Posted by on February 26, 2015 in Blog, Uncategorized | 2 comments

“Uterine rupture stands as a single obstetric accident that exposes the flaws and inequities of health systems and the society at large due to the degree of neglect that it entails”.  –Ghana Medical Journal (A Two-Year Review of Uterine Rupture in a Regional Hospital)

Tuesday: February 17th, 12:15am.
I’ve always known there is abuse on multiple levels to women during labor and birth worldwide.  I’ve always known that this abuse happens here in Madagascar as well.  I’ve seen with my own eyes this abuse inflicted upon multiple women in three different countries.  I’ve heard women’s stories in even more countries.  Tonight we experienced the brutal truth and reality of this abuse on an even deeper level.  Tonight we experienced this deep violation of human rights to a woman and her baby and her family.

Thursday: February 26th
One of our ladies at the Sarobidy Maternity Center was a week past her due date… now know that “due dates” really have a 4-week window… 2 weeks before, 2 weeks after.  So she was 41 weeks pregnant.  At just 26 years old, this was her 7th pregnancy– but she only has two living children that she carried to term, a 9 year old and 6 year old– the rest of her pregnancies ended in abortion.


On Monday morning, she arrived to prenatal day experiencing some light and inconsistent contractions.  She was doing great, baby was doing great so we decided to see what happened that evening and through the night.  We all agreed, mama included, that if there wasn’t any changes, that she would go to our back-up physician’s clinic on Tuesday morning with Rota, our Malagasy midwife.  Sure enough, Tuesday morning rolled around and there weren’t any changes– her cervix was long and just 1cm dilated.  So off they went to our back-up physician where the doctor decided to start an induction.  The dose was inserted and mama was sent home and instructed to return when contractions began.  A few hours later, she called Rota and said that her contractions were strong and intense and her water had broken.  Rota encouraged her to return right away to our back-up physician’s clinic where she was working and would be waiting for her.  2.5 hours later, mama returned, with contractions that were one on top of another.  At this point in time, her cervix had effaced and was thin and was still 1cm dilated.  Recognizing that these contractions were too fierce, the doctor gave something to help to slow things down… but without success.  Mama was still doing well but baby’s heart rate dropped below 120 on occasion.  At this, our back-up physician felt that it would be best to transport mama– encouraging her that she still believed a vaginal birth would occur but in the event of a change, they would already be at the hospital.

So off Rota and this mama went to the regional government hospital.  When they arrived, the contractions were still just as fierce, there weren’t any changes in her cervix and baby’s heart rate was still normal with the occasional slight deceleration.  Upon seeing all these things, the staff midwife at the government hospital decided to give this mama MORE induction meds!  Of course, contractions intensified even MORE and 45 minutes later, our sweet and strong mama began to hemorrhage.  Rota called me frantically, “Alissa, she’s hemorrhaging and nobody is doing anything about it– “tsy misy olona taitra– tena tsy taitra izy ireo!” — “nobody is scared, they’re NOT scared!”  I came immediately.

{Interjection: now it must be known that the minute we walk into our back-up physician’s clinic or one of the hospitals, the mom and baby are completely out of our care– we now are playing by their rules}

When I arrived, the mama was still hemorrhaging and was waiting for surgery– another 45+  minutes away.  Her body was going into shock and the baby’s heartbeat was consistently around 108– to low.  Why the wait?  They were waiting for her blood typing results to be ready so they could get the blood ready and the surgeon on call refused to do the surgery because she was scheduled to be “going home soon”.  No *^%#@&^ joke!  So, we waited, and waited, and waited… and prayed and prayed and prayed and with each passing second, we had the very real sense of impending doom.  Finally, when the new surgeon didn’t arrive (!!), the refusing surgeon finally gave in and mama and baby were wheeled into the operating room and Rota was allowed to accompany them.  It was 2.5 hours after the hemorrhage began!

We were bearing witness to one of the catastrophic obstetrical emergencies– uterine rupture.  Her uterus had totally split open as a result of these intensely fierce contractions, most likely a weakened uterine wall due to past scarring and total negligence.  One report states that “best outcomes are reached where surgical delivery is achieved within 17 minutes of the onset”.

In the end, a beautiful 6.8 pound baby girl was born but never took a breath and a mama was perilously hanging onto life.  We continued to pray fervently that this mama would live to raise her two sweet children who desperately would need her.

Mama made it through the night and the next day and the next night and the one after that too.  We praise God for His protection over her life!  Oh, how we PRAISE Him!  We have visited her on several occasions in the hospital and have continued with postpartum home visits now that she has been discharged.  She is healing physically and is faced with the hard road of emotional and mental anguish and healing over the loss of her precious baby girl and the hope for more children because of the hysterectomy that occurred as a result.  Please, please, please join us in praying.

Uterine rupture is rare– in developed countries the stats are just 0.5% of all deliveries, resulting in 4.2% maternal mortality and 46% infant mortality and morbidity– again in developed wealthy countries!  You can guess that these numbers, these lives impacted, are much higher in countries like Madagascar.

This sweet mama has been sharing a room in the hospital with two other women.  The rooms all around them are full of new moms and new babies, the sounds of new life in the hallway.  And yet, in this particular room, it’s quiet.  Each of these three women all had ruptured uteruses, all lost their babies, all had hysterectomies.  Total devastation.  And like the research article stated above, “uterine rupture stands as a single obstetric accident that exposes the flaws and inequities of health systems and the society at large due to the degree of neglect that it entails”.  –Ghana Medical Journal (A Two-Year Review of Uterine Rupture in a Regional Hospital)

Please be in prayer for this mama, these ladies, these babies, these families, the broken medical system here, the country at large.  Come Lord Jesus, Come.



  1. We pray that the stronghold of our Lord Jesus would surround this and these women that have suffered such a great loss. Father God please envelop this woman and these ladies Lord and provide them a comfort and a peace that is just not understandable at this time of grievance lord, please be with them and help to give them hope and show them your hope Lord God and your love which surpasses all understanding. in Jesus mighty name Amen

  2. Sorry for your loss. I’m praying for you and the Mama.

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