Although Masaka Regional Referral Hospital is a hospital that provides emergency medical services, there are plenty of opportunities for normal childbirth. Much of what we do here in normal labour and delivery care is similar to what we do in Canada, although sometimes with less clinical information and often lower level technologies.
After admissions, the women are sent to either the first stage or delivery rooms. We ask her name to locate her chart. Looking at the chart, we need to know whether she is preterm or term, whether she has any medical conditions, if she has had any ultrasounds, and whether she has a singleton or multiple pregnancy. We check her blood pressure, pulse, and sometimes temperature. We examine her belly and palpate to find out fetal position and presentation, fetal descent into the pelvis, number of fetuses, and whether she appears to be term or preterm. Next, we listen to the fetal heart rate using a fetoscope or Pinard horn. If she is due for another internal assessment, we conduct a cervical exam as usual.
When she is approaching second stage, we try to get her into a bed in the delivery room. Although we try to have the women birth in the delivery room, often the beds are full so we conduct deliveries in the first stage room as needed. We draw up oxytocin for active management, and prepare a small sterile field with three elastic ties (ripped from the wrists of our own gloves) and a sterile blade, double check that the resuscitation table and equipment are prepared, and ensure we have a second attendant on standby for delivery and checking fetal hearts when possible.
Most moms have at least one attendant with them during labour and the birth. Sometimes they are out gathering supplies, food, or resting, so we try to locate them whenever possible on maternal request for support, and/or for the birth. After the baby is born, we do delayed cord clamping and help dry and stimulate the baby as usual, as well as provide active third stage management with oxytocin IM. The babies are brought to the warming table (which has a bright lightbulb for warmth) where we give tetracycline eye ointment and the standard Vitamin K injection, and do an abbreviated but careful newborn exam. Sometimes there are two or three little bundles of baby lined up in a row on the warmer, licking their fingers and looking around, waiting to get back with their mamas!
Moms typically want to get up for a shower prior to holding their newborns here, especially as we have linen-free births with plastic drapes under them during the birth. As long as mom and babe are stable, we try to get them back together as soon as possible for more skin to skin and the first breastfeed, and the joyful walk together to “General Happiness,” the postpartum ward for moms, newborns, and families who are healthy and well!