The Labor Room
Sr. Dr. Marie Jose Labor Ward
Sengerma Designated District
Hospital
Sengerma, Tanzania
February 2016
My friend is a new doctor who has
just started a Peace Corp assignment in Tanzania. She is the delivery doctor in this small
hospital in the northwest part of the country. The volume of pregnancies
overwhelms her. This hospital delivers twice the number of babies than her
previous hospital in the USA. But her
previous hospital had dozens of doctors delivering babies. She stands alone in this ward and oversees
all of the births. I spent three days in
the hospital with her. Most of my days
were spent, sitting on a chair, trying to stay in the background. But if I had put on rubber gloves, I could
possibly have been called in to service.
9:00 AM- A young woman just delivers a
dead baby. But there is a twin yet to be
born. So she waits silently, sadly for the next birth.
Another woman delivers a baby so small that
I can’t see him as he is swaddled so tightly in blankets. There is something wrong with this baby. He is rushed to the heat lamp and extraordinary
measures are taken to get him breathing. After a few minutes, he is taken up to the N
ICU. But his spot under the heat lamp is
immediately filled with another baby who is laboring in his breathing. Efforts are made to get all the fluid out of
his lungs. But no effort is given to supplying him with oxygen. This life-saving
necessity just isn’t available in this hospital.
“Sad
thing is, we could save him but he could have serious brain damage from the lack of
oxygen”’ my nurse friend confides in me. “He went too long without oxygen.”
A woman delivers the first healthy baby of the
day. It’s the first crying I hear. The
baby is swept up, weighed on an old, old rusty scale, wrapped up in blankets and left on the counter top.
The midwife goes back to the mother and sops up the blood and placenta. The
mother doesn’t hold her baby for another hour.
There
are six beds, all full now. The women waddle in with their bucket of belongings. They bring everything with them: food and water, black plastic sheets for the delivery table and several pieces of fabric sheets and anything else they need or want. They take these pieces of cloth on and off all day long as the day gets hot.
There is very little noise from the mothers-to-be. They lay there and wait for the outcome, appearing indifferent to good or bad news. It is a wasted effort to try to bring themselves some comfort. Nothing brings them much comfort. Nothing will comfort them until that baby is out of them.
There is very little noise from the mothers-to-be. They lay there and wait for the outcome, appearing indifferent to good or bad news. It is a wasted effort to try to bring themselves some comfort. Nothing brings them much comfort. Nothing will comfort them until that baby is out of them.
10:00 AM- in our first hour there are seven births: two
dead, two in critical care and three healthy. None of these situations elicit
any emotion from anyone. There’s no
sorrow or joy in this room, just process. Babies are delivered. The mothers are cleaned
up. The floor and delivery table are swapped down. Then the mother and child are taken away to
the maternity ward. A few minutes later
another woman, in labor, waddles in with her bucket of belongings. She comes in without her partner, without
drugs, without anybody to comfort her.
As a baby begins to emerge from their mothers, there’s no hurry for the nursing staff to step in. They saunter to look for surgical gloves and then slowly make their way to the mother, sometimes arriving just in time to catch the baby.
The
mothers don’t scream with labor pain. They bear down and gripped themselves to
help endure some of the pain. But mostly they suffer in silence. When a woman
does cry out in pain, the nurses show no sympathy. It appears to me that there is a distain for
this behavior.
I
hear few cries. Sometimes there’s a silence after the baby is born and then the
bundle is rushed to the heat lamp. The mother is told nothing. She lays there
and waits for the news from the doctor or the nurse.
Noon: A 14-year-old girl is here by herself, just
like the others expecting mothers. but she is such a baby herself. She lays on her delivery table but she has to
urinate so she takes all of her possessions out of her bucket, on the floor, and urinate in
it. Now she has to leave the labor room and find someplace to discard her
urine. She waddles back with her soiled bucket and lets it air dry before she
puts her belongings back in. Then she climbs back up on her table and waits.
2:00 PM- A woman cried out about something. A nurse translates for me. This woman has already had nine births and
these births were fine but this labor is so much more difficult. So she now
believes someone is trying to kill her and her baby. Someone comes, maybe a
family member, and consoles her. She quiets
down for a while.
3:00 PM- A woman is struggling with her labor. The
doctor puts on long rubber gloves and inserts two fingers inside the woman. The baby is sideways. An effort is made to turn the baby in a better
position. The doctor stopped for a minute and removes her fingers and turns
away for just a second. With that a tiny
foot emerges from the mother.
“Holy
shit”’ says the doctor. She inserts her
fingers back inside the woman and feels a small hand. “That’s a problem. This
will be a difficult birth.” She struggles to move the baby around. But then
another foot comes out and in seconds the whole body is out. This is the second birth for this mother today.
She gave birth to a little boy two hours ago. Now both of her babies will be in
NICU for a while.
Where
babies are in the NICU, the mother stays with them, providing all the food and
regular care the child needs. They wash
the children and their clothing. They
feed the babies and sleep beside them. One nurse in NICU monitors the baby’s fragile
health.
5:00 PM- we leave the ward to go in to town for an
early dinner. There have been 20 births
so far today.
7:00 PM-
as we come back to town we find Josefina, an expected mother, in the
streets. She left her hospital bed to find an affordable street vendor. She’s
hungry and buys an ear of corn to satisfy her hunger. When she is finished, she returns to the
labor ward and waits for the baby to come.
Night shift: twenty-five babies are born
throughout the night. Another woman
delivers dead twins. And the same pattern of delivery starts the new day.
