Johannesburg - Could complications arising from being morbidly obese be the reason a woman died immediately after giving birth, or is negligence to blame, as her family suspects?
Bongiwe Edwana, of Katlehong, Ekurhuleni, who weighed 148kg, died after the Natalspruit Hospital staff tried unsuccessfully to resuscitate her following childbirth complications.
Two years later her family are not satisfied with answers they got and believe there is more they are not being told.
The Gauteng health department, on the other hand, claims they did what they could for 28-year-old Edwana and that her weight contributed to her death.
Edwana died on March 12, 2012.
Her brother, Luvuyo, said although his sister attended the pre-natal clinic at the hospital, it was only when doctors performed a Caesarean on her that they realised her pregnancy was extra-uterine and the baby was not in the womb. The hospital had decided to operate on her because she had gone past her due date.
The surgeon first cut Edwana vertically to reach the womb, but found no baby there. He then made another incision that ran from under the breast to her navel.
In the process, the baby was cut on the back, something the family believes contributed to its death three weeks later.
When Luvuyo went to see his sister after the surgery, she was shaking and could not speak.
“The doctor told me there were complications during labour and that she needed five specialists. When I asked why she was not taken to Bara (Chris Hani Baragwanath Academic Hospital), where there are specialists, I was told that there had been no time,” he said.
Edwana bled excessively, her organs collapsed and she died.
Luvuyo was called at night and told about his sister’s death. When he arrived at the hospital he wanted to speak to the doctor.
“I was told that he was busy at the labour ward assisting a woman who was giving birth to twins. When I returned to the hospital two days later, some nurses told me that that woman and those twins also died,” he recalled.
Edwana’s mother, Thandi, who was working in London at the time, returned home to bury her daughter. She said the hospital did not give them answers until a newspaper published the story of Edwana’s death.
They called the family to a meeting, but both Thandi and Luvuyo said they were left with more questions than answers. The doctor who treated Edwana was never present.
Thandi said the doctor had said he was scared that Edwana’s father would assault him.
“Only the student doctor who assisted him was present and at some point she burst into tears and left the meeting. Nothing will ever bring Bongiwe back, but I just need the truth,” she said.
Health department spokesman Simon Zwane said Edwana was morbidly obese, with a body mass index of 57. Her weight made it difficult to diagnose that her baby was growing outside the womb.
Even with a sonar, it was not an easy diagnosis unless you had a high index of suspicion, he said.
“Ms Edwana’s weight contributed to her death as it made diagnosis of extra-uterine pregnancy difficult and she also booked late, giving clinicians less time to identify complications. During the delivery, the doctor noted the complications and called for assistance. Together the health workers did all they could to save her and the baby, but unfortunately her death was unavoidable,” he said.
Professor Eckhart Buchmann, of Wits’s Department of Obstetrics and Gynaecology, said the pregnancy of an obese or overweight person was high-risk, as it could lead to the death of either the baby or the mother because of complications that could arise.
Buchmann agreed with Zwane that being obese could make the diagnosis of extra-uterine pregnancy difficult. “This pregnancy is extremely rare and can happen in anyone, regardless of their weight, but if you are obese, it is difficult to diagnose. You can’t feel with your hands what is going on and you can’t also do it with an ultrasound. What we would like women to do is to exercise, go on weight programmes or a diet if they decide to fall pregnant, as they would prevent all these problems. Obese parents normally give birth to fat babies who will be fat adults with high blood pressure, arthritis and cardiovascular diseases – it’s a vicious cycle,” said Buchmann.
RISKS ASSOCIATED WITH OBESITY
According to Professor Eckhart Buchmann of Wits’s Obstetrics and Gynaecology Department, the following risks are particularly associated with obesity in pregnancy:
Pre-eclampsia
‘This is a special form of high blood pressure. It’s nasty, it’s dangerous and can lead to death. It interferes with the blood circulation and the woman swells up.’
Gestational Diabetes
‘The baby becomes dependent on sugar and becomes fat and has to be weaned off the sugar after birth. In some instances the baby’s heart suddenly stops in the last month of the pregnancy.’
Post-date babies
‘Pregnancy in obese women tends to go on longer and the babies grow big. Labour has to be induced and the babies don’t cope, as they have outgrown the placenta.’
Deep-vein thrombosis
‘The woman can develop clots in her heart and lungs and that can be deadly. These women tend to die soon after delivery.’
Dysfunctional labour
‘Because of the woman’s weight, labour will progress poorly. This may necessitate a Caesarean section, which is usually difficult on an obese person. Excessive bleeding can occur and there may be injury to other organs.’
Complications after the Caesar
‘After the procedure, the wound often becomes septic and takes longer to heal. The woman would then have to go back to the hospital. These women struggle post- operation.’ - The Star