I’m 7 months pregnant and one of my biggest problems right now is, where and how shall I give birth? Tough decision, right?! I saw my midwife today and I’ve been offered antenatal classes, 3 choices of where I can give birth, as well as tours of said birthing centres and hospitals. And just to prove how privileged I am, I’ll be starting Hypno-birthing classes soon – just to keep me mindful during labour!
I wanted to listen to the Radio 4 Woman’s Hour: Childbirth Special (12 August 2013) before I brought this article to you, because I wanted to get a better picture of how women feel about childbirth in the UK. The picture painted was, I’m sorry to say ladies, dire.
Don’t get me wrong we’re all still heroes, no matter where in the world we give birth but it’s our attitude that seems a little awry to me. Many mothers report feeling disappointed when they didn’t get to follow their birth plan to the letter. One mother says she felt “cheated” because she didn’t get the drug-free water birth that she planned for. Some women feel that they have had their rights denied if they have to have an emergency C-section. I have to wonder, have we all lost our minds? The fact that we can give birth in modern NHS hospitals filled with equipment, supplies and staff should surely leave us feeling grateful and privileged, no?
I have to stop myself there, and remember that most women in the world do not have a choice of where and how they will give birth. So, whilst I consider whether to give birth with views of wild deer in the New Forest, I wanted to paint a picture for you of what an average woman in Tanzania, in East Africa, is facing as they approach childbirth. What better way to do that than to speak to newly qualified nurse, Jessica Morgan, who spent part of her degree placement helping to deliver babies in Tanzania:
How did you end up in Tanzania?
I went to Tanzania on my elective placement as part of my nurse training. I chose to go to Arusha as the Government Hospital there is a typical example of the healthcare available to most of the country and so would give me a genuine experience of what the Tanzanian healthcare system is like, a stark comparison to the NHS.
Was your focus solely on maternal health?
I was studying adult nursing and so experienced a range of adult healthcare settings whilst on placement. I soon found the maternity unit to be the most welcoming and interesting and so spent the latter few weeks there.
What was the facility like where the women came to give birth?
It’s hard to truly put across how appalling the facilities were and yet how well the nursing staff managed, providing the best possible care in the circumstances. The ward and labour rooms themselves were situated in a long corridor on the ground floor. Women in labour would share an old rusty bed on a sheet that was changed once a day (if there was even a sheet on the bed). When the baby was just crowning, the mother was expected to walk herself down the corridor to one of the small labour rooms where another rusty bed with no sheet would await her. Once the baby had been delivered he or she was wrapped in a ‘kanga’, which is a patterned piece of traditional African dress. The pattern should match the kanga the mother was wearing so that the staff could identify which baby belonged to which mother!!
What was the atmosphere like, were the mothers excited?
The atmosphere in the unit varied; the staff were very joyful and friendly, the mothers were mostly in a great deal of pain with no form of analgesia and so, whilst in labour the mothers mainly kept to themselves. Many were trying hard to disguise the pain as is expected of them within the culture of their tribe. I do not remember seeing a mother appear excited, at least not until after she had given birth. Once the mothers had given birth they were often very happy, however on a number of occasions the mothers would appear sad and sometimes even flee the hospital without the baby! It was rare that a father was nearby, if he was there would be many more smiles and much more joy from the mother, clearly a sign of a happy, loving family.
What medical staff and materials were available?
Supplies were limited to say the least. Each mother was given a metal kidney dish on arrival which contained a clamp, a pair of scissors, a suture and a single glass vial of analgesia. It was the mother’s responsibility to look after this and bring it to the labour room with her. After each birth the reusable items were cleaned with water then sterilised in an autoclave in a sluice-style room. There was no such thing as ‘clinical waste’ it all went into a big bin, even the placentas… There was one ‘wheelchair’ – a plastic garden chair tied to wheels – for labours that were difficult or required a cesarian section. The mother would be wheeled in this chair to theatre in another part of the hospital. The only item that the unit appeared to have a stock of was latex gloves!
Did you encounter many difficult deliveries?
I did see a few difficult deliveries however most of these ladies were quickly wheeled away to theatre. The nurses were very experienced and dealt well with difficulties such as when a baby was born breech (presenting bottom first) or if the umbilical cord had become tangled. The worst experience was witnessing a premature still birth. A memory I do not like to revisit.
If you don’t mind, can you tell me about any infant or maternal mortality while you were there?
Unfortunately I did witness a number of full term still births. I would estimate that there was one every other day or so. I did not experience any deaths of babies post birth, this may have been as they did not stay on the unit for very long. I do not know of the infant mortality rates in Arusha but I can image that they will be high.
Do all women in Tanzania give birth in facilities like this Government Hospital?
No, there are some private hospitals for those who can afford it and there are also rural clinics for those who cannot reach a hospital. This Government Hospital was midrange, the type of facility that most Tanzanians would experience.
Did all the women in your community come to this facility or did some give birth at home?
I’m afraid I don’t know the answer to this except that those in rural areas would either go to a rural clinic if there is one nearby, otherwise I imagine they would give birth at home.
What other issues of reproductive health did you encounter; HIV, other disease, birth defects, education etc?
There was a shocking lack of education, which I thought I was prepared for however it’s not until you visit this kind of place that you can really appreciate how little the people know of contraception and HIV etc. HIV was not openly discussed. If any patient wanted to be tested for HIV they would have to specifically ask and often pay. I asked the staff why this was, not just for the patient but also for the protection of the staff and the answer was simply… funds!! I did spend a day in the post-natal clinic where contraception and family planning advice was given. Here condoms were provided to the women who would accept them.
So, to all the future mothers and fathers, whether you are giving birth in the UK or any other country, please consider the options laid out before you and decide just how privileged you are.
written by Jesamine Somerville