Driving home from the hospital today we (my two midwifery colleagues and I) compared maternity care here and that available at the State tertiary referral hospital in Perth. We all agreed that if women who refuse treatment could see what happens when there is no treatment and found a balance between the two extremes, then perhaps they would have a different view of the service they can access so readily and at no cost in Australia.
We saw orphaned babies in the nursery because their mothers had died, we saw many women with eclampsia (seizures in pregnancy or after birth due to high blood pressure), a woman who was having continuous seizures due to a cerebral vascular accident 20 days after giving birth, 2 babies with Spina bifida, many preterm and small for gestational age babies, sick babies with infections, seizures, birth asphyxia. I saw 2 babies being wheeled out of the nursery because they had died. It really was overwhelming.
In a situation like this it is quite common to feel so overwhelmed that you become stuck in a state of inertia. The images are shocking to all your senses: sight, sound, smell. I’ve found that I need to focus on one thing that I know I can do. So for instance, in the nursery this morning, where the room is kept at 34 degrees centigrade because there is not enough room for incubators, I saw a mother struggling to express breast milk to feed her baby. So, I gathered up the course participants in my group and we proceeded to offer her some education and practical help. Soon other mothers sitting nearby (the room is so small and the mothers are crammed on a wooden bench down the middle) were asking questions and looking at us like sponges wanting to soak up information which may help them as they care for their sick, small and preterm babies. I was delighted to see the students teaching and sharing information with the mothers that they had learned in class. Needless to say they all achieved a pass in their breastfeeding and care for the small for gestational age or preterm baby!
I just want to add here that I have never sweated so much as I did in the neonatal room. There were rivers of water streaming down my face and body. If I had just given birth and was anaemic too, I would have fainted and been lying on the floor…
In the maternity ICU we went through the case histories of the eight women there. One after the other had been referred due to having seizures. A number of them had lost their babies (fresh stillbirths) and most had had very little antenatal care. I remember last time I was in Tanzania, I read the book “Call the Midwife” which gave me great insight into the state of maternal health in postwar Britain. I recall thinking at the time that the issues faced by those English women are what these African (and PNG) women that I have come across, deal with in 2014. Many deaths of mothers and babies can be prevented through quality antenatal care, family planning, birth with a skilled attendant, breastfeeding supposed and infection prevention and control.
The sister in charge of this ward gave us some great education about the cases she deals with on a daily basis: With very little medical support, few resources and hardly any equipment. There are no IV pumps so that the dangerous medications being given can be properly titrated. There is only one ventilator and cardiac monitor between 8 patients. And there are only 2 nurses between 8 acutely sick patients. I tried to encourage her and offer some support. I got the feeling she was moved by what I said.
So, to end this blog post, what shall I say? My senses are overwhelmed. My heart breaks for the suffering of the people. I feel for the staff. But I am also so encouraged by the improvement in the knowledge and skills of the course students. The level of care & kindness is delightful to see and they have told me that they feel more confident in their midwifery practice. They are also inspired to go back to their clinical areas to be good role models for others and provide quality education and support to the mothers in their care.
The pebble has been dropped and the ripples are spreading…one midwife at a time, one mother at a time.