When newly delivered mothers prefer discharge against medical advice
They deliver at a facility but do not wait for discharge. They put at risk both their lives and those of their babies to go back home as soon as possible. They are faced with dilemma of caring both for their infant and for the ones who are already home. They are mothers who have to renounce aid because extra care equals extra expenditures. We could call them runaway mothers.
Ending up with easy and superficial judgements is easy. Pointing fingers towards mothers and accusing them of not wanting to care for their baby, and holding the hospital staff responsible for these disappearances seems almost logical at first. Unfortunately, understanding the underlying causes behind the choice of running away is not as straightforward as one might imagine.
While collecting data at Buluba Mission Hospital members of the MANeSCALE study team witnessed the heart-breaking decision of a mother who asked to be discharged against the doctors’ decision.
Esther (not real name) delivered her baby, but she realised she had no milk, meaning that the infant risked becoming hypoglycaemic and developing secondary health threatening risks connected with low glucose levels. In the meantime, the baby also developed a pulmonary infection that required antibiotic treatment. For both reasons, the new-born needed a cannula to be inserted as soon as possible.
No baby really likes to be pricked. After the first couple of attempts, as the veins were very tiny and kept breaking, the baby started crying. No mother likes to see her baby cry. Hence the Esther’s decision to take the baby away. Or at least her first version of the decision.
The nurse in charge of the maternal ward, patiently, started talking to her, trying to explain in simple words the gravity of the situation and the risks the baby would have faced without medical care.
After an hour, Esther was still not convinced and is almost ready to sign. Esther was evidently exhausted and did not even have the time to clean herself after delivery as evidenced by the bloodstains on her dress. The discussion went on and Esther added on top of her first version that she had not enough money to cover the extra care, and, on top of that, she had to go home to take care of her husband.
Now, put yourself in the nurse’s shoes. She is doing her best to convince a mother to stay at the hospital to help the baby improve. At the same time, she realises that if she is too insisting, the mother may never come back to the facility because she is scared of what may happen to her baby. Rationally speaking, the fact that Esther decided to deliver her baby in a facility rather than at home is already a great success, and the nurse knows it.
On the other hand, Esther cannot freely make a decision because of socioeconomic struggles that are forcing her to risk her baby’s life for the overall good.
Force the mother to stay and save the baby, or let her go and hope she will come back? Risk a baby’s life for the sake of the others at home or spend more money for the antibiotics?
Dozens of Esthers run away from health care facilities every day for similar reasons.
Once again, the realities of patients’ decision-making processes and of hospital staff’s impotence reflect the complexity of a leaking system that has to struggle with internal and external points at issue and dilemmas that no mother or health care worker should be required to decide on.
Written by Vittoria Crispino – A Global Health Fellow attached to the MANeSCALE project of the Makerere University Centre of Excellence for Maternal and Newborn Health Research