Death at birth

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High number of maternal deaths frightens pregnant women and their families


Nguyen Thi Bong mourns her 23-year-old daughter Le Thi Huong, who died at the Quang Ngai Province General Hospital on April 20 while giving birth. Huong's newborn son died a week later.
Photo: Hien Cu

Huynh Thi Thanh Tung, a 33-year-old woman, was in good health during her gestation period.

Her family was shocked when she and her baby died early morning on June 9 after being admitted to the Mo Duc District General Hospital in Quang Ngai Province for delivery.

They have accused two nurse midwifes Nguyen Thi Tuyet Nga and Duong Thi Ly who were on duty on the evening of June 8, of acting slowly and irresponsibly, leading to Tung's death.

Huynh Thi Kim Chinh, Tung's sister, told Vietweek health officers at the hospital said Tung and her baby were in stable condition after she was taken to hospital on her due date.

The hospital staff asked the family to wait until Tung gave birth naturally. Later that night, when Tung developed pains and became weaker, the family asked the two nurses to call doctors and perform a C-section.

The two nurses ignored the request, with Nga even asking the family to leave her alone for some time to rest, according to Chinh.

When the family repeatedly pressed the nurses to examine Tung, Nga gave Tung an injection to "boost her health."

Tung, meanwhile, turned blue and lost consciousness. The two nurses then called a doctor to help but she was dead by the time the doctor showed up.

The family has lodged a complaint with the Quang Ngai Province Health Department, asking for an investigation into Tung's death.

Tung's was among 14 maternal deaths across the country and the third one to happen in Quang Ngai between April 20 and June 9.

The high number has caused anxiety among pregnant women and their families, prompting relevant authorities to investigate the deaths. However, no conclusions have been reached.

Unexpected or uncaring?

In most cases, hospitals and doctors have denied responsibility for the deaths of women and their babies, saying these were unavoidable due to unexpected complications during delivery and some rare conditions.

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For example, in Tung's case, Pham Minh Duc, director of the Mo Duc District General Hospital, blamed amniotic fluid embolism a rare and not entirely understood obstetric emergency in which amniotic fluid, fetal cells, hair, or other debris enters the mother's blood stream via the placental bed of the uterus and triggers an allergic reaction.

But her family blames the hospital for a lack of trained doctors, which meant that two "neglectful" nurses were in charge on the night that Tung died. They also said that the nurses are to blame for ignoring their request to perform C-section for Tung in time, which could have saved her life and that of the baby.

While no conclusions have been reached in this case as well, the hospital on June 9 suspended the two nurses pending further investigations.

The maternal deaths have one thing in common: the pregnant women were all healthy and did not receive any warning from doctors about their health when they underwent periodical prenatal checkups.

Dr. Huynh Thi Thu Thuy, deputy director of the country's leading obstetric hospital, Tu Du, in Ho Chi Minh City, said in an interview with the Sai Gon Tiep Thi newspaper June 11 that a recent inspection of hospitals in the central region revealed a lack of skilled staff as well as medical equipment and medicines in obstetric wards.

"And the most worrisome fact is that doctors pay little attention to improving their professionalism," she said.

Dr. Pham Viet Thanh, former deputy chief of the Health Ministry's Maternal Health Department, told online newspaper VnExpress no single conclusion can be drawn for the maternal deaths.

"(The lack of) doctors' professionalism may be a reason, but some deaths, including three in HCMC, were caused by unexpected obstetrical accidents," he said.

No accountability

The maternal mortality rate in Vietnam is 75 per 100,000 live births, more than five times the rate in developed countries, according to statistics released at a conference held by the HCMC Health Department last month.

The director of a hospital in HCMC, who spoke under condition of anonymity, told Vietweek that in case of maternal deaths, most Vietnamese hospitals try to conceal the deaths and do not admit any fault on their part.

"If the families of the deceased complain, the hospital will immediately blame complications or rare conditions for the deaths," he said.

 He added that medical records the important evidence for investigations into maternal deaths are not completed punctually, giving hospitals the opportunity to make changes and cover up their faults.

Some health experts have called for an independent agency to investigate the deaths in obstetrics and other sectors as well, saying it would help ease the increasingly tense relationship between doctors and patients. They say this is the only way relatives of the deceased patients can be convinced about the fairness of conclusions drawn in any investigation.

Recently, the Health Ministry announced it will train doctors in obstetrics emergency procedures this month in a bid to reduce the alarmingly high number of maternal deaths in Vietnam.

Each province will send two doctors to receive the specialized training at the country's leading obstetric hospitals, Tu Du in HCMC and the Central Obstetrics Hospital in Hanoi, it said.

NO PUNISHMENT YET FOR DOCTORS, NURSES INVOLVED

Authorities have not initiated any punitive measure against doctors or nurses in the recent spate of maternal deaths across the country, a senior health official has affirmed.

Nguyen Duy Khe, head of the Health Ministry's Department for Protection of Mothers and Children's Health, told Tuoi Tre (Youth) newspaper on Monday, June 11, that initial findings of inspection teams sent to several provinces to investigate the deaths show some of them were unavoidable because they were caused by preexisting medical conditions.

Some deaths were caused by the lack of staff and medical equipment and others by "limited professionalism," he said.

Khe said he was particularly concerned by the lack of medical equipment and skilled staff found in district hospitals across the country.

"In Nghe An Province, we found that some district hospitals have only one obstetrician, which means there is no doctor on duty for several nights a week.

"In Ho Chi Minh City, there is a district hospital where a doctor is in charge of both the obstetrics ward and the general medicine ward."

The inspection has found only 68 percent of district hospitals have equipment to monitor the condition of pregnant women before giving birth, in a situation where hospitals receive up to 20 delivery cases a day.

Khe said health departments of provinces and centrally-governed cities usually send statistics on maternal and newborn deaths to the Health Ministry at the end of the year, so it was not possible at present to say if the number of fatalities so far this year was higher than the same period last year.

"If we look at the overall picture, the maternal mortality rate in Vietnam has sharply decreased over the last few decades.

"But if we look at each single case, we'll see that some deaths should not have happened. We could have prevented them from happening."

Khe said his department will work with the Health Ministry's Science and Training Department to review the curriculum of training programs for obstetricians and nurses at district hospitals.

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