I'M TIRED, MY LEGS ACHE, MY HEART ACHES

I have spent most of the past 4 days in Bwaila hospital on the labour ward. Starting at 7.15 in the morning and continuing until 5 or 6 o'clock in the evening almost without a break. Drinking fruit juice to keep going and wondering how to slow down.

So many women to attend, so few of us to care for them. I want... I need... to give them of my best but how can I give more? How can I give what is needed? It is every one of those women´s right to be given the very best of care but we just can't physically do it. How can I divide myself into so many parts? How can I attend them all? I have no answer. I am trying to learn what to do, how to cope, what are my priorities? If I give more to one, if I give the right amount to one, then others will have little or nothing. So what will it be? A little here and a little there just the minimum so as to keep them safe and healthy... if I am lucky or if they are lucky.

There is an overwhelming amount of work, more than when I was here 14 months ago and such a huge lack of midwives, of trained and particularly, experienced staff.

Most days I will attend 5 or 6 births as well as helping out other midwives and students. They are not easy. Many complications such as prem babies, unhealthy mothers, difficult labour, too long or often too short. Born in the parking area, in the ambulance bringing them from the villages. They are already high risk pregnancies, already problematic. I have often been called to receive babies in theatre who have been born by cesarean section. That has been particularly traumatic for me as most women arrive in the operating room very late when all else has failed. This generally means that the baby will be born in poor condition and needing resuscitation. This is the job of the midwife. The delay in getting them born, for all sorts of reasons (only one theatre, the aneathetist may not be on site, the already overworked doctors are not available) means many of these babies will need to be very stong and determined if they are to pull through. I have been amazed at their strength, their will to live and have also been saddened when despite all efforts it just doesn't work.

At the end of my first shift on Monday a young mother was wheeled into the labour room. Very few arrive in this way, most will walk in even if " pushing." There was blood running down here legs and onto the floor. I took her to an empty bed so she could lie down. Wrapped up in coloured cloths held in her lap was a timy prem baby. The cord was still not cut, the placenta was still inside and she was bleeding. I ran to find a delivery pack (which if you are lucky consists of 2 clamps and some rusty scissors... though more often than not there are no scissors) and called to a colleague to attend the mother whilst I took the baby. I could see that it was not more than 28 or 30 weeks gestation. I cut the cord and rushed to the resusitating cot. There was no heart beat no signs of breathing. When had this baby been born? How long had it been in this state? I had no idea... so I gave it a go. Cardiac massage, inflating its little lungs with oxygen, drying it off and warming it up. It started to give a few gasps, little by little showing signs of breathing so I carried on. How long for? Could it really make it? I had no idea. One of the Malawi midwives came to see. She said it was a fighter, that it would make it! I couldn't believe it. I took the little one to the nursery and went back to labour ward to care for the mum and tell her that the little one was waiting for her. Does it really have a chance? It still has a long way to go. And back to what? Two days later I called in to the nursery. Yes it was a fighter and is doing ok... not well just ok. The baby has no name but his mum Soflet gave me hug and we said we would keep in touch.

It is early days still. I have some good stories and some bad ones. But SO REAL, JUST SO REAL.

This is life at its most basic. They say that the moment of birth is a moment that hovers between life and death but never so much as here in Bwaila hospital... in Malawi.