In Canada, we have taken away much of the suspense and "unknowns" when having a baby. People in developing counties like Canada have become largely attached to the strict plans they have created, leaving little room for what was once called a natural experience. Couples nowadays are able to: know the gestation of a baby, the gender of the child, visualize the baby on an ultrasound, screen for abnormalities, genetically engineer a child, and/or abort by choice. Presently, couples have "birthing plans" that are developed prior to labor to communicate to midwives, doctors and nurses what one would like to have, happen and avoid. Couples have the opportunity to attend prenatal classes to help them understand the best birthing options and choices available. A birth plan includes: a birthing companion, various birthing positions, pain relief and fetal heart rate monitoring. Basically, couples have taken out the mystery of having a baby.
During our last clinical week in Mongu we ( Amanda and Trisha) were placed on the maternity ward. Right away we could tell that the atmosphere on the maternity ward here was not like the maternity wards we have practiced on in Canada. Women were not accompanied by their families and as a result often gave birth alone. Women were not given a choice of position, instead they gave birth solely on their backs holding their own legs back (where stirrups would be in Canada). Unfortunately, there was limited supply for a high demand of analgesic so most women were forced to fight through the pain on their own. Another difference we noticed was that the fetal heart rate was assessed with manual auscultation (horn) instead of the advanced fetal heart monitor you would see on maternity wards in Canada. Due to a lack of accessibility and antenatal care, most woman were unaware of their gestational age which made both maternal and fetal health assessments difficult. Adjusting to the women labouring with little privacy or support was emotionally challenging. Clearly, in Mongu, birthing plans do not exist.
On Friday morning a mother came to the ward from a clinic in the community. She had delivered her first baby at 2400 hours in community and was awaiting the birth of the twin. She had failed to progress to deliver the second baby which had brought her to Lewanika General Hospital,where we were anxiously waiting. The second twin was delivered breech, crying and healthy. When the midwife went to deliver the placenta he was in for a big surprise!
While assessing the second baby, we turned around and noticed a third baby was delivered. This was not only a surprise for the midwife and us, but the mother as well! We were quickly put to work drying, assessing, weighing and labelling the triplets (with masking tape on foreheads) to avoid confusion.
This situation enabled us to reflect on the antenatal care and resources that we have back home in Canada. We are privileged to have access to frequent ultrasound visits and health check ups that are largely taken for granted. The element of surprise in Canada is minimal and unknown triplets would rarely happen.
Despite the lack of resources this strong mother delivered healthy triplets. Two baby girls had entered he world and joined their older brother this morning. This situation shows that the birthing process is part of natures course whether we choose to intervene or not; technology is not always necessary for the birth of healthy babies. The opportunity to be part of the delivery of triplets here in Mongu is something we were so grateful to be apart of and will cherish this memory. We couldn't be more thrilled to welcome beautiful triplets to the world on our last day here at Lewanika General Hospital!
Trisha and Amanda