The past week here in Masaka has flown by! We have now had a total of five days on the maternity ward, and have collectively attended 34 births so far!! In addition to attending births, we have managed a variety of emergencies including a shoulder dystocia, several postpartum haemorrhages, two ruptured ectopic pregnancies, four women in shock, and two newborn resuscitations. In addition, we have attended a breech birth, twins, and even a car delivery outside the hospital! All of the care we provide is with the ongoing guidance and assistance from our preceptors, as many of the emergency skills we have practiced to date have been in simulations, and we are of course still learners.
On a typical day, we might have a head nurse, intern doctors, many nursing, midwifery, and medical students, and our preceptors on the ward. Usually there is also an OB either on-call or on-site at the hospital. There are many opportunities for cross-cultural and interpersonal learning and teaching moments. After one of the births we attended, an intern doctor approached me to ask more about the birthing position (side lying for slow delivery of the head) that we had encouraged the woman to take. It was an incredible moment to discuss the many options for birthing positions, as well as how to avoid episiotomy and encourage minimal-to-no perineal tearing for birthing women. The local staff and interns know so much about deliveries in their home settings and also share their knowledge with us. We all have many things to teach one another, and so much to learn from each other.
Supplies are often scarce, so the staff are creative (e.g. using an enteral feeding tube and large syringe as a makeshift suction for a newborn resuscitation!) and we have to be judicious with how we manage resources. We carry most of our equipment in our scrub pockets and fanny packs, especially emergency supplies like IV cannulas, delivery sets (clamps and scissors to cut the cord quickly in cases of needing resuscitation), catheters, and of course many gloves.
Women labour in the halllways, outside, in the first stage room, and in the delivery room. As difficult as it can sometimes be to communicate with women when we do not speak the same language, it is also a good reminder that body language and intentional eye contact can go a long way in providing quality care to women and their babies. We learn small phrases to encourage women and help them deliver their babies safely. Thankfully we have also had opportunities to ask for assistance from other local people who are on the ward when more in-depth conversations or information is needed.
Somehow it simultaneously feels as though we have been here for ages, and that we have just arrived. We all look forward to seeing what the next few weeks brings!
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