Bellinda, Chioma and I headed off to Pasua this morning in the taxi - still no daladala experience however I have heard rumours that that may happen tomorrow. Sandy stayed home today as she was not feeling well.
I was really looking forward to placement as today was my turn in Labour and Delivery. When we arrived we went to the morning hand over meeting. There had been two births during the night but one inparticular had the Sisters' attention. An 18 year old girl had attended the clinic in labour claiming to be about 5 months pregnant however she had given birth to a full term baby. The Sisters were amused as the girl had only been married for about 5 months so they believed she was fibbing about the babies due date. They were all chuckling about it!
After hand over I went to the delivery room with Melanie (one of the midwives) and was very excited to see a Mama on one of the two delivery room beds. She was in labour and was waiting for a pelvic examination to assess the progress of her labour. This helps the midwife to know how far into the labour the Mama is and how much further she needs to go. Melanie examined the Mama and found that her cervix was 7cm dilated. This was good news to me as I knew she only had another 3cm to go which meant I would probably be able to be there for the birth!
I helped Melanie clean the labour and delivery and postnatal rooms with a cold water and bleach solution and a rag and then I spent time with the Mama.
It is different here than at home. The Mamas birth alone with no family members at all...not even the baby's father. Even the midwives ignore them! This Mama's name was Happiness (that is not unusual here!) and she was in a lot of pain but she kept as quiet as possible. She was definitely a lot quieter than I was (for those who don't know, I was very loud through each of my deliveries!). She was trying to rub her own back unsuccessfully and the midwife continued to ignore her so I rubbed and massaged her back for her. I couldn't understand her and she couldn't understand me but she appeared to appreciate it. There is no pain relief offered to labouring women so natural methods are the only option. Also, unlike home, the Mama brings all the equipment needed with them to the clinic when they come in. This includes kitenge (similar to a sarong and is used as the bed sheet), sterile gloves, cord clamp, a large roll of cotton swab, oxytocin, syringe and needle. When Happiness was standing I tried to encourage her to lean on the bed and sway her hips but she either didn't understand or wasn't interested!
Happiness's contractions had started at 5am this morning and she was 7cm dilated at 8:30am. This was the first stage of labour. At about 11am to 11:30am she had reached 10cm dilated and was entering the second stage of labour. During the second stage the contractions slowed down a bit and this stage was delayed. Second stage would usually last about 30 minutes but it took longer. Happiness gave birth to a baby girl at 12:25pm. I was luck enough to help Melanie guide the baby out and hand her to her Mama!
The third stage is to deliver the placenta. Unfortunately, that was done very differently here than at home. The baby was wrapped and taken away to be weighed and then placed on the next bed alone. Happiness was given the injection of oxytocin and the midwife then started to pull on the umbilical cord straight away. The placenta wasn't ready to come out so I collected the baby and tried to encourage the Mama to breastfeed her as this releases natural hormones in the body which causes contractions and helps the placenta to come away from the wall of the uterus more easily however I was told she was not to breastfeed the baby until the placenta had been birthed. As the pulling of the umbilical cord was not sucessful the midwife proceeded to push her whole hand in and dig the placenta out. I was horrified! Again, I offered to let the Mama breastfeed but again I was told no. Not only was this method the last thing she needs after giving birth but it is dangerous for the Mama. It introduces bacteria which cause infection and increases the risk of bleeding and pieces of the placenta being left behind which also causes infection. The infection caused by doing what this midwife did is very serious and has the potential to kill the Mama if not picked up and treated early enough, which is very possible in a third world country like Tanzania. The birthing of the placenta should be relatively simple and easy. It does not usually require the intervention that was used today!
I am still trying to work out how to deal with this situation however I am considering printing out some journal articles regarding best practice for placenta delivery and talking about it with Tabatha (the director of nursing).
So, while the delivery of the baby was amazing, the delivery of the placenta was horrifying! However, I now know with 100% confidence that I want to be a midwife and next year I will enroll in the Master of Midwifery starting part-time in 2014 (sorry Steve!).
After work Bellinda and I went into town for lunch and to do some shopping. We tried a different restaurant called Deli Chez or Chez Deli that some of the girls had recommended but the meals took about an hour to come out and they were not very good! Grandad, while shopping I got you a green 'hippy shirt' (you know the style!) with a picture of Africa on it.
Anyway, it is time for bed now. Tomorrow I will be working in Family Planning and Antenatal which I am also looking forward to because they are my other favourite areas to work in. I will give you boys a call some time tomorrow as I am going on safari on Saturday and I probably won't have access to an internet connection again until Wednesday so I won't be able to contact you.
I love you and I hope you are enjoying your holidays <3