CONFLICTS AND ISSUES

Could a seemingly right decision that turns out wrong, be thus called a wrong decision ?

Or a wrong decision, for turning out right, is therefore right ?

This is where I am this week. Let me explain....

The woman was in labour with a twin pregnancy. Not large babies, no over extended uterus. It was her forth pregnancy .First child born by c/section, no details but didnt survive the neonatal period..probably severe birthing problems .Second and third born normally and still living. Her labour was abnormally violent ..probably as a result of herbal potions that can be bought or obtained just outside the gate of the hospital. These very often cause too many contractions and much too strong right from the begining of labour thus leading to fetal distress and unnecessary pain and suffering for the woman.But African ways and tribal powers are stong and the women are easily influenced. I/we made the decision to try for a vaginal birth rather then going for an immediate c/section. Surgery of any kind carries a very high risk here in Malawi and should be avoided as much as possible.It is often difficult to make the decision between the fetal well being and the mothers health. A live baby has limited posibilities with a dead mother. The babies were born quickly, both small but lively, active and healthy. 1.500kg and 1.800kg. All was going well untill she started bleeding.
At Bwaila there is no sense of urgency. Nothing moves quickly so whilst all was set in motion to attend this urgent situation, time passed. When a woman is bleeding after birth there is little time. It was one delay after another. With only one operating theatre the c/section in progress had to be completed, theatre cleaned and prepared. No blood in the blood bank meant sending to the nearest hospital 4kms. away through traffic and unfortunately staff lunch hour. Lack of materials plus nothing is ever where you think it should be, resulted in a difficult situation, becoming a live and death situation. Pirilani is still alive. Her bleeding uterus was removed and apart from a fever post operatively, important anaemia, despite the blood transfusion, she is on her way to recovery. The twins are OK for now. Having spent the first night in the nursery with little care and just a little glucose to drink I went to collect them the 2nd day and was thrilled to see how they excitedly latched on to her breasts. Since then I have tried to advise her on how to suplement her diminished milk supply bringing them myself formula milk powderfrom home. I only hope they will follow my instructions and boil the water first, give the right strength and continue with the so very important breast feeding. I worry that I may be causing more problems than I am solving. But without supplements they will surely die.
So maybe now you understand ? Are these decisions good ones ? Or will it only depend on the outcome ?

Work had been steady all day Wednesday untill 4pm. I suddenly found myself assisting births on the floor practically under the beds.I am still not sure where they all came from but when someone shouts "baby coming" whoever is available grabs a few materials and runs. By that time of day materials have not been replenishing for night staff, meaning that there is normally hardly anything available. So with 2 pieces of thread and a razor blade not forgetting a handful of gloves I do what I know best what comes automatically..I catch babies. With a smile, with a squeeze of the hand with gushing words of praise, for this woman has laboured alone, in pain and often frightened she has done what all women instinctively know how to do but should never do alone. She has successfully brought another small child into this world. Much to the amazement of my Malawian colleagues who all came to stare I then proceeded to suture a small perineal tear kneeling down on the floor. My time at Acuario and my home birth experience had trained me perfectly for this, it certainly wasnt the first time for me!! I went home late and exhausted. Its great to find Luki there when I get back it just somehow puts things right and normal again.

Entering labour ward at 7.15am on Thursday morning I found every bed full.
In that first hour I assisted 5 births. One with birth asphyxia, two post partum hemmorrages,one shoulder distocia..shoulders got stuck.. twin breeches and prepared a woman for a much needed c/section. Where was everyone else.The night nurses were going off duty and the day nurses had not yet arrived or were chatting and exchanging news. The cries and pleas of the delivering women were completely ignored or not heard nd I was left to catch babies again. Just time to change gloves but little else, thank heavens for Janet, a dutch midwife, who called in on her way to nursery and delivered placentas for me and helped out with the emergencies. Most of the problems encountered at this time of the morning...and there are many ..is directly due to lack of care and attention during the night, in short, to negligence. That day I finished at 13.30 and took the afternoon off. I really couldn't do any more, I ached and I was tired and not a little disheartened.

The teaching plans are moving forward.I shall have 4 groups of 7 midwives in each group.I will repeat the same workshop over 2 weeks. Tuesdays and Thursdays for 2 hour sessions.
It wont be easy and I shall have to adapt so much of my material for we are not starting from the same baseline with the same feelings or objectives. They will be informal sessions with lots of group participation and lots of feed back. I have a lot to learn and much to share .I am confident I will find a way forward to reach these midwives and something really positive will come from our time together. This will be an ongoing thing which will hopefully last during my entire stay. Other teachers could also be involved. I am hoping it will become such a regular occurence that the midwives will see it as an important part of their working life. A time when midwives can share experiences, discuss cases and practices and complain all they like. Oh how I wish midwives would complain! How I wish women would complain!