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What my work experience in Ghana taught me about giving birth

In December 2011 I spent 4 weeks working in Ghana. My first 2 weeks were spent on a labour and birth ward in a large regional hospital (approx 750 beds), the next week was in the ‘NICU’, and the last week was in a rural village working in the only medical clinic available

On the labour and birth ward women laboured 5 to a room, with little to no privacy. They had to bring all their own stuff - strips of material and plastic to lie on, a bucket to urinate in, pads and soap. They were told to lie on their left side and be quiet. No husbands or family members were allowed. Messages were passed to anxious husbands who waited down the corridor.

The 'nurses station'. Family members had to wait on the other side of that yellow partition, to the immedate left was a the 'birth room' and to the left past the desk was the labour room (with 5 beds and no curtains)

There was no air conditioning. Temperatures ranged from 35 – 42oC, humidity hovered around 85%. There was running water and instruments were sterilised in a back room. Money often exchanged hands between the matron and waiting family members, but for what, I was never really sure.

Occasionally there was a woman who would start making too much noise or crying. But with a stern word from the matron she would stop.

The room was often full which means I saw about 30 – 40 women labour in 2 weeks. Epidurals weren’t available. A few women got an injection of morphine (maybe this is what the money was for). Maybe about 5 went to have a caesarean (under general anaethetic).

The labour room showing 2 of the 5 beds

Labours were sometimes augmented with Syntocinon (synthetic oxytocin), but it was put through a free flowing drip, not measured by a pump. I once tried to ask a nurse what the dose was. She said that 10IU was put into a bag of fluid (although sometimes this bag was already half empty) and then started at 20 drops/min. When I asked what dose that was – there is a formula to work out how many drops makes 1ml and then you can work out how many millilitres you are giving according to how many drops/min – but she didn’t know this, so she couldn’t tell me. They just estimated it.

The women have to bring their own sheets - material and plastic

When it was time for the baby to come out they were moved to the 'delivery' room (the room just next door). I didn't see any women push for longer than 15 minutes. None of them died and none of their babies died or even needed to be resuscitated (we occasionally came in the next day to hear about a stillbirth from overnight). None need forceps or a vacuum to birth the baby. None of the women bled excessively, although injections of Syntocinon were given routinely. I went through their birth register thoroughly and worked out they had an approx 15-20% caesarean rate. They had about a 5-10% stillbirth rate, but with limited monitoring it was hard to tell which babies had died before labour or during (there was 1 doppler but it wasn’t used very ofen).

The only piece of monitoring equipment, but it was rarely used

The purpose of me telling you about this is that sometimes perspective can really make us re-evaluate our opinion on the subject. Just because we have access to epidurals, and monitoring, and the ability to induce labour or do elective caesareans doesn’t mean we SHOULD be doing it! Sometimes it is best to just leave things alone! In no way I am saying that if there is a problem that nothing should be done, but sometimes we create problems where is there actually isn’t one. Its something to think about, isn't it....

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