Wednesday 4th April
So, I delivered my first Malawian baby today. It was beautiful, but my gosh it was scary. Here’s why:
So, I think Danni’s kind of explained to you the conditions of the delivery room here. By UK standards, it’s barbaric. No privacy, lying on a plastic bag on a plastic mattress surrounded by insects and very little else. It really is every woman’s nightmare. The midwives do their absolute best and are 1000% professional and they do an amazing job but really – you would NOT want to deliver a baby here.
Mum was a primigravida [i.e. this was her first pregnancy] and she was 17 years old. She was clearly scared and in a lot of pain. Danni did an absolutely sterling job of comforting her, since nobody else seemed to care [Seriously, this girl will never forget the kindness she was shown by Danni this afternoon]. Her contractions were coming in thick and fast, and the midwife determined it was time to push. “Who’s delivering this one then?” she asked. It was my turn so I gowned and gloved up and got ready. The head was delivering slowly but steadily and as it was coming out I could see some umbilical cord. In the heat of the moment I didn’t think much of it, and the midwife was just looking at something else. She turned back 5 seconds later, by which time we could see that the cord was wrapped around the newborn’s neck. Shit. The midwife acted fast and cut the cord whilst it was still basically in the woman’s vagina. I then delivered the shoulders and then rest just kind of plopped out [like it should]. The baby was floppy. I stood back as the midwife tried to get the baby to cry [breathe]. She wasn’t crying [breathing]. What felt like 20 minutes [but was in fact probably 45 seconds], I stood there limp as the midwife initiated neonatal resuscitation procedures given our woefully limited resources. Thankfully, baby eventually started crying. We were out of the woods….or were we?
“Do you want to deliver the placenta?” “I’ll try”. I gave the woman an intramuscular injection of oxytocin [which helps the uterus contract] and then lightly pulled on the umbilical cord [the end still coming out of the woman’s vagina, which is attached to the placenta]. There was some give and then some tension. I [rightly] handed over to the midwife, as I felt out of my depth. Just as I did so, the placenta plopped out like the bag of Jelly that it is. Then the woman started bleeding. PPH, or post-partum haemorrhage is such an important emergency that it was an entire station in my practical obstetrics and gynaecology exam back in Oxford. Behind the woman’s head was a chart on the wall describing how to manage just such an emergency [since my rubbish memory had forgotten most of it]. 1) Rub up contractions – done. Still bleeding. 2) Administer some more oxytocin – done. Still bleeding. 3) Remove clots – done. Still bleeding. 4) Empty bladder – it was empty. Still bleeding. 5) Put up a litre bag of IV fluids – we have no IV fluids. Shit. Back to rubbing up a contraction and looking for tears in the vagina or cervix. The girl lost over a litre of blood before we got it to stop. I’d never been so relieved. Mum and baby are now both fine, thankfully.
In spite of all the scariness, bringing life into the world is a massive privilege. I can’t tell you how much I appreciate the amazing obstetric care we have in the UK. It makes me even angrier that “free birthers” [women who want completely “unmedicalised” pregnancy to the extent that they don’t go for scans and give birth alone or with their partners only] are allowed to do what they do. Women in this part of Malawi don’t have access to scans, or even an obstetrician. Their sad options in labour are often “push” or “die”, especially with the current fuel crisis, meaning ambulances are unable to transport women to bigger centres. When birth is “unmedicalised” only bad things happen. Women and newborns die by the thousands. To any woman I know who will ever get pregnant – please take full advantage of every medical interaction you are lucky enough to have. Women here would.
Hope you’re all enjoying life as much as I am!
Dan
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