“ Between 100 to 130 women die due to pregnancy related causes every year in Sri Lanka. Hospital data shows nearly 48,000 miscarriages and 1,700 stillbirths. We need to do more research to find out why these babies are dying while still in their mothers’ womb ( in utera)”, National Program Manager - Maternal & Child Morbidity & Mortality Surveillance, Family Health Bureau - Ministry of Health, Dr Kapila Jayaratne told the Sunday Observer. Commenting on the discrepancy in figures with a large number of miscarriages, he said, “That is because some early pregnancies are not registered because they have ended up as early pregnancy losses. Many women don’t even realize they are pregnant before miscarrying.”
He said Sri Lanka had done well to improve maternal care service provision and reduce maternal and perinatal deaths in the country, with maternal, perinatal and neonatal mortality rates ranked the best in the region and on par with developed countries. He further noted that while 95% pregnant mothers were registered and antenatal care was provided for 99% mothers, with nearly 100% delivering in a hospital, the health status of pregnant mothers was unsatisfactory. “We are not satisfied even with such a high coverage of services, due to the relatively high number of miscarriages and stillbirths”, he said.
He said several factors could cause stillbirths.. “We don’t know all the causes. Sometimes, there are unexplained stillbirths. Both maternal and foetal factors contribute to stillbirths. Some of the risks are beyond one’s control, and mothers should not blame themselves if they have a stillbirth. No one seems to be sure exactly why some women are more affected”.
Listing some risk factors he said women who are obese, have had previous miscarriages or stillbirths, or have chronic diseases, such as diabetes or hypertension, were more at risk. Being pregnant with multiple babies also puts a woman at high risk for a stillbirth. Maternal age is also crucial, women older than 35 years have more odds of stillbirth.
“A history of miscarriages, chronic diseases, uterine and cervical problems, a history of baby with birth defects, long term medications, and infections are found to be contributing to stillbirths,” he added.
He said, “ for a proper evaluation of causality, we need to do an autopsy, placental exam, genetic testing. These tests may take time, and a conclusive answer about what went wrong may never be reached which can be frustrating to parents. However, now it is mandatory to do a pathological postmortem on all stillbirths if a valid cause of death is not ascertained with the parents’consent.”
He added that being physically and mentally well would help mothers to give birth to healthy, live babies. “If a maternal illness was found, appropriate medical consultations should be done. If a genetic cause of the dead baby was detected, they may be referred to a geneticist. Geneticists are available all over the country now. The main centre is the Human Genetics Unit at the Colombo Medical Faculty. Geneticists can perform certain investigations, weigh the risks of recurrence and provide genetic counselling.
“Generally, if the mother is otherwise healthy, waiting two to three menstrual cycles after a stillbirth is recommended,” he said.
Exclusive breast feeding needs to be improved
Sri Lanka has topped the world’s rank in breastfeeding, but the period of exclusive breast feeding by new mothers leaves room for improvement, NHSL Coordinator Dr Ramya Premaratne told the Sunday Observer.
She said healthcare workers, employers, staff at work places and fathers as well as the community needs to be made aware of the importance of exclusive breastfeeding. She said that since 2005, the national policy on breastfeeding in Sri Lanka is exclusive breastfeeding up to 6 months, as recommended by the World Health Organization. This is because it is the best milk an infant can have. “Human milk is a dynamic, multi-faceted fluid containing nutrients and bioactive factors needed for infant health and development. Its composition varies by the stage of lactation and between term and preterm infants. No other fluid is needed for the infant for the first six months if breast fed exclusively”, she informed. Human milk is uniquely suited to the human infant, both in its nutritional composition and in the non-nutritive bioactive factors that promote survival and healthy development.
Some of these components have been proposed as novel medical agents for prevention or treatment of disease, including lactoferrin, lactadherin, epidermal growth factor, erythropoietin, and human milk oligosaccharides. Breastfeeding has many health benefits for both, mother and infant. Breast milk contains all the nutrients an infant needs in the first six months of life. Breastfeeding protects against diarrhoea and common childhood illnesses such as pneumonia, and may also have longer-term health benefits, such as reducing the risk of overweight and obesity in childhood and adolescence”, she reiterated. She said the World Health Organization recommends exclusive breastfeeding (i.e. no other fluids or solids) for six months and then continued breastfeeding combined with solid foods for 2 years or as long as mother and baby desire. She said the first fluid produced by mothers after delivery is colostrum. Colostrum, produced in low quantities in the first few days postpartum, is rich in immunologic components such as, secretory IgA, lactoferrin, leukocytes, as well as developmental factors such as epidermal growth factor. Colostrum also contains relatively low concentrations of lactose, indicating its primary functions to be immunologic and trophic rather than nutritional. Levels of sodium, chloride and magnesium are higher and levels of potassium and calcium are lower in colostrum than later milk. Unfortunately, some mothers throw away this precious milk without realizing how important it is,” she said.
She noted that it was time to change the legislation in order to provide 6 months maternity leave for all working mothers, to make all work places breastfeeding friendly and make feeding places available at all public places. In Sri Lanka full pay maternity leave is 3 months. Hence, early supplementation is commenced in order to return to work. Although legislation exists which allows a mother to take time off for breastfeeding once she returns to work, many are unaware of their rights. “ It is important to update and train maternity and infant health care givers both in hospitals and the community about breastfeeding. Mass media promotion of breastfeeding, legislative control regarding promotion of artificial feeds and leave entitlements and working hours of mothers who breastfeed would also help promote breastfeeding, she added.