Back in Lac La Biche, I used to do everything possible to avoid having anything to do with labour and delivery. It's not that it's not a throughly interesting area of nursing, it's just that labouring women freak me out! Seriously, they're crazy, they have every right to be so, but they're crazy nonetheless. Every time a lady would come to my desk and pronounce "I think I'm having my baby" a little shiver would run up my spine.
Here in Ngong, nurses do all the deliveries (they are shocked to find out doctors or midwives do deliveries in Canada). Apperently they have also trained the cleaning ladies to deliver babies, just incase the nurse is busy (busy doing what???) Of course they only handle uncomplicated deliveries here, usually only women who have had at least one baby previously. The closest hospital which can handle complicated deliveres and c-sections is Kenyatta National Hospital, about an hour away by car - but there's no ambulance so women must find their own way there, even if it means taking a taxi.
It has been maternity madness here this week - they just keep coming! I delivered my first baby on Wednesday (I did the whole delivery, start to finish, pretty impressive?) I'm not sure how the mother felt about haing the somewhat flustered looking muzungu delivering her baby, but the nurses were pretty excited - by lunch the news was all over the hospital and people were congratulating me on my initiation to midwifery. The whole delivery was a bit chaotic actually, 2 nurses shouting directions at me in English and at the lady in Swahili. I learned two very important Swahili phrases: "PUSH" and "It's a girl!"
Labour seems to be a very different experience here than in Canada. Women in labour here are very stoic, most are silent, many scarcely make a grimace with even the strongest contractions. I have no doubt they are feeling the same pains as women in Canada, it's just that the reaction is so different. There isn't even any pain control available to women here (unless they choose to deliver in a National Hospital, at a much greater cost). The nurses have a very different approach as well - of course I can't be sure as it's all in Swahili, but it sounds like they're just yelling at the women. And they punch them in the knees alot; I'm not sure what that's all about, but it doesn't appear very encouraging or sensitive.
I suppose the whole idea around birth is just completely different. Women usually come with their mother and maybe one other female family member, the husbands are rarely even at the hospital. And when the child is born, the mothers never seem that eager to hold it or anything. Most women are anxious to leave the hospital as soon as possible, they are up and showered and dressed and ready to go before I've even finished weighing and cleaning the baby. They are encouraged to stay 24 hours, but most don't.
Reactions to everything (the birth of the child, the sex of the child, everything) are just never what I expect here. The other day there was a baby born with a pretty serious birth defect. Of course, birth defects also happen in Canada - forming a human being from two cells is a pretty complicated process and there are about a million things that can go wrong. The difference is that in Canada, the defect would likely have been detected by ultrasound, the lady would have delivered in a major hospital and the child taken immediately to surgery. Here it was a complete shock. The child was born and the nurse, with a rather frightened expression on her face, whispered, "what is it?" "I've never seen it before" I whispered back. Then she told me to take the child to the next room so the mother wouldn't see it. I could still hear the calls of "praise Jehovah God" from the woman's family while I whisked the child away. I completed my assessment of the baby and finally the nurse brought the family into the room saying "come and see the way God has made the child". We referred teh baby to Kenyatta hospital, wrapping it up carefully while the family procured a ride - the mother never even saw the defect.
It was all a very surreal experience. As much as I avoided labour and delivery before, I now find it so fascinating, and see it as an area where good health care can really make such a difference. I work so much here in all areas of maternal wellbeing, from prenatal clinic, to well child clinics and immunizations. Women are the so receptive to health care and most are so keen to give their child the best chance they can. I'm finding myself more an more interested in the entire area of women and children's health.
Well, I am off to Mombasa this weekend to soak up the sun... should be a lovely weekend.
Kelsey Aaron
3 comments:
Kelsey,
I am really enjoying reading your blog. I put it under favorites at work. I loved reading about your Ob experiences. It is really interesting to hear about the differences. Women in our culture don't realize how fortunate they are.
I admire you for all you are learning and contributing.
Keep on letting us know how things are going and about your experiences.
Mary S.
Kelsey,
Sherry and I were just talking about you "Maternal Madness" posting and were wondering what birth defect the baby had.
Mary and Sherry
That's great, Kelsey! I recently delivered a baby too-it was the mother's 5th; she came in contracting, with ruptured membranes, and by the time I checked her she was fully. Her whole labour was 65 minutes from start to finish. She told me later that the doctor had made it for only 1 of her children's births-the other four (including this one) were caught by the nurse. Baby girl-healthy and Mom did well.
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