Birthing Mothers, the True Heroines of Tanzania!

Today is my last day in Obstetrics.  I will miss working with the midwives and nurses.  It’s done differently here with the majority of the deliveries conducted by the nursing staff.  The only time the doctor gets involved is if a caesarean is recommended. (We’ve been seeing pre-eclampsia and pregnancy induced hypertension as big causes for c-section.)  Otherwise, the women labor on without the obstetrician’s presence.  I think it’s similar practice in Australia and Britain where the midwives take on a huge role in routine deliveries, at least that is what my fellow Australian and British students are telling me.  And at the public hospital of Mt. Meru Regional, the mothers come down from the overcrowded antenatal ward when they are 4-5cm dilated.  They find an empty bed in the delivery room, which is rather small, just 10 beds all in one room and no divider between the beds.  Modesty is completely out the window.  There are no epidurals or pain control.  The woman bring there own birthing blankets (congas) to lay upon while in bed as well as to use as swaddling clothes.  They bring their own canister of something to eat/drink while there.  They even bring their own suture material in case they tear during the delivery.  There are no electronic fetal heart monitors, just the old school fetal scope funnels to check for heart tones now and again.  The staff is supposed to check fetal heart rates every 30 min, every 15 min when the baby is getting close, but that rarely happens, especially when it gets busy, 3 or 4 births all happening simultaneously.  In the states, my obstetrics month was somewhat weak.  I never got to catch a baby b/c the patients build up a good report with their doctor; it was never my place to conduct the delivery.  After being here, I have done several and have really enjoyed the hands-on learning experience.  It has been quite scary at times since these mothers get very little prenatal care before they deliver.  I never know what’s going to pop out.  I don’t think they do quad screens here; maternal healthcare can be quite expensive apparently, and I’m not sure even how many mothers get their ultrasounds done.  The delivery room could very well be the first time these patients are being seen for their pregnancy. We have had several neonates born this week where resuscitative measures were utilized.  The extent of resuscitation that I’ve seen is suction and oxygen.   They don’t utilize CPR, and any medications that might be used are quite scarce.  And intubation?  What is that! I haven't seen any vents here.  We did have a fetal demise.  The hospital just does not have the resources to live up to the standards we in America have come accustom to.  There isn’t really a NICU, at least not what we would call a NICU back home, therefore the babes either make it or they die.  I have noticed too, that the neonates don’t get screenings.  We do no heel sticks to check bili levels and other blood/electrolyte abnormalities.  We give no Vit K; no erythromycin eye drops, no Hep B vaccine before departure from the hospital.  6 hrs later, if the mother and neonate are doing well, they are sent off.  I’m not sure of pediatric follow-up.  To an up and coming pediatrician, the care these children get is quite unacceptable! 

As soon as the baby is born, we are cleaning up mom, asking her to stand up, get dressed, and get out, since we must make room for the next mom.  The mother quickly departs from L &  D to the postnatal ward (where there is easily 3 or 4 to a bed) where the moms are monitored for 6hrs post delivery to ensure no post-partum hemorrhage or other obvious problems.  Then they are discharged home.  It’s incredible how these women are treated like the laboring process is no big deal.  If they scream too loudly in their pains, the nurses yell at them to be quiet.   They aren’t allowed visitors while they are laboring.  At least in this public hospital, the father is not permitted at the bedside.  The women labor in pain, completely alone.  It’s incredible, and that is why I have called them the heroines of Tanzania.  All mothers are heroines but the pain these women have to endure here is unfathomable to us Westerners.  Today, since we were out of lidocaine, I even watched a vaginal tear get sewn up without any local anesthesia whatsoever.  Yep, they are my heroines, handling the whole ordeal very courageously.