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The Smile of a Healthy Mother

Rashida Begum was overjoyed when she became pregnant for the first time at age 19. But following the delivery of a stillborn child, she bled profusely and had to seek treatment from the village doctor in the Sadar subdistrict of Cox’s Bazar district in Bangladesh, where she lives.

Over the next 11 years, Rashida, the wife of a fisherman, delivered four healthy babies, each time at home and with untrained birth attendants. Following each birth, Rashida again experienced postpartum hemorrhage (PPH), which left her weak, requiring medical attention, and unable to care for her newborn. PPH is the leading cause of maternal death in Bangladesh.

In 2009, Rashida became pregnant once more. But this time everything was different—and not just because she was carrying twins. Rashida was visited by Uma-Shree Pal, a field-worker trained by EngenderHealth, in partnership with the Directorate General of Health Services (DGHS).

Uma-Shree counseled not only Rashida, but also her mother-in-law and her birth attendant, on the proper use of misoprostol, a pill that prevents excessive postdelivery bleeding. Rashida should take all three tablets immediately after the delivery of the baby, she explained, and before the delivery of the placenta. Most importantly, Rashida was not to take the tablets before the delivery. Uma-Shree also gave them a leaflet, from which Rashida’s husband learned of the benefits of misoprostol. All of this information created a supportive environment for Rashida as the birth approached.

After 32 weeks of pregnancy, with Rashida’s permission, Uma-Shree gave her a dose of misoprostol that would lessen bleeding following the births of her babies. During labor and delivery, Rashida again experienced PPH after the first baby was born. Immediately after the second baby arrived, she swallowed the misoprostol tablets as instructed, and the bleeding gradually subsided.

“This time, I had less bleeding than that of any of my previous deliveries,” Rashida said. “I didn’t have any problems using the tablets—they were so easy to take. I felt good and strong after the birth, which allowed me to focus on caring for my new twin babies.” She was also relieved that the treatment was free.

“Seeing the smile of a woman who has just given birth gives me such great happiness,” said Uma-Shree, herself a mother of a 5-year-old boy. “I consider that smile a priceless reward for my hard work.”

The 35-year-old health worker hopes that more community members and stakeholders will help spread the word about misoprosotol and that the program will be extended throughout the country to benefit all mothers of Bangladesh.

Learn more about EngenderHealth’s work to prevent PPH in Bangladesh.

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