I have given birth once today and died due to unkind and neglectful midwifery care. I then assisted a beautiful baby into the world and there were no complications despite it being the mother’s sixth baby. But then I helped a woman give birth who had a massive 1.5 litre postpartum haemorrhage and I struggled to find her urethra to insert an in dwelling catheter, although I did manage to demonstrate a very good bimanual compression of the uterus to stop the bleeding. I couldn’t stop the red fluid from staining Mary’s lovely white pants though and so we ended up in fits of laughter as we tried to mop up the “blood” inconspicuously!
There were quite a few times today where we all ended up laughing, the local midwives too. We had them shimmying to demonstrate how the baby can be rocked down through the pelvis. They loved slow dancing together and trying out different positions, supporting one another. They also really enjoyed feeling the bones in their pelvis and learning what happens to the opening when standing, squatting, lunging. Lots of laughs all round.
It was a great day, full of energy and learning new things. Mary and I have been very impressed with their level of knowledge which they can roll off their tongue, but our aim is to try and get them to translate that knowledge into practise, really understanding the information and applying it to their clinical areas. Another aim is to get the midwives to be able to educate the women in their care, explaining information in simple terms so that the women understand, especially the many illiterate women who come to their hospitals .
Yesterday we spent time going over the importance of antenatal care in reducing poor outcomes for mothers and babies. We had some great discussions about education, clinical assessment and early referral of women who present with problems in pregnancy. We got the midwives to engage in a role play with each other where one was a midwife, one a pregnant woman and the third person either a difficult husband or a controlling mother in law. They really got into their roles! At one point an irate ‘husband’ was pointing a finger at the midwife and telling her off about something in Swahili. The midwife calmly told him the facts about the issue she wanted to discuss and eventually won him over. This was a great exercise in getting the midwives to gain confidence in dealing with difficult relatives who have strong and misguided ideas about things. They loved it and could see the benefit in practising this so that they didn’t get caught up in the argument, but remained calm and focused on objective facts. It was hilarious.
We also had a very serious discussion about caring for women who have lost a baby. It was very moving to hear Mary share about how attitudes to the death of a baby have changed over the years in Australia, where we now acknowledge that it’s important for mothers to be able to hold their dead baby, grieve the loss in a caring environment. Unfortunately death of neonates is very common here in Tanzania, but it was reassuring to hear that they are working towards providing more mother friendly care for grieving mothers.
Where the knowledge of the midwives has been very good, we’ve made them think more laterally about issues and problem-solve more complex situations. I think so far the midwives have enjoyed the course. Every now and then someone will fall asleep, but then we call upon the ice breaker person who gets us all up, dancing and singing! It’s fun. And tiring… But I feel good.