "We keep doing it because we have to do the work," she says. "We have to save lives."
And bring tiny new ones into the world, too.
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Transcript
MELISSA BLOCK, HOST:
In West Africa, complications during childbirth can quickly become deadly. Hospitals are few and far between. When a woman is bleeding, minutes can mean the difference between life or death for the baby and the mother. And now the Ebola outbreak has also made it deadly for those caring for pregnant women. NPR's Michaeleen Doucleff reports that the ripple effects of that breakdown in the health care system could be more catastrophic than Ebola itself.
MICHAELEEN DOUCLEFF, BYLINE: When you walk into the headquarters of the Liberian Midwives' Association, one thing is clear - this place runs on a shoestring. The offices in Monrovia are in an old, decrepit building. You have to step over trash to enter. Inside, there's hardly any place to sit down. That's where I met the association's president, Lucy Bahr. She's been helping women have babies for more than two decades. Even during the country's civil war, when other midwives left, Bahr stuck around. But none of this prepared her for a patient she saw a few months ago.
LUCY BAHR: I was on duty that day when this patient came in. We did the examination. She was not in labor.
DOUCLEFF: She didn't even seem close, so Bahr sent her home and told her to come back to the maternity ward when her contractions start. Bahr was expecting her in a week or so, but the very next day...
BAHR: To our utmost surprise, that woman was rushed on our ward, bleeding, profusely.
DOUCLEFF: The woman was in full-on labor. The midwives raced to deliver the baby and the bleeding got worse.
BAHR: Right after the fetus came out, that woman started bleeding from all over. We did everything we could, you know, just to save her life, but even with the blood transfusion, she ended up dying.
DOUCLEFF: She died and her baby died too. It was only after all this that Bahr and her team learned the truth about the woman's medical history. Her relatives said there was Ebola in her family. If a person can get treatment, they have about a 40 percent chance of surviving Ebola, but for a pregnant woman, Ebola is almost a death sentence. The fatality rate is around 95 percent and she always passes the virus to the fetus. The fetus dies before labor or it's born and dies shortly after, but the devastation doesn't stop there. Both the baby and the woman's amniotic fluid are flooded with Ebola virus and they are highly infectious.
BAHR: After a few days, the midwife who did that delivery came down with Ebola.
DOUCLEFF: Lucy Bahr says, the midwife spent 21 days in a treatment center.
BAHR: It was only by the grace of God that she recovered.
DOUCLEFF: She recovered, but many other midwives haven't been so lucky. Right outside Bahr's office is a whiteboard. There are about three dozen photos taped on it. At the top, it says, nurses and midwives who have died during the Ebola crisis. Not all of them caught the infection from pregnant women, but in Liberia, you hear the same story over and over again - someone getting Ebola while trying to help a pregnant woman in trouble.
BAHR: Sometimes it doesn't even give you ample time, you know, to even wear your gloves and then you find yourself rushing into that delivery just to save lives. I mean, that alone is so dangerous for the midwives.
DOUCLEFF: So dangerous because there's so much blood and so much bodily fluid involved. Even doctors with access to protective gear are getting infected. Because of the risk to health care workers, many clinics now refuse to see pregnant women. They say they can't tell which women have Ebola and which don't, and in those life-and-death moments in the ER, there's no time to wait for an Ebola test result.
JOHN FANKHAUSER: It's very difficult. Some of the complications of pregnancy look maybe like they could have Ebola.
DOUCLEFF: That's Dr. John Fankhauser. He works at one of the few hospitals still delivering babies around Monrovia. It's called ELWA, Eternal Love Winning Africa. He shows me around the maternity ward.
FANKHAUSER: The obstetrics ward is on the left-hand side here. We have a delivery room just to the left and then there's about five ladies - four or five ladies - in labor in this room.
DOUCLEFF: ELWA is outside of Monrovia, nestled in a tropical forest. The Atlantic Ocean is just a few hundred yards away and the maternity area is actually beautiful. There are a few one-story buildings painted yellow. They're connected by outdoor hallways, and with the rain trickling down, there's a sense of calmness here, but there's also sadness. The place has been battered by Ebola.
FANKHAUSER: We were the first Ebola unit in Monrovia.
DOUCLEFF: In America, we've heard the story of Dr. Rick Sacra. He caught Ebola while treating pregnant women at ELWA. He was evacuated and is now recovering in Worcester, Massachusetts. Fankhauser says Sacra was being cautious.
FANKHAUSER: But it's also risky. It's just very risky. What we consider our two riskiest areas are the OB ward and the operating room.
DOUCLEFF: Since Sacra got infected at ELWA, midwives have started delivering all babies wearing full Ebola suits - a gown, gloves, facemask, goggles - and they get sprayed down with chlorine, just like at an Ebola clinic.
FANKHAUSER: So far we've - by the grace of God - not had another infection, but I think, you know, all we can do is take great precautions. And I think we can't stop caring for patients.
DOUCLEFF: But even as careful as Fankhauser was, a few weeks after I talked to him, he was back in the U.S. under quarantine for a possible exposure to Ebola. So far he's testing negative.
ESTHER KOLLEH: (Foreign language spoken).
DOUCLEFF: Esther Kolleh worked with Fankhauser at ELWA and she's the lead midwife there. She says many of her colleagues at other hospitals have quit or stopped coming to work.
Do you feel afraid of catching Ebola?
KOLLEH: Yes, everybody afraid to catch Ebola.
DOUCLEFF: Right around that moment, a nurse walks by. She's holding in her arms a baby who isn't moving. Kolleh tells me what happened.
KOLLEH: Last night, we received three ladies. They had been in labor for one week, two weeks - nobody to help them.
DOUCLEFF: The three women had gone from hospital to hospital in Monrovia. They were turned away at each one. By the time they made it to ELWA, it was too late for their babies.
KOLLEH: All of them had stillbirth. They couldn't get help from anywhere. The baby dies before they come.
DOUCLEFF: And is that happening more often?
KOLLEH: Yes.
DOUCLEFF: The United Nations Population Fund says the problem is widespread across Liberia, Sierra Leone and Guinea. The agency predicts that tens of thousands of women - and their babies - could die in the region over the next year unless more maternity wards reopen and ERs start seeing pregnant women again. Kolleh says that's why she's not quitting, no matter the danger.
KOLLEH: We keep doing it because we have to do the work. We have to save lives.
DOUCLEFF: Save lives and bring tiny new ones into the world too. Michaeleen Doucleff, NPR News. Transcript provided by NPR, Copyright NPR.
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