I used to work as a midwife/nurse in a rural East African hospital. AMA

[NicoAndTheNiners]

That’s it really, only spent a few months there but it was an eye opening experience.

I dare say you could use the elephant sedative as you wished; I'm not clear as to the exact form in which it was available. The pharmacy I used also supplied vets, so I think it was intended for animal use!

For donating, from what I saw, you really want to know someone who is in the country and can see that the money is being used to help those in need - e.g. NicoAndTheNiners when she was there.

Were you working in a government/public hospital, or one run by an NGO? Did the doctors come from overseas too? If you had more than one doctor, I'm guessing it was a pretty major hospital - the clinic I mentioned earlier didn't have any doctors, but the nearest large(r) hospital was 2 hours away in a good 4wd vehicle. Rather longer on most local transport, which wasn't great if you needed a c-section.

I also spent time in an East African country and lived with a midwife for a while there. I worked in the school nearby and she worked in the hospital at the bottom of the road. She was amazing but I remember her telling me sad stories about stillbirths. And HIV was rife. This was early nineties. Several people we knew died during the year we were there. This was early nineties. It took courage to do her job.

Well done NicoAndTheNiners

The midwives had been to university. They'd have been nurses first then extra training. I don't mean to put them down but I don't think a university training there was as robust as here. But I know they're looking at this and are looking at raising standards of training.

I never met any traditional birth attendants but they were in the villages. An ex UK colleague lives there permanently now and spends all her time training TBAs.

The doctors were all male and would do forceps and sections. But otherwise not get involved on labour ward.

The doctor for the day would do a full hospital ward round every morning which I always attended. So he would come to the maternity block and see all the antental and postnatal women. See who was in and with what.

I forgot to ask you a question!

Umm - do you have red hair? (Just checking this isn't a weird Mumsnet coincidence)

It was an NGO hospital, set up as a one off by an amazing English woman who'd gone there in the 1960s to teach for a year and never left. She must have been in her 70s and ran the place.

Money came from fund raising I think mainly from christian/church links in the UK.

I don't have red hair.

The doctors were local. There were only 2 of them! I think they normally had 3 but one had left.

Not my old housemate then!

(That would have been weird)

What was the farthest (distance or time) that a woman walked to the clinic?

Did you see any fistulas that hadn’t been repaired? - That’s probably a weird question but it was a big topic when I was training!!

Did you HIV test the mothers to try to prevent transmission to their children? I think maternal transmission in the UK is really rare (though so is HIV), but I sadly knew several families with AIDS orphans where I used to live.

Would you have been happy to give birth in the hospital where you worked?

Probably 3-4 day walk.

I didn't actually see any fistulas which is suprising. Not sure if that's because women with unrepaired fistulas can become outcasts so wouldn't be pregnant again,?

Women would be encouraged to have a HIV test if they had antenatal care. They could then start meds which I guess would lower viral load. Not sure how well that would work over a few months. We didn't test the newborns! So not sure what transmission rates were. Overall HIV rates in the country were around 10%. So fairly low for Africa I think.

Did you driver many breach babies?

And no I wouldn't have been happy to give birth there. I'd have been terrified.

Yes that’s true, I suppose as they were considered so “dirty” they wouldn’t be pregnant.

Were there any multiple births? The first set of twins I delivered was to an African woman, I’ll remember that day for so many reasons

I saw some breaches, the local midwives didn't bat an eyelid about a breach. Perfectly normal.

Just saw one set of twins.

I had (expat) colleagues who did give birth in the country I lived in - definitely not a choice I would have made. Not least because I was born with a condition which still wouldn't be treatable there now, 40 years after surgery was available in the UK (DD hasn't got it, but had a raised likelihood). But even without that, just no way. I (personally) had a transverse baby - did you see many of those (more likely in those who've already had several children from what I've been told), and did they make it to hospital in time?

Only saw one transverse baby. The woman had laboured at home for 3 days at which point they put her in a car and drove her to the hospital. Relatives then drove off.

Baby was dead. Dr did turn the baby and she delivered it vaginally.

After 3 days, I'd have thought the woman was lucky to make it, the baby didn't stand a chance.

How many children did women typically have? And what was the highest number you saw?

Typically they might be on pregnancy 7 or 8 but with 3 or 4 kids at home. Saw someone on pregnancy number 12, think she had 6 kids at home.

Did you allow the babies father’s to attend the births or was it ‘no men allowed’?

Never saw a partner/husband set foot in the maternity unit. I don’t think they’d have wanted to be there. Literally cars would drive up and women would get out the car by themselves and the car would just drive off while the woman was walking up the steps. Or the women would walk to the hospital with a female relative. But the female relatives didn’t come in the actual hospital building, they’d wait outside. So no birth partners at all.

Did labours take the same amount of time as they typically do in the West?

At what point do the women come to the Clinic?

It's a bit hard to say how long they took for sure because they were pretty much ignored for first stage. I would say probably a bit quicker.

Women seemed to either come in labour either days too early or at the pushing stage!

For an clinic appts were approx monthly but people would just turn up whenever. There was no actual appt lists. You'd just see whoever showed up....I didn't have much to do with clinic to be honest. Mainly labour ward or the main hospital.