Our first few births were a harsh introduction to birth in Senegal and made us realize why we were there. We saw women very roughly handled, slapped, yelled at, gagged and held down. We saw unnecessary, painful and risky interventions, incorrect diagnoses and general mismanagement of births. Senegal is really ahead of the rest of Africa in a lot of ways but so much of their care still lacking.
The first labor I took part in was attended on a hot day in a small, dirty one-windowed room. When we arrived it seemed as though things were going at a normal pace. It was the woman's 3rd baby, she was already dilated to a 7 and finished dilating within an hour which seemed very normal to us but we were only there to observe and the Senegalese attendants were concerned about her progress and about the baby's size. I admit, her belly was huge but with these ladies...it's hard to say how much of it is actually baby because their high carb diets produce rivers and lakes of amniotic fluid. That sounds like an exaggeration, but trust me it's not. These women's water would break and leave us nearly ankle deep in fluid. It's like that.
Either way, the attendants weren't satisfied with the progress and started a pitocin IV drip to speed things up but not once did they checked the baby's heart tones so we started checking. Pitocin can stress babies out and make their heartrate drop dangerously low. Soon after the IV was started we noticed that she was having really long contractions and pretty soon, contractions that didn't stop at all. On top of that the midwives started pushing on the top of her uterus with all their body weight (fundal pressure is the technical term) to try to help but really, it was only adding insult to injury. We couldn't find the baby's heart rate at all which could have been because the contractions were so hard but we were starting to get worried now as well and they decided to transfer her to the clinic in Tivouan.
They got an ambulance there and we piled in the back with the woman and a few of her family members and went toTivouan. Her contractions didn't stop for the entire 30 minute ride. The ambulance didn't provide oxygen (which would have helped the baby) because they said the woman was fine but Jane Ann (the supervisor) and I had a feeling the baby wasn't doing well. Once we got to the health center I wasn't sure why we had come. They didn't have C-section capabilities let alone an OB. Once we got her into the delivery room we tried listening for the baby and didn't find anything. The baby had died in the ambulance but the midwives there still seemed unconvinced and after another hour we transferred again, this time to a hospital for a C-section. When we arrived there they also listened for the baby and heard the uterine artery and since the mother's pulse had risen to 120, they mistook it for the baby. Jane Ann took the mother's pulse while they were listening with the fetal monitor and the heart rates were the same. Still, they didn't realize the baby was dead until it was born by cesarean 4 hours later.
Senegal has high infant and maternal mortality rates so death is very much a part of their lives and they are very stoic about these losses but you still can't minimize it which was why we were there: to share information and practices that could reduce these rates but it was complicated.
The first labor I took part in was attended on a hot day in a small, dirty one-windowed room. When we arrived it seemed as though things were going at a normal pace. It was the woman's 3rd baby, she was already dilated to a 7 and finished dilating within an hour which seemed very normal to us but we were only there to observe and the Senegalese attendants were concerned about her progress and about the baby's size. I admit, her belly was huge but with these ladies...it's hard to say how much of it is actually baby because their high carb diets produce rivers and lakes of amniotic fluid. That sounds like an exaggeration, but trust me it's not. These women's water would break and leave us nearly ankle deep in fluid. It's like that.
Either way, the attendants weren't satisfied with the progress and started a pitocin IV drip to speed things up but not once did they checked the baby's heart tones so we started checking. Pitocin can stress babies out and make their heartrate drop dangerously low. Soon after the IV was started we noticed that she was having really long contractions and pretty soon, contractions that didn't stop at all. On top of that the midwives started pushing on the top of her uterus with all their body weight (fundal pressure is the technical term) to try to help but really, it was only adding insult to injury. We couldn't find the baby's heart rate at all which could have been because the contractions were so hard but we were starting to get worried now as well and they decided to transfer her to the clinic in Tivouan.
They got an ambulance there and we piled in the back with the woman and a few of her family members and went toTivouan. Her contractions didn't stop for the entire 30 minute ride. The ambulance didn't provide oxygen (which would have helped the baby) because they said the woman was fine but Jane Ann (the supervisor) and I had a feeling the baby wasn't doing well. Once we got to the health center I wasn't sure why we had come. They didn't have C-section capabilities let alone an OB. Once we got her into the delivery room we tried listening for the baby and didn't find anything. The baby had died in the ambulance but the midwives there still seemed unconvinced and after another hour we transferred again, this time to a hospital for a C-section. When we arrived there they also listened for the baby and heard the uterine artery and since the mother's pulse had risen to 120, they mistook it for the baby. Jane Ann took the mother's pulse while they were listening with the fetal monitor and the heart rates were the same. Still, they didn't realize the baby was dead until it was born by cesarean 4 hours later.
Senegal has high infant and maternal mortality rates so death is very much a part of their lives and they are very stoic about these losses but you still can't minimize it which was why we were there: to share information and practices that could reduce these rates but it was complicated.
I'm so glad you're blogging all of this. Fascinating/sobering. So glad you're over there. Hope you're able to make some serious headway.
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