A 37-year-old woman carrying twins gave birth to her first child at Karnali Provincial Hospital in Surkhet on Tuesday night. After the first child was born through normal delivery, her health condition suddenly deteriorated. Her blood pressure rose sharply, and most of her vital signs, including pulse and heart rate, began to deteriorate.

The woman, who had been hospitalized for two weeks, had polyhydramnios. This is the accumulation of excess fluid around the body of the fetus. The doctors involved in the treatment immediately took her to the operation theater and surgically removed the other baby in her stomach.

'We performed an immediate caesarean section, but we could not save the second baby,' said Dr. Amit Singh, head of the hospital's obstetrics and gynecology department, over the phone from Birendranagar in Surkhet. 'She was 34 weeks pregnant. If we had been even 10 minutes late, the outcome could have been completely different. There was a lot of bleeding. We were able to save the mother's life by starting treatment immediately.'

According to doctors, such emergencies are happening in maternity hospitals and birthing centers across the country, and mothers and newborns are losing their lives even after reaching a health facility.

A separate study conducted by the Ministry of Health and Food Security in 7 provinces last Chaitra showed that about 3 out of every 4 maternal deaths in Nepal occur inside a health facility or on the way to a health facility for treatment.

The report pointed out that a weak referral system, limited functionality of health facilities, lack of skilled manpower, and delays in receiving quality services on time as the main causes of maternal deaths.

According to the report, about 78 percent of women in Karnali province who are referred for labor have to travel more than 2 hours to reach a health facility. Then, more than 50 percent in Sudurpaschim Province and about 50 percent in Koshi Province have to travel more than 2 hours to reach a health facility.

Madhesh and Lumbini Provinces are comparatively better in terms of emergency maternity and newborn care. However, even in those provinces, most of the basic service centers have not been able to meet the minimum required standards.

According to the report, none of the basic emergency maternity and newborn care centers in Koshi, Bagmati, Gandaki, Lumbini, Karnali and Sudurpaschim Provinces have met the performance standards for emergency maternity and newborn care. Out of 32 basic emergency maternity and newborn care centers in Madhesh Province, only 4 centers have met such standards.

The basic standards for emergency maternity and newborn care are a measure of whether a health facility has the capacity to provide essential services when needed. This includes the availability of trained health workers 24 hours a day, essential medicines and equipment, and the ability to routinely perform critical emergency procedures. Experts say that even if just one of these requirements is not met, the lives of the mother and newborn can be at risk.

'Some time ago, doctors at the district hospital attempted to perform a cesarean section on a woman who had not been able to have a normal delivery, but when they could not control the bleeding, they temporarily closed the surgical wound and brought the woman to our hospital,' said Dr. Amit Singh, an obstetrician at Karnali Provincial Hospital. 'In this case, we were able to save the lives of both the mother and the baby. But even small shortcomings can be fatal.'

The report shows that some settlements in each province still have to travel more than 2 hours for emergency obstetric and neonatal care. According to the report, it is risky for a referred patient to take more than 2 hours to reach another health facility because it increases the risk of maternal death during the journey.

Most provinces have more emergency maternity and newborn care centers than required . But many of these health facilities are not even fully utilized .

'More women and newborns are dying in health facilities or on the way to health facilities than at home,' said maternal and child health expert Dr. Ganesh Dangol, 'This is a very serious issue . This shows that there are weaknesses in efforts to prevent maternal and newborn deaths . Losing a life even while going to a health facility is a tragedy in itself .'

Experts say that the relevant agencies should ensure access to trained manpower, equipment, life-saving drugs and timely treatment services .

Nepal has made significant improvements in institutional delivery rates  in recent years. According to the Nepal Multicluster Survey 2024/2025 report, the rate of delivery in health facilities has reached nearly 80.5 percent . This rate was only about 18 percent in 2009. After the government launched a free maternity program in 2009 to reduce maternal mortality, the number of people going to health institutions for childbirth increased significantly, while maternal and infant mortality rates also decreased. The maternal mortality rate had fallen from 539 per 100,000 live births in 1996 to 239 in 2016. Nepal was also awarded for achieving the Millennium Development Goals.

Institutionalized childbirth services are a priority program for Nepal, through which the government aims to achieve the Sustainable Development Goals. But despite a significant increase in the number of people going to health institutions for childbirth in recent years, maternal and infant mortality rates are still high. Experts say that this is due to delays in identifying complications, delays in treatment, and lack of access to specialist services.

According to the World Health Organization, Nepal has reduced the maternal mortality rate by more than 70 percent since 2000. According to the organization's latest report, 142 women now die during pregnancy or childbirth for every 100,000 live births. Under the United Nations' Sustainable Development Goals, Nepal has set a target of reducing the maternal mortality rate to 75 per 100,000 live births by 2030.