jeudi 5 avril 2012

Caring for women in labour

Je m'excuse auprès de tous mes lecteurs francophones mais cet article necessite trop de jargon spécifique que je ne sais pas traduire en français.

Finally on Tuesday we got to assess, admit and care (to a certain extent, without being able to communicate) for two women in labour. Both prims, we picked one each and were going backward and forward to the labour room, listening in to fetal heart, etc… The midwives were more or less translating what we were saying but from my point of view they lack the caring soft voice that midwives should use to some extent when caring for laboring women.
We admitted them at about 2.30pm and by 5.30, my lady was acting really distressed, curling up her body with each contraction and as I had been massaging her back for most of the afternoon (her only “pain relief”), I could feel the tail bone slowly shifting and I was getting excited. I then went to find one of the midwives for her to translate and ask my women whether she was feeling any pressure in her bottom. This was a new midwife, night shift, and apparently she had a different conception of intrapartum care… She asked me whether the woman was fully and I said I didn’t know and quite frankly it wasn’t really the point. I only wanted a very simple question answered: “is she feeling pressure in her bottom?”
Anyway, she came round to the woman, shouted something in oromifa upon which the woman rolled onto her back, put a glove on and promptly examined her. My question was left unanswered. She then faced me and said she was 4 cm, no information about station or position was given.
By that point, Tessa was having an equally distressing and frustrating time with her lady who she had ARM’d for augmentation on Dr Jeremy’s orders and found meconium stained liquor and therefore wasn’t allowed to walk around (!!). The lady was rolling around in her bed and saying that she wanted to get up and walk (according to the midwife’s translation). All the same, the midwife was categorical that she shouldn’t walk around.
At that stage, we decided to go out and get some fresh air and debrief on the lack of evidence backing up the midwife’s decision. We also felt like there was no easy way of telling her that. By the time we came back, I found out my lady had delivered. She had been able to get up and mobilize. Even so, one hour to go from 4 cm to fully for a prim seems pretty hard going. Anyway, there is no way of checking if the midwife was right.
Tessa’s woman was sent for section at 8.00 for failure to progress. Not fetal distress. Failure to progress. We’ll never know if a little walking around would have spared that Ethiopian lady the scar tissue on her young uterus.
So that was our first experience of labour ward, and we wish we had a few more years of experience in order to be able to take over the care completely and take full responsibility.

On Thursday, we had agreed to phone Tyler should anybody deliver as he wanted to see a normal delivery. We witness the delivery of a para 3, I had never seen so much perineal stretching in my life, the midwife was pushing and pulling so hard on that poor woman’s perineum, it was sore just watching. When the head crowned, she then promptly pushed on the “ring of fire” to “help” deliver the head. Then again, there was no lingering about waiting for restitution, she pulled on the baby’s head and what would normally take at least a couple of minutes took a couple of seconds. Thankfully, the woman had a very resilient vagina and did not tear although we were expecting to see a third degree at least!
Third stage management is also an epic demonstration of fundus fiddling, as if they were trying their best to give this woman a PPH. They simply won’t stop massaging the uterus until the placenta gets out. And even then, they’ll carry on rubbing it for some time. Some midwives are worse than others, but I don’t think any of them would pass the exam on third stage management. All women get an active third stage management too, it is not an option not to have one.
All in all, probably not the best first experience for Tyler to watch. All the while I was hearing Becky (the local midwifery college lecturer)'s voice in my head telling her midwifery student that “Midwifery is all about waiting” and “why do midwives get less tears than doctors? Because they wait!” How ironic!

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Anonyme a dit…

tu ne sais plus écrire en français? M-R