The lack of medical facilities in rural hospitals has brought to the fore yet another maternal healthcare problem in Maharashtra’s Palghar district. A 22-year-old pregnant woman was due to deliver her first child on December 26. But in the early hours of December 25, Asha Nandakumar Bhosare was brought to Mokhada Rural Hospital, 16 kms from her home in Koldyachapada hamlet in Mokhada taluka of Palghar distict, as she started to experience early phase of labour. By the same night, she went into active phase of labour and gave birth to a boy at 9 a.m. on December 26.

After giving birth, Ms. Bhosare experienced postpartum haemorrhage (PPH), a condition of severe bleeding in which more than 500 ml to 1,000 ml blood is lost within 24 hours of giving birth. Dr. Bharat Kumar Mahale, Medical Superintendent of Mokhada and Jawhar, said that in normal birth cases, 300 to 400 ml of blood loss happens, and bleeding is arrested within 15 to 20 minutes. “But in her case, she was continuously bleeding for over 20 minutes. At 10 a.m., she was transferred from Mokhada Rural Hospital to Jawhar Sub-District Hospital (distance of 22 km) as the rural hospital did not have a blood bank facility,” Dr. Mahale said.

She was brought in critical condition to the sub-district hospital and put on artificial respiration with four bags of blood (each containing 350 ml) transfusion given to her. At the same time, the gynaecologist at the hospital was trying to stop the bleeding but in vain. Since the sub-district hospital did not have any intensive care unit (ICU) or a ventilator facility, she was then transferred to Nashik District Hospital (distance of 80 km) at 1.45 p.m. the same day.

“A medical staff from Jawhar hospital accompanied her in the two-hour journey but on reaching the Nashik District Hospital, she was declared brought dead,” Dr. Mahale added.

Regarding the future of the baby, who is healthy, Dr. Mahale said: “Our team has visited the house and asked the family to admit the [newborn] baby at Jawhar Sub-District Hospital for proper feeding. At the hospital, we have separate staff nurses for feeding of such babies who lose their mother at the time of birth. Such babies are provided formula milk. The family members will be trained on how to feed the baby for six months.

In June this year, the Journal of Obstetrics and Gynecology of India published an article titled, ‘Postpartum Hemorrhage: Enhancing Outcomes for Mothers by Effective Management’ which stated that PPH remains a significant contributor to maternal morbidity and mortality worldwide. In India, PPH affects approximately 12% of women.

“In postpartum hemorrhage, it is very important to provide the patient with timely blood transfusion and surgical intervention to stop bleeding. A month ago, we had a similar case in the sub-district hospital and the mother was saved because of timely intervention. Since this was a rural hospital that does not have a blood bank facility it was challenging to save her life,” Dr. Mahale said.

Palghar MP Hemant Vishnu Savara has urged the Health department in the State to ensure rural healthcare is equipped with basic life support. “This is a very unfortunate incident and should not have happened if the rural hospital was equipped with required facilities. None of the rural hospitals in Maharashtra have blood bank facilities. Every hospital, even if it is a rural hospital, must have experienced gynaecologists, paediatricians, blood banks and 24-hour ambulance services. I have asked the State health department to provide us support to equip the rural healthcare facilities better.”

Watchdog Foundation, a citizens group in Mumbai, has condemned the incident and wrote to the State government to use funds for public wisely. “A young tribal mother from Mokhada, Palghar Taluka who was forced to travel 102 kilometers to access an ICU, succumbed to post-delivery complications en route. While the government has allocated significant funds for welfare programs like the Ladki Bahin Yojana, it is disheartening to note the neglect of basic healthcare needs in remote tribal areas. This neglect is costing lives, especially among the most vulnerable sections of society,” said the letter.