Unpredictable and unfair
It’s dark out when the young woman arrives in labor. With the help of the clinic midwife, Motari, she delivers a healthy baby. There is that moment of joy. And then, things start to go wrong. The mother begins to bleed—profusely—and does not stop.
Motari works furiously, administering drugs, massaging the uterus. But the bleeding still does not stop. The mother’s blood pressure is dropping, and she’s going into shock. She could die any minute.
This is postpartum hemorrhage. It kills about 130,000 women every year, the vast majority in sub-Saharan Africa and India. These women are vulnerable because the health facilities where they give birth don’t have emergency obstetric care, such as blood transfusions or surgeons that hospitals in wealthy countries have at the ready.
“Postpartum hemorrhage is very unpredictable,” says Elizabeth Abu-Haydar, a public health specialist at PATH who looks for ways that technology can make childbirth safer. “It can happen in a flash to any woman giving birth.”
Still, she says, “No woman should die from postpartum hemorrhage. It’s treatable.”
A balloon to the rescue
That conviction has driven Elizabeth to champion a simple device with a complicated name: the uterine balloon tamponade, or UBT for short.
The UBT is standard in wealthy countries, but with a price tag of nearly $400 for a single use, it’s far too expensive for low-resource settings. Looking for a more affordable solution, Elizabeth learned that a team at Massachusetts General Hospital had created a simple kit, called Every Second Matters (ESM-UBT).
Assembled with items that can be found in a clinic, the kit costs one-tenth of the commercial UBT. It includes a condom (the “balloon”), which is filled with water using a syringe and rubber tubing. The water-filled balloon exerts pressure on the walls of the uterus, creating a tamponade that stops the flow of blood.
PATH is working with Mass General to ensure the device can be easily and safely used by nurses and midwives and to accelerate its introduction in rural and underserved communities. The ESM-UBT kit has been introduced in 149 clinics in Western Kenya that are part of PATH’s APHIAplus project.
One of those clinics was Motari’s.
The Every Second Matters uterine balloon tamponade saves lives with items that can be found in a clinic. Photo: Dr. Thomas Burke/Massachusetts General Hospital.
12:30 a.m. in a village clinic in Western Kenya
Motari and the mom are exhausted and scared. This is their worst nightmare. The nearest hospital is two hours away, and right now every single second counts.
Then Motari remembers the new UBT kit. It hasn’t been used yet, and the midwife is nervous about whether it will be successful. Following the directions, Motari assembles the device and fills it slowly, slowly with water.
After what feels like ten excruciatingly long minutes, a miracle happens—the bleeding stops.
The potential to save 169,000 mothers
Elizabeth has heard a number of stories like this from across the study sites. The data back the stories up: there’s been a 98 percent survival rate when the UBT is used properly by trained providers.
According to modeling done for the Innovation Countdown 2030 report, the UBT could save the lives of 169,000 women over the next 15 years. “It not only saves lives,” says Elizabeth, “it reduces the economic and emotional suffering of families and the costs to governments.”
Feedback from health care workers and experts also pointed to the need for an affordable preassembled UBT, which would save health workers time during those critical moments and free up hands. So PATH developed a prototype with the South African manufacturer, Sinapi biomedical. Next steps for the team include clinical testing in Africa to ensure its safety and applying for regulatory approvals to help speed up access to the device in more clinics like Motari’s.
1:30 p.m. in a village in Western Kenya
The young mother and her baby go home—together.
This prototype of a preassembled uterine balloon tamponade could save time and free up hands for health workers. Photo: PATH/Patrick McKern.
Goal: to reach thousands more
Elizabeth is excited about the impact UBTs could have, but to get them into the hands of the midwives and nurses who deliver babies, more funding is needed. The project has made it this far thanks to support from a variety of funders, including grants from the United States Agency for International Development and donations made to PATH’s Reach Campaign. Elizabeth’s current goals are to finalize the design of the preassembled Sinapi device and to continue to support the introduction of UBTs in countries in Africa.
“I’ve struggled to get funding for the UBT, but it’s the one that energizes me most,” Elizabeth says. “These midwives have dealt with situations that doctors in the US have never seen. They’re so grateful to have this tool when the situation is desperate. The results are so immediate.”
