Saturday, March 28, 2015

Maternity nursing in Mongu

This week Liona and I were on the maternity ward. While there was some difficult moments during our time there, there were some great moments that we will always remember. 

The highlights for both of us was the opportunity to deliver babies with the skilled midwifes at our sides to guide us. This was an amazing experience that we would have never gotten in Canada. We were apprehensive at first, due to it being our first time delivering a baby but having the midwifes there eased our fears and we were glad we jumped in! Being there for these happy moments in the moms lives was extremely rewarding. Thankfully both the babies we delivered were healthy and happy and the moms were very thankful for the patient centred care and support we gave them. We both came to Africa with the dream to deliver a baby and our dreams came true! 

Although much about the maternity ward was amazing we had a few difficult moments that reminded us where we are. There are little resources here and some practices that would never be done in Canada. We saw some aggressive pushing on a moms abdomen to force her baby out faster then natural without giving mom time to progress. The midwife present seemed to give no thought about the wellbeing of the mom. He seemed like he was just in a hurry to move on with his day. It was very hard for us to watch. Pushing on a pregnant woman's abdomen increases the chances of a ruptured uterus, post-partum hemorrhage or other complications, and is never done in Canada. Why this was done here may be is due to an education gap, lack of research based practice or lack of patient centred care such as we are accustomed to back in Canada. Patients are very low on the hierarchy here which is completely different than what we are used. We  feel that the meaning behind nursing and the reason for healthcare is the patient. We originally went to nursing to help people so it was incredibly difficult to see the lack of respect for that patient. Although it was traumatic to watch this practice being done we were relieved to hear from the midwife students and the obstetrician that this practice is no longer being taught and is not condoned to perform. Our only regret from this past week is that we did not adequately advocate for that patient because we were so shocked by what we were seeing. 
On our last day on the ward we saw first hand the lack of resources here. There was a woman that needed emergency intervention to assist the delivery of her baby, and all that was available was minimal amounts of very basic and outdated equipment. Despite this seeming primitive to us the reality was this was  the best care that the mom could have received here. What would have been less then basic care back home, was high level care for here. According to the WHO only 42% of women in subsarahan Africa give birth with a medical personal present to assist the delivery and only one in three women requiring emergency intervention receive it. Each year in Africa a quarter of a million women die due to pregnancy and childbirth complications. This particular mom was very lucky to get the care that she did, and could have easily became one of those statistics. It was an eye-opening experience for us that made us feel very grateful for the level of care we can receive at home, which is very easily taken for granted. 
After our week we are so grateful to have had the chance to work with the amazing midwifes on the maternity ward. They do so much with the little they have to work with. We wish we could stay on the ward to support the incredible strong moms during those amazing moments in their lives. This experience may have turned us into maternity nurses! 

1 comment:

  1. You have shared such an important lesson with us in your story.... which is that poor practice is poor practice anywhere - and that we can advocate as nurses for safer care, wherever we are. Yes, resources often make a difference - but as you so articulately point out, resources were not at issue when the midwife was pushing on the mother's uterus - it was knowledge and/or attitude.

    You did a good thing by asking the students and the obstetricians about what you witnessed - and I am betting that you would not let this go by again without questioning it. It takes courage to question poor practice at home - or in Zambia - and yes it is part of what we as nurses must do. Your story reminds us all that we can and must call it when we see it. We can be respectful, we can find the right person to ask - but we can't let it go by.

    Onwards - as the wisdom accumulates,

    Tricia Marck