To Make a Difference Between Life and Death

I should not have had the chocolate milk yesterday. Too optimistic was I. Paid for it last night with terrible gripe. My gut is obviously traumatised from that awful bug and will take a bit longer to recover. Be patient Sara.

Be patient Sara. That’s me, always pushing forward, wanting to get stuff done, frustrated when I don’t feel fully well and able! Take a deep breath and reflect on Yamen and what you learned there…

Well, one of the big things we noticed was that everyone walked really slowly whereas we were racing everywhere. It took great self-control and effort to just slow down and amble along with everyone else. Life was simple in the village. Time stood still. It was quite funny because there was a man who beat a drum to let people know what time it was. His name was Raphael and he is the pastor at the village of Kambuku (along the Black Keram on the way back to Angoram). He is this beautiful round man with a huge smile. Anyway, a few times he fell asleep and so wasn’t around to beat the drum for everyone to know what was happening. I’d look across to the haus behind us and see him curled up on the matting floor fast asleep. A few times the church leaders would give the people a stern talking to about being at places on time – for food, church worship, leadership training and the maternal and child health sessions. They were trying to run a conference and make sure everyone got the best out of the event, but it really was an uphill battle getting people there on time.

I used to wait about 10 minutes and then make a start. It was quite nice because the only pressure was what I put on myself. They were relaxed, so I could be too, but making sure the information I gave them was thorough and meeting their needs.

On the Monday afternoon, after hearing all the stories from the women, I decided to dedicate the entire time to the uterus (haus belong bel). I really wanted them to understand what the uterus is, what it is made of, how it works and also how sensitive it is. I was so thankful for all my work in looking at the uterus in regards to Vaginal Birth After Caesareans and the risk of uterine rupture. Through that research I really feel I gained understanding about the mechanics of how the uterus works and the incredible power it has.

I used my knitted uterus, doll and pelvis for demonstration purposes and a 2D drawing of a uterus on the blackboard. I really wanted them to come to the conclusion that it was not a good idea for women to lie flat on their backs during labour and that it was also not necessary for women to push on the abdomen to help the baby out throughout the labour! It was an amazing session because I really felt their full attention and that they really ’got it’. Seeing what the uterus looks like, that it is a strong muscle that works all by itself without our help was a new concept for them. They also really got the idea that through movement, position changes, being upright, slow dancing or swinging the hips, the baby can be wriggled into a better position for birth which can make it a shorter labour and easier birth, rather than pushing on the uterus. They loved it when I jiggled my hips around with the pelvis model in front of my body and then showed how the baby doll jiggled too, finding a better position which will fit through the pelvis.

I talked about how important it is to be gentle with the uterus because if it is overstimulated then there is the risk of uterine rupture or that the uterus just doesn’t want to ‘harden up’ after birth because it is exhausted, both leading to excessive bleeding and the death of the mother. There were knowing nods around the room. I talked about safe delivery of the placenta (belum) too, using the doll with attached cord (rop) and placenta. Between Lyn and I we role modelled different birth positions and then showed them how a woman could then recline in a comfortable position for delivery of the placenta. There we were, dripping in sweat, kneeling on the dirt floor of the church, acting out giving birth – I kept thinking, thank goodness I won’t bump into these people on the street in Australia. There was a sense of freedom to knowing that. All our inhibitions were lost and we could just demonstrate it as it is!! Liberating.

In regards to the placenta I really wanted them to understand that it is not right to pull hard on the cord, and also for them to learn the signs of separation (when the placenta falls away from the uterus there are 2 signs: a trickle of blood and lengthening of the cord because the placenta has dropped closer to the cervix/opening of the womb. The woman may also have another urge to push). The other issue is, when do they need to transfer to a health centre because of a retained placenta? In Australia, immediately after a baby is born, the mother is given an injection of a drug to speed up the separation of the placenta from the uterus and hence the delivery of the placenta. It usually happens within 10 minutes of birth. In a physiological 3^rd stage (where no drugs are given) the placenta can sometimes take up to an hr to deliver. ‘What do I tell these women?’, I was thinking.  I then told them what should happen and if by 1 hr nothing had happened or the woman was bleeding heavily, they needed to call for help ie. Get someone to let the men know to prepare a boat for transferring the woman to a health centre. I also demonstrated to them what to do if a woman was bleeding heavily, how to assess the uterus through the abdomen and how to ‘rub the uterus up’ to help it harden up.

I hope they understood it all. From the general feeling and energy in the room, I think they did. I now hope it is translated into action and helps to make a difference between life and death.

Some of the resources and charts that I used during the sessions which were fantastic. I then gave them to Vivienne who is a Village Birth Attendant in her village and she will use them to help teach the mothers and other VBAs. I did find it hard to let my resources go…