When I was 7 years old, my primary school classmates and I put on a school play, and I was the doctor. I’ve always loved medicine. I also love to make people happy, and medicine is one of the best professions for helping people. This is especially true of being an obstetrician-gynecologist, because you immediately see the results of your work. As you hand the baby over to the new mother, it’s the best moment you can have.
Pregnancy should always be safe, but in Nigeria some families are scared about what the outcome might be. About 75,000 women in my country die each year during pregnancy or delivery—about a quarter of them from postpartum hemorrhage (PPH), or severe blood loss after giving birth. As their doctor, you are watching their life slip out of your hands.
The most tragic part of this is that many maternal deaths are preventable. But I know that progress is possible, with smart interventions and dedicated health care workers. I see it every day in my work, and it’s what drives me to wake up every morning and do what I do.
Come spend a day with me in Kano, Nigeria, and see how we are working to make every birth a joyful one.
How Dr. Galadanci starts her day
I start my day at 5:30 with the dawn prayer, then rest a little more and get up around 7 to get ready for work. I have breakfast with my family and begin answering messages and calls on the way to work.
To be honest, it wasn’t obvious that I would be able to pursue 7-year-old Hadiza’s dream of being a doctor. My father was an educator, and he wanted all of his children, including girls, to be educated, but that was not the norm at the time. When I received my bachelor’s in medicine and surgery from Ahmadu Bello University in Zaria, I became the first female obstetrician trained in the Kano region. I practiced for many years, but I wondered, with all the interventions that exist, why are Nigerian women still dying at rates far higher than in other countries? As much as I loved working with patients, I decided to also become a researcher so I could affect policy and save many more lives.
Going from being a clinician to also a researcher gives you an advantage because you are intimately familiar with the problems that clinicians face, Dr. Galadanci says.
Improving health outcomes for women in Kano
At our hospital, one of the biggest obstacles to addressing PPH is the failure to diagnose in time. PPH is defined as losing 500 milliliters of blood in the first 24 hours after giving birth. Health care providers usually estimate the amount of blood loss based on a visual assessment, which is very hard to do accurately.
I cared for my cousin during her fourth pregnancy. Everything was fine leading up to the birth, but when she came in to deliver, her blood pressure spiked. After she delivered, there was blood everywhere. I administered every single treatment I could think of—tranexamic acid, misoprostol, oxytocin—but she continued to bleed. I knew I had to do something, so we rushed her to the operating room for a hysterectomy and gave her six pints of blood. She stabilized by morning.
My colleagues and I at the hospital eventually introduced the PPH drape, an inexpensive plastic sheet that channels a mother’s blood into a V-shaped plastic bag with measurement markings so health workers can see and track blood loss in real time.
This plastic drape, which costs less than US$2, helps quickly and accurately identify postpartum hemorrhage.
Being able to diagnose PPH early is the first step in a protocol known as E-MOTIVE. E stands for early detection—using the PPH drape. Each subsequent letter indicates a step in the process—uterine massage, oxytocic drugs, tranexamic acid, intravenous fluids, examination, and escalation—but in reality, the idea is to do them all as quickly as possible without waiting because time is the most critical factor in stopping the bleeding. Before E-MOTIVE, clinicians would typically administer one intervention, wait to see if it worked, and, if not, try another, losing valuable time. Waiting can cost lives.
What is beautiful about E-MOTIVE is that it doesn’t require additional clinical training, because these are mostly standard interventions, just bundled together so as not to lose time.
With support from the Gates Foundation, researchers in Kenya, Nigeria, South Africa, and Tanzania, including my team, conducted a study on the effectiveness of E-MOTIVE involving 210,132 patients who had vaginal deliveries. Our results, published in the New England Journal of Medicine in 2023, showed a 60% reduction in heavy bleeding in the intervention group compared with patients who received usual care. Within 6 months, the World Health Organization adopted E-MOTIVE in its guidelines. Countries have implemented it, too—including Nigeria, thanks to partnerships with the Federal Ministry of Health & Social Welfare and the state ministries of health.
Frontline health care workers have told me that since they started using E-MOTIVE, they haven’t had a single mother die from PPH. If we could implement it across Nigeria, this approach has the potential to significantly reduce deaths from PPH.
I know we can do even more. I want to address preeclampsia, another leading reason moms die in birth. I am optimistic about the future because we have many new tools to improve maternal and child health. Simple sensors can monitor high blood pressure, a symptom of preeclampsia. Ultrasound devices that use artificial intelligence can help health care providers in rural settings refer high-risk patients to the right care. Continuous positive airway pressure (CPAP) machines can enable premature babies to breathe more effectively. I’ve seen E-MOTIVE adopted in record time, so that gives me hope that these other innovations can move quickly from research to policy—and save lives.
Dr. Hadiza Galadanci is a professor of obstetrics and gynecology at Bayero University and an OB-GYN and researcher at Aminu Kano Teaching Hospital in Kano, Nigeria. An advocate for maternal health in Nigeria and globally, Dr. Galadanci is the director of the Africa Center of Excellence for Population Health and Policy.
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