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Midwifery in Uganda - Report from Marion Toepke McLean

January 31st, 2009 (01:38 pm)

Marion, who you read about in my previous blog post, has shared this little picture of Uganda with us and also a lovely birth story. Midwifery Today sent Marion with a Doppler which was the piece of equipment the midwives wanted most. -Jan

I'm greeting you from Soroti, Uganda, here on the high savannah. It has rained a bit lately and brightened things up, and I have been realizing what an incredibly beautiful, livable landscape this is! So green, such a variety of vegetation.

There have been maybe six births since I've been here, at the birth center, that is. We also do a lot of care for women who deliver in the villages, and in the hospital. I have attended two of the births. One very special woman, by the name of Ediso, had a bit of a harder labor than she has had with previous children. She is 38 and has three girls and a boy at home. (She says she's done!) Anyway, we went outside and sat in the shade for a long time. Not sharing a language, we just shared the time and the space, chickens and little piglets scuffling around the clinic compound.

Ediso hadn't eaten through the night, but I persuaded her to slowly chew a roll and drink a cup of tea. The way we make tea here is, put some dry tea leaves in a cup, add sugar, then pour steaming water out of a thermos. It's very good! Uganda produces a lot of tea, so it's very fresh. The way Ediso made her tea was to put about 1/4 tsp. of tea leaves in the cup and add about six tsp. of sugar! That was probably what gave her the energy to go on! She went inside and bathed, then we spent some more time out in the shade.

About 1 pm we went inside again. There is a shared maternity room with three single beds (one already occupied by the mother of a boy) and further inside, a small birthing room. Her contractions, which for a while were quite spaced out, were coming on strong. She made a couple little moans with the pains. Then she drew her legs apart just a bit, and I noticed the glistening waterbag peeping from the vulva. Things went fast from there. She birthed very spontaneously, just opened her legs and let the uterus do the pushing. The bag bulged more, broke, and the fluid was clear. The new doppler from Midwifery Today registered steady strong fetal heart tones, and some dark curly hair started to show. Within minutes, a strong, 3-1/2 kilo baby boy was born.

Here at the Safe Motherhood Clinic, we follow the WHO guidelines for active management of the third stage. This is because the mothers have low hemaglobins and, despite their big gardens and the bags of beans and rice that are given out on each prenatal visit, are somewhat malnourished. A hemaglobin of 9 or above is considered good. But we do give pitocin IM directly after the birth, and that's what I did with Ediso. Boy, do those placentas deliver neatly! Ediso lost maybe 120 cc's of blood. I also had made sure to have misoprostol on hand. It's used only for postpartum hemorrhage, for which it can be lifesaving. This mom did not need it.

Ediso wondered what my name was. She said she wanted to name her son after me. I told her my name, and said that, luckily, Marion can be either a girl's name or a boy's. So that's how a small African man came to be named after me.

Twice, walking back to the guest house from the clinic, on the pathways with the brownish red dust and hard packed earth, I have met Ediso's husband. He always greets me and tells me the baby is fine. He speaks a little more English than she does. They are very unassuming, kindly people.

More later! The midwives say thanks for the gift; they are very excited about it. They don't all have watches, so the digital display of the FHR is very reassuring to them.

Love to all, Marion