Last week we all headed back to Kampala to spend some time on the high risk ward. This is the place Jan and I described in one of our first e-mails where women are labouring on mats in the corridors because there is not enough room to accomate them in the labour and deliver ward. This is also the ward where a woman dies every other day. We were blessed not to have any losses of mamas while we were there for a couple of days. There were unfortunately stillbirths. It seems these are much more common than we see at home. Every week, there are a few women with stillbirths we either care for or hear about. Definitely a sad reality here.
The first day on the ward, the hallways were lined with women labouring on mats on the floor just as was the case when we visited the ward the first week. We got there in time to partake in morning rounds, where residents and obstetricians come to review how every woman on the ward is doing. It was impressive to see how many women they actually assess.
As the beds were full in labour and delivery, there was a woman who had to give up her bed during the rounds assessments and she was relegated to the floor where she lay on her plastic sheet until the rounds were finshed (about an hour later). During this time her (meconium stained) waters broke all ofer thr floor, which she was lying in. But here, where there is so much going on, getting her out of her the puddle isn't a priority, so she waited until the assessments were done to have a bed back, where she delivered her baby shortly thereafter.
Not too long after wrapping up with this birth, I heard a cry in the hallway, so I went to see where it was coming from. It was a young woman who I learned was 17 years old and having her first baby. I wanted to examine her to see how close she was, but when I gently approached her with my gloves on, she adamantly refused-- kicking her legs, pushing me away with her arms--and the look of terror in her eyes was heartbreaking. I learned from one of the local midwives who walked by, that she cannot hear or speak (due to a bout of malaria at age 3 that impacted her hearing and speech). How sad! Her mom was with her as her attendant and she tried to calm her so that I could check her but to no avail. The midwife who walked past told me that this young woman reacted similarly with other midwives and suggested I just leave her. My sense though was that she was petrified--she can't hear or communicate, this was her first labour expereince and on top of that, I suspect she has a history of sexual abuse.
Despite the recommendation of the midwife, I decided to stay with her. I felt that more than anyone there she would benefit most from continuous support. I used touch and facial expressions to try to comfort her and to let her know she would be fine. I touched her forehead a lot and smiled. It was amazing how quickly she calmed down and tuned into her body's cues. As I waited and watched through a few contractions, I knew her baby was near as I could see wisps of her baby's hair in the perineum with her contractions. Her mom had left by now and so it was just her and I for quite some time--well amidst the hallway of labouring women-- but on her mat it was just her and I. Once she calmed down she also really tuned into her body's cues. Early on when pushing she decided to squat, and, as her baby's head came down she moved herself into a semi-sitting position where she propped herself up on her elbows and watched her baby's head emerged slowly, slowly with every push. It was amazing to watch her expressions--ones of amazement, intensity and joy. It was also incredible to be reminded that when given the space, women intuitively know how to birth their babies. I had no words to offer her. All I really did was create a safe space for her to birth her baby.
Eventually the baby's head was born, and at that moment I looked at her, and she threw her head back and smiled. Not long after, the rest of her baby was born into my hands and I placed her on her mom's chest. She was so elated. I was so touched, I wanted to cry. As I was delivering her placenta, I noticed her hand on my knee and her smiling at me. I think this was her way of saying thank you. I wish I could have somehow conveyed to her how incredibly privilged I felt to have wintessed her strength and the beaufitul birth of her daughter.
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UBC Students for Global Citizenship
The Midwifery Education Program at the University of British Columbia (UBC) has created a global midwifery placement option for students. This year, two midwifery faculty members and a family physician will accompany the students for part of their practicum and then local midwives, nurses and physicians will continue supervision.
For the past 4 years, UBC Midwifery students have participated in this 6 - 8 week global placement at the end of the 3rd year of their midwifery education. This year Midwifery is pleased to have colleagues from Medicine and Nursing join us.
In these placements students attend births and experience the ways that health care workers deal with normal and difficult births in a low-resource setting. These skills are especially relevant to student accouchers as they prepare to respond to the critical shortage of skilled maternity providers in rural and remote areas of British Columbia. In exchange, students and faculty share ways of practice taught at UBC with the global midwifery community.
Students return energized by their global experience and have a deeper understanding about women’s health issues, women’s rights and birthing practices, and with new friendships across borders.
Uganda. Maternal mortality is high in rural Uganda. Over 510 per 100,000 women die in childbirth. There are few trained attendants to assist women in childbirth, and transportation problems as well as social customs prevent many women from attending health centres and hospitals for deliveries. Those who attend hospitals for delivery often have risk factors and complications rarely seen in Canadian maternity practice.
Students and faculty take donations of gloves, delivery instruments, medication to prevent and treat hemorrhage, and academic articles and books on continuing education topics. Midwifery faculty work in collaboration with local staff to present continuing education topics on maternity subjects requested by the local nurse-midwife managers and medical directors. This year we raised funds to buy supplies for maternity wards and to bring a Ugandan Midwife to B.C. for an educational visit this past April.
For the past 4 years, UBC Midwifery students have participated in this 6 - 8 week global placement at the end of the 3rd year of their midwifery education. This year Midwifery is pleased to have colleagues from Medicine and Nursing join us.
In these placements students attend births and experience the ways that health care workers deal with normal and difficult births in a low-resource setting. These skills are especially relevant to student accouchers as they prepare to respond to the critical shortage of skilled maternity providers in rural and remote areas of British Columbia. In exchange, students and faculty share ways of practice taught at UBC with the global midwifery community.
Students return energized by their global experience and have a deeper understanding about women’s health issues, women’s rights and birthing practices, and with new friendships across borders.
Uganda. Maternal mortality is high in rural Uganda. Over 510 per 100,000 women die in childbirth. There are few trained attendants to assist women in childbirth, and transportation problems as well as social customs prevent many women from attending health centres and hospitals for deliveries. Those who attend hospitals for delivery often have risk factors and complications rarely seen in Canadian maternity practice.
Students and faculty take donations of gloves, delivery instruments, medication to prevent and treat hemorrhage, and academic articles and books on continuing education topics. Midwifery faculty work in collaboration with local staff to present continuing education topics on maternity subjects requested by the local nurse-midwife managers and medical directors. This year we raised funds to buy supplies for maternity wards and to bring a Ugandan Midwife to B.C. for an educational visit this past April.
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