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 know a fair few "natural parenting" people who have had (and advocate) "freebirths" with no medical intervention whatsoever during pregnancy or labour*. They say pregnancy and birth in the West is too medicalised and women just need to trust nature/their bodies. What is your opinion on freebirth having had your experiences in Africa? And did the women there wish for less intervention than they got, or wish they could have more?

• some who freebirth will have antenatal care, but the three I've known personally didn't

Just realised I said "a fair few" and then three! Tbf I do only know three who have had freebirths but I know a lot who think most medical intervention is unnecessary.

unadventuretime freebirthing makes me really angry, having spoken to women who've lost children because they couldn't get to an appropriate clinic in time - I've mentioned above visiting a clinic that could oversee vaginal deliveries, but didn't have the staff or equipment to perform a c-section. That regularly proved fatal, for the baby at least. Without medical help, about 1/50 deliveries leads to the death of the mother , more lead to the death of the baby. No mother wants her child to die. Those mothers who were too far from a well-equipped clinic would have given an awful lot to have had a live baby - they certainly wanted a (timely) c-section.

I think the women were grateful and realised that they lived close enough to a hospital which provided care which they could afford. I’m sure some women in the area couldn’t afford it and I’m sure others were too far away.

I think due to the high fetal mortality rate and to a lesser extent the maternal mortality rate they would want a higher level of care (not necessarily intervention). But yes more intervention of it was needed I guess.

They knew that most of the time at the hospital if a woman had a pph we could stop it (not always) whereas the women who birthed in the villages with the traditional birth attendants would probably die if they had a pph.

Did you learn any skills, techniques or practices from the midwives, mothers or TBAs there?

Can’t think of any specific skills (apart from wrapping babies in cloth slings before it was popular here) but the experience gave me a lot more confidence especially in emergencies. Being able to deal with stuff with minimal equipment or support. It certainly opened my eyes to how strong women can be both physically and emotionally.

Thanks for your answer, very interesting. I had no idea just how dangerous birth is. Bloody hell, 1 in 50! Freebirth makes me angry too, even more so now I know those statistics (also for personal reasons - a close family member had a stillbirth and it wasn't because they didn't trust their body enough or whatever. Also it means I have experience that nature doesn't always get us the outcome we want).

Another question! Was abortion legal there and did you ever see women who needed help connected with that (e.g. because of backstreet abortions)?

I'm still internally echoing twins one born dead. Super brilliant NHS. Elder baby will be off to university in September. The one who would have been born dead.

Abortion is illegal unless the mothers life is at risk. I never saw any abortions and I don’t know how common back street abortions were. I think if anyone suffered complications they’d be very reluctant to seek medical help at a hospital both because of legal ramifications and also the concern of becoming a social outcast if it became public knowledge in the community.

While I was there someone died after being raped. Not due to injuries as such, though she had a broken pelvis. She starved to death as nobody would feed her/care for her because she was considered to have brought shame on her family.

Thanks for this thread OP, it is eye opening on the reality of dangers of childbirth.

Have you seen any maternal deaths during your work there? Due to what causes?

Saw one due to blood loss, pph. Only one I personally saw in labour.

There was a pregnant woman who had an eclampsia fit and died in the local village.

Also pregnant women who died of non pregnancy related stuff, malaria, cholera, dysentery,

There was quite a big cholera epidemic when I was there. Malaria is always an issue.

The story about the woman who died after being raped is horrendous.

What positions did they generally give birth in? I gave birth twice on all fours or on my knees holding onto the bed but I know that most do so on their backs, did that differ to the women where you were? Did they seem to just know what they were doing more?

Yes, what op wrote about the woman who was raped and died left an impression on me too. I read a few such stories of horrific violence towards women (along the lines of rape-disfigurement-left to die) from different “primitive” cultures over the years. It always leaves me to ruminate about the roots of sexism in our own society- how all sorts of discrimination against women which we are used to in our everyday life and which we are conditioned to accept is actually rooted in this kind of open vicious hate. This is what it started from and this is what it was very close to just a few centuries ago.

Anyway, op - so how did your experiences alter your own outlook on life?

Thanks for this AMA.

Women gave birth flat on their back, it was all quite medicalised really. I’m sure it would be very different in the villages.

Yes the woman who was raped and died still haunts me and I question myself about it. I can remember saying to one of the doctors (who very obviously didn’t want to discuss the issue) that I could feed her and he said no, that she was better off dying because she had no life now.....no family, no friends, no home.

I suppose the whole experience has made me so grateful for what I have.....better healthcare, education for my dc, transport, a comfortable house, being safe, or at least a lot safer.

Returning to work as a midwife in the U.K. there’s been times when I’ve had to bite my tongue with women/their partners. Normally when they’ve been waiting an hour to be seen and someone will start ranting “it’s like a bloody third world country/service here”.

And I feel like saying no actually it isn’t, third world health service is two to a bed, a woman starving to death on the floor of the ward because nobody will feed her, horrendous mortality and morbidity rates. It’s not waiting to be seen for an hour.

Most fascinating thread ever !!
Thank you
What an experience for you

Would you recommend it to others for a few weeks /months?
Would you ever do it again?

If you’d asked me years and years ago would I do it again I’d have said yes......that was always the plan. And I would have recommended others doing it.

Now, not so much but only because of how unsafe the world feels. There’s been ISIS linked terrorist attacks in the country over the last few years.

To be honest I’d struggle going on holiday to Spain these days! Maybe if my anxiety over travelling wasn’t so bad but as things stand I can’t ever see me getting on a plane again anywhere. Never mind somewhere where the Foreign Office advice is that terrorist attacks are likely.