Mining for babies - a night in the maternity ward

Charlotte, Jay and I decided to go to the labour ward in the evening as there were 5 woman who were about to give birth. We had dinner by torch light in a shack outside the hospital, and had egg and mayo butties and oranges for less than a pound for all of us! The evenings are buzzing here, despite the lack of electricity, there are still food stalls run by atmospheric candle light and plenty of people having a gossip and having dinner. After dinner, we braced ourselves for an interesting evening in the hospital. The hospital was pitch dark, and eerily quiet, apart from the screams coming from the labour ward. We arrived and the midwives were working by torch light. They were pleased to see us and instructed us which ladies we should assist with. All of the women had severe infections in their wombs, which created a stench in the small, hot, airless room like no other. All of the women were also experiencing their first birth, and some were scared to push, others were tired, after being brought to the hospital already having experienced 2-3 days of labour in their village. Most woman in Sierra Leone also have FGM (female genital mutilation). This is where their vaginas are cut, often very dramatically, leaving scar tissue where there should be elastic tissue. This makes labour very difficult as their vagina opening cannot stretch, making it extremely difficult for the baby to be born. Charlotte’s mother gave birth first, after many hours of pushing and screaming ‘why why why?’ It was a baby girl. The mother wanted a baby boy, so the midwives just told her it was a boy. After the baby is born, it is rubbed dry, has suction to remove any fluid that it may have breathed in, and then has it’s cord cut. Here, they also traditionally rub the baby with oil ‘to keep it warm.’ I’m not sure how effective this process is, as they then wrap it in the wet towel they had originally dried it in, and surprisingly they do not allow the mother to feed her baby straight away, until she has her knickers back on. This is a shame because by the time the mother was ready to feed, she was too tired and so was her baby who was asleep, and breast feeding releases maternal hormones which help reduce bleeding after birth.
The next birth, was by my mother. Due to the FGM, there was no stretching of the vagina, and after hours and hours of labour the woman needed an episiotomy. This is where the vagina is cut to allow for the head to come out. Unfortunately for the mother, this was done with no anaesthetic and the baby was a still birth. Charlotte and I started to resuscitate it, doing chest compressions, but without a mask and bag to help the baby breathe and no other equipment available, we soon stopped. We were absolutely gutted, but didn’t have time to be upset. We saw to the next birth, while the midwife rather unskilfully stitched the episiotomy by torchlight. The next birth, like the previous one needed an episiotomy but fortunately the baby was alive.
It was midnight by the time we had run out of gloves, and there was still one more labour to go. The patient was a 17 year old girl who had been brought in by her parents after being in labour for several hours. She was tired and begged for Jay to stay with her. The midwife was cross that she was not pushing, and the midwife herself was tired and lay on the bed next to her to rest. Charlotte and I decided to go home, there was not much we could do without gloves and we were shattered. We checked the foetal heart rate of the young girls baby and it was strong. Jay decided to stay as when we left she cried and screamed after him. He stayed until she fell asleep and we got a lift in an ambulance back, as the midwives thought it would be dangerous for us to make our own way home.
The next day on the ward round, we saw the young girl in the postnatal ward. She was without a baby, and the midwife said it had been a stillbirth. Another baby who if treated with a simple intervention to assist with the labour such as forceps could have lived. Perhaps with the girl being so young and with a ‘man in Freetown’ like many young girls in the village, it was a blessing in disguise, but it still was a tragedy. To me, this injustice is highlighted to us even more when a few metres away from the midwives working by candle and torchlight is the lassa fever lab, an international research centre funded by the World Health Organisation and in part by the USA Department of Defence who had state of the art facilities. The concept of millennium development goals (MDGs) seems distant and a pisstake when here in rural Sierra Leone, they have seen little funding and do not have the basic facilities.

By Alix