Nomusa Khumalo knows the pain of losing a child. She has endured the heartbreak of multiple stillbirths. 

The 38-year-old Soweto resident was convinced something was wrong with her. Despite attending regular check-ups and the pregnancies seeming healthy, she still lost her babies. 

She experienced her first stillbirth in 2006.

“I was 28 weeks pregnant (seven months) when I went to the hospital for a pregnancy checkup. While I was queueing to get the scan, I could not feel the baby. I started bleeding and was rushed to the theatre for an emergency caesarean section. Afterwards, I was told I lost some amniotic fluid, that’s why I lost my baby,” she recalls. 

The same thing happened when she got pregnant in 2007. At 28 weeks she lost her baby.  

The loss of a baby after 20 weeks of pregnancy or at delivery is known as a stillbirth. Around 16 000 stillbirths occur in South Africa annually. This loss is caused by many factors, many of which are beyond the woman’s control.  But stillbirth is shrouded in misconceptions.  

“When such things happen you feel like you are being punished by the ancestors,” Khumalo says. 

In 2021 she fell pregnant again. 

“The scan showed that I was carrying a boy. We even named him: Muzingaye (pillar of our home). At 28 weeks I was not feeling well and I went to Chris Hani Baragwanath Hospital (Bara),” she says. 

At the hospital, she was immediately rushed to the theatre for a caesarean section. 

“I could still see the baby’s heartbeat on the scans. I had hoped that he would survive. Unfortunately, he did not make it either. It was such a traumatic experience that brought back sad memories,” she says.

But this time she wouldn’t be sent home with vague explanations.

Finally getting answers

At Bara, Khumalo was introduced to the Child Health and Mortality Prevention Surveillance (CHAMPS) network, which collects and shares data about the causes of death in children under the age of five. Through the network, she was referred to a specialist who investigated the cause of the pregnancy losses.  

“Previously the doctors would say I lost the baby without any further explanations,” Khumalo says.

After extensive tests, doctors from CHAMPS found that Khumalo had high blood pressure and gestational diabetes. Dr Phuti Ratshabedi, an obstetrician and gynaecologist at  Bara tells Health-e News that high blood pressure is a leading contributor to stillbirth. 

But Khumalo, who has been pregnant four times, was shocked. She had never been diagnosed with high blood pressure before – despite this being part of routine antenatal care. The repeated missed diagnoses of Khumalo’s high blood pressure highlight gaps in the standard of antenatal care being provided. 

Khumalo is determined to expand her family. Now that she knows what has caused her to lose three babies she is confident that, under the watchful eye of specialist doctors, she will be able to carry her next pregnancy to term and give birth to a healthy baby.

“I am on my pre-conception journey. My blood pressure is still a problem but the doctors from CHAMPS are trying to have it controlled. They said if I fall pregnant they have a plan for me,” she says.

Factors leading to stillbirths 

In addition to high blood pressure and diabetes, numerous other factors increase the risk of stillbirth. These include infections of the placenta, blood circulatory abnormalities, and placental inflammation.  

Dr Helen Mulol, senior researcher at the University of Pretoria and South African Medical Research Council Research Centre for Maternal, Fetal, Newborn & Child Health Care Strategies, explains that in absolute numbers, most stillbirths in South Africa occur among women who appear healthy and are attending antenatal care at the primary healthcare level. 

“One of the major causes of stillbirths is undetected placental insufficiency which means that the placenta does not function optimally resulting in the foetus not receiving adequate nutrition and oxygen. If this is not detected then the foetus could eventually starve with a resultant stillbirth,” Mulol says.

Mulol says research shows that in South Africa, approximately 12% of women at the primary healthcare level had placental insufficiency when screened with the Umbiflow (a Doppler ultrasound device that measures the blood flow in the umbilical artery).

“The causes of stillbirths in high-risk pregnancies include maternal disorders such as hypertension, obesity and diabetes mellitus. Maternal infections during pregnancy including malaria, syphilis and HIV and post-term pregnancy contribute to stillbirths as well,” she says. 

Most of these conditions can be detected and treated during routine antenatal care. 

“Late booking of a pregnancy significantly impacts the outcome of a pregnancy. We found that only 70% of women in Soweto book their pregnancy before the recommended 20 weeks,” says CHAMPS South Africa’s co-director Professor Ziyaad Dangor. 

Dangor says the delay significantly reduces opportunities for early medical intervention and comprehensive pregnancy monitoring.

Health system challenges 

Dangor warns that health system limitations such as staff shortages severely compromise pregnancy care quality and are major contributors to inadequate antenatal care.

“A lack of skilled sonographers means that high-risk women such as those with hypertension may not have access to an ultrasound that would determine if their baby is compromised and possibly prevent adverse outcomes of the pregnancy such as stillbirth,” Dangor says.

Improved maternal healthcare, early diagnosis, and targeted interventions can go a long way towards reducing stillbirths. – Health-e News