As she writhed about on the maternity bed at Bwaila Hospital in MalawiÃ¢â‚¬â„¢s capital, Lilongwe, Thokozani Phiri knew only one thing: She was about to deliver her first born child.
Ã¢â‚¬Å“The baby was kicking in my womb. I hoped to hold it but it died in the birth canal,Ã¢â‚¬Â said the short Phiri.
According to nurse/midwife and mental health specialist Charity Salima, short women are at risk of having birth complications.
Ã¢â‚¬Å“Women who are less than 150 centimetres in height or wear shoe size three usually have smaller pelvis. It is advisable that they attend antenatal clinics at bigger hospitals,Ã¢â‚¬Â she says.
Salima says all pregnant women need to attend antenatal clinics where they undergo assessment of the pelvis and baby size to determine if they will have a normal delivery or will require a Caesarean.Ã¢â‚¬Â
This, she adds, is also one of the reasons pregnant women are discouraged from seeking help from traditional birth attendants (TBAs).
Ã¢â‚¬Å“Having worked in bigger public hospitals, I have encountered a number of at-risk mothers who first sought help from TBAs and came to the hospital late as a result,Ã¢â‚¬Â she says.
While height can be genetic, shortness can also result from poor nutrition during childhood and adolescence.
Online writer Dr. Bo Moller of the department of obstetrics and gynaecology at Malar Hospital in Sweden says a short maternal stature is associated with an increased risk of obstructed labour due to a condition called cephalo-pelvic disproportion (CPD).
She says studies of nations in the industrialisation era and the US showed urban slums suffered dietary deficiencies including vitamin D, combined with a lack of exposure to sunlight which led to rickets with bone and pelvic deformities and later complications in labour.
Ã¢â‚¬Å“Increased nutritional intake brought about increased height and foetal size,Ã¢â‚¬Â noted Moller.
It was revealed such women were not in current state of malnutrition, but it occurred in their childhood and adolescence.
In an article published in the Malawi Medical Journal titled Short Height: A Maternal Risk Factor, B.F Kalanda writes: Ã¢â‚¬Å“Maternal short stature has also been shown to be related to poor pregnancy outcomes even in very rich countries.Ã¢â‚¬Â
Dr. Maggie Blott, a consultant obstetrician at the Royal Victoria Infirmary, Newcastle, wrote on her blog that many short women have a small pelvis, which increases their risk of cephalo-pelvic disproportion (where your babyÃ¢â‚¬â„¢s head is too big to come through your pelvis) and needing a Caesarean.
Ã¢â‚¬Å“However, we wouldnÃ¢â‚¬â„¢t offer a woman a Caesarean [operation to assist in delivery] just because sheÃ¢â‚¬â„¢s short. Give a natural delivery your best shotÃ¢â‚¬â€but be prepared for a C-section if you donÃ¢â‚¬â„¢t progress,Ã¢â‚¬Â she writes.
The Fistula Foundation adds that short women also risk developing fistula. Obstetric fistula is an abnormal opening between a womanÃ¢â‚¬â„¢s vagina and bladder and/or rectum, through which her urine and/or faeces continually leak.
The condition is common in developing countries because, according to the foundation, it is rooted in Ã¢â‚¬Ëœgrinding poverty and the low status of women and girlsÃ¢â‚¬â„¢.
Ã¢â‚¬Å“In developing countries, the poverty and malnutrition in children contributes to the condition of stunting, where girlsÃ¢â‚¬â„¢ skeletonsÃ‚Â do not fully mature. This stunted condition can contribute to obstructed labour and, therefore, fistula,Ã¢â‚¬Â reads a statement of the Fistula Foundation website.
The risk of maternal death from obstructed labour is greatest in developing countries with poorly resourced health services, especially those offered by TBAs.
The status of stunted heights in the country is significant and Secretary for Nutrition, HIV and Aids in the Office of the President and Cabinet (OPC) Dr. Mary Shawa says half of the adult population is stunted.
Ã¢â‚¬Å“In terms of [stunted] women, their pelvis is deformed and as a result, they are bound to experience obstructed labour,Ã¢â‚¬Â says Shawa.
UnicefÃ¢â‚¬â„¢s deputy country representative Jane Miuta once said because of the deformed pelvis sustained from short heights, women are likely to suffer from vesico-vagina fistula (VVF).
Ã¢â‚¬Å“VVF is a condition when the baby presses hard against the birth canal walls and causes injury. Blood leaks for long and the woman has to go for operation,Ã¢â‚¬Â Miuta said, corroborating that poor nutrition in young girls is sometimes the source of this.
Proper intake of nutritious foods from pregnancy to adulthood is one sure way to avoid the situation, affirms Shawa.
But for women like Thokozani Phiri, who cannot do much about their height now, they have no choice but to ensure they deliver their babies with skilled medical practitioners and feed their babies nutritional food to avoid a similar predicament.