My African Midwifery Adventure – Day 2 – first day in the Hospital & Observing a footling breech!

Day two out here in Tanzania was my first official day in the hospital. I was starting with two other midwifery students and we were meeting one of the Work The World team members at the hospital at 8.30 so she could introduce us and make sure we were all settled etc so we got up at 6.45 and headed into the main house for breakfast.

Breakfast in the Work The World house is different every day, with cooked specials such as pancakes, sausages, baked beans or homemade doughnuts, and then every morning there is also a huge fruit platter with things like watermelon, pineapple, orange and mango to munch on – perfect way to start the day and make sure you are all set for whatever the day may bring!

We had been given a tip by some of the previous students that, rather than getting the dala dala and then changing in the hospital, we could get an uber to the hospital and travel in our scrubs (majorly beneficial given that there is nowhere to change in the hospital!), so, of course, we went for that!

We arrived at the hospital at about 8.20 and sat outside to wait. It wasn’t long before our wonderful Work The World rep arrived and took us into the unit to introduce us to everyone.

We started on the Antenatal ward, where women come with any complex antenatal conditions in the latter stages of pregnancy, as well as all the labouring women who are less than 6cm dilated and those who are in for induction of labour. We were quickly asked to undertake full observations on one half of the ward – which actually proved quite difficult with such a language barrier, but we got there in the end and the women were all very friendly and understanding!

There were several women in a little waiting area between the antenatal ward and the labour ward who were advancing in labour and waiting for a bed to become available on labour ward. we were observing them and so when one of them went through to labour ward we were invited to come through and see where she was going and how it worked through there, which we did.

Labour ward is mad. It’s busy, it’s hot, and for a room that is full of women in the advanced stages of labour, it is so quiet! The women are told to keep quiet and if the scream out they are told to shut up – you simply wouldn’t believe it was a labour ward if there weren’t babies being born left, right and centre!

We had only been on labour ward a few minutes and the lady we had followed through was up on the bed and pushing, and the top of the head was visible. I asked the nurse in charge if I could “catch” and she nodded but told me to put on another pair of gloves – infection control is so so important in a country like this. Unfortunately, by the time I got my gloves on, the women had delivered into the nurses waiting hands – so quickly! Ah well, there’s bound to be more opportunities!

The women on labour ward have to bring in so much of their own stuff – they have to bring a huge roll of cotton wool, as well as several mum-sized and baby-sized kangas (the colourful fabric sheets that they wrap around themselves and their babies) As soon as they get to labour ward, they lay out one of the bigger kangas on the bed and that is their bedsheet for delivery – we then give it back to them after delivery, covered in all sorts of “goo” (amniotic fluid, vernix, poo, blood etc)

After that missed delivery I assisted with the clean up after delivery. This process is really quick and the mum is expected to be up and dressed minutes after delivery (or suturing if they have needed it) – they even carry their own bags to the bench where the women sit before moving to the postnatal ward.

After delivery, their babies are taken from them for weighing, then they are wrapped in the baby kangas, labelled and all put together on a slanted shelf at the other end of labour ward under heated lights until the mums are dressed and sorted. It seems very odd, particularly since we are so pro-bonding and skin-to-skin in the UK, but it is just how they do it here.

A little bit later on, Emily (who I know from my course at home) called me over so I could observe a delivery with her – there was a foot-presentation; literally just the baby’s right foot had delivered and the midwife was preparing for a breech delivery. I’ve never seen a breech delivery, let alone a footling breech so this was a really unique thing to see.

In the UK, the “buzz-phrase” is “Hands off the breech”, where there are certain manoeuvres but otherwise you keep your hands off and allow gravity to do most of the work – clearly this is not the rule here. Honestly, this delivery was quite brutal to watch. The midwife was very much hands-on, pulling, pushing and twisting the baby quite roughly, until the body was completely delivered. There was a very tense few minutes where the body was delivered but the head wasn’t and despite all the mum’s pushing efforts, the head didn’t look like it was getting any closer to delivering. Finally, the head delivered but the baby had come out floppy & pale and didn’t seem to be making any effort to breathe.

The midwife called over one of the nurses with their equivalent of a bag-valve mask (kinda the same thing but the bag is a plastic cylinder) and suction (a nasal aspirator thing that you squeeze and let go) and finally after another tense minute or two, the baby cried! Such a relief!

It was so interesting to observe this delivery – you would simply never see a footling breech delivery in the UK, and a breech delivery was one of the things I really wanted to see out here, so I got to tick something off the list on the first day in the hospital!

It was an intense but really interesting first day in the hospital and we were certainly very appreciative of a good lie down and a dip in the pool when we got back to the house – that ward is WARM!

Dinner was at 6.30 and then we had a bit of an early night; after all, it had been quite an intense day!

To read about the rest of my trip, see the “My African Midwifery Adventure” posts here, or click on the links below.