Well maybe not never, but six months is really not much in terms of getting used to African midwifery, even though Africa is not new to me. Yesterday was just another routine day in antenatal clinic in most respects, but a few things always remind me that this is Africa.
First thing in the morning we all had a good laugh about at shift handover - one of the midwives handed over that one of the woman had a baby boy in the night, to which one of the other midwives said 'are you sure its a boy - its this baby on my lap' and there he was kitted out in bright pink top, bottoms and matching bright pink hat. So we looked and confirmed that he was in fact a boy, probably now with a complex as we all discussed his clothing. That made us all smile, obviously there is kind of unwritten rule here about pink being a girls colour just like elsewhere in the world, I wouldn't have been sure otherwise if they hadn't have said about it!
One of the ladies I saw came into the unit for her second antenatal check - her notes said she was 28 weeks pregnant. I couldn't quite match her size with this information and was unable to find a fetal heart beat. Another midwife came and checked and couldn't find it either. The lady said the baby had not been moving yesterday - so we had a fair number of warning signs that all was not well. We are blessed to have an Obstetrician here at the moment so she took her for a scan wondering if the baby had died- only to discover - she wasn't pregnant (and hadn't been)!! I confirmed this by pregnancy test, just in case we were missing something somewhere but it was negative, so we had to explain to her that there was actually no baby. Quite a bizzarre finding, especially as it wasn't even her first check up!!
Two of us couldn't find a fetal heart beat on another lady, but had she assured us that the baby had been moving about (usually a good sign of the baby being fine). Our Obstetrician did a scan and sadly confirmed that the baby had died and any movement felt was probably related to there being a lot of fluid swishing about. What I can't get used to is that there is no privacy here, there is just not the space for single rooms or anything. We called this lady's family to come and support her, they sat outside with a bunch of other pregnant women waiting for their checks. Later we admitted the lady to the ward to start an induction of labour, and she was just sat on the bed, looking completely shocked, while next to her other Mums were looking after their beautiful babies. I can't really get used to the different way women show emotion here, how there is the expectation that they have to be strong and quiet when things go wrong. Not that I really want them wailing around the unit, given its small size, but it still suprises me that they are not.
One thing that is very different here to in the Uk is that women don't always come the day you ask them to for their antenatal checks. Sometimes maybe for good reasons - some of them have to work hard to earn enough for that days food, some of them because of it being difficult to travel to us, sometimes it just seems like they just decide to come on a different day or at a random time and expect that to be fine. I learnt a lesson the hard way though about not always judging women for coming late. I joked with a woman that she was two months late and her reply was that her three year old had died from convulsions and she had been busy. And that was not the answer I was expecting. I'm not sure how long it will take me to really understand the difficulty women have living here and just how fragile life is.
One lady I met was in her fifth pregnancy, this would be her sixth child. She was very unusual here in that all of them were alive. Looking at women's obstetric histories is actually quite heartbreaking when you see just how many have lost children, but we have to remind ourselves that the unit I am working at is so much better than other's around. It has had many good outcomes with live babies for women that have had two or three stillbirths previously and this is really a reason to be positive amidst it all. Anyway, we are currently able to offer sterilisation (they type where they tie the tubes so that women won't get pregnant again) free of charge so I gently talked with this lady about whether she would want to consider this. I suggested she talked with her husband to see if it was something they would want to consider and that I could give her the paperwork next time. She told me how hard life was, how difficult it was caring for and providing for her 5 children and how she really didn't want any more after this one. She said her husband would be overjoyed to know that this option would be possible and that Praise God, He has answered her prayers - there is a solution to her keep getting pregnant that she didn't know about. She was ready to sign there and then! That made me smile, but I assured her there was plenty of time and that next time would be fine once she had talked to her husband!
Sorry that these thoughts and encounters with women at work are all a bit random and disjointed - much of clinic is pretty dull and I get fustrated with the numbers of women coming. For most of them it is just the same checks, the same medicines, the same advice.... But it is through good, regular antenatal care that we are able to promote better health and pick up any warning signs along the way. I have to remind myself that it is just as important as being a good birthing midwife and when it is my turn run clinic with a smile anyway, just with less jokes about women who come late.