Toughest Place to be a Midwife...anyone watching this?

[DrSpechemin]

have watched the previous two programmes (ambulance and bus driver) and they have been really good.
Tonights looks as though it'll be pretty harrowing though...

agree hockey but we have to see everything as relative...

Personally the heartbreak of this program and the reaction of the women to stillbirth - the main thing i take from this program is that these women need contraception. Less pregnancy ,less back street abortion, less stillbirth and therefore better care for the women and babies . This would surely surely be the cheapest solution

Absolutely. Women need access to contraception and safe abortion.

And access to well trained midwives and not have to depend on unqualified neighbours.

yes - would be the cheapest option - but if you are living hand to mouth the cost of contraception vs unknown future cost would be too high.

libya is also v relgious country so contraception would be a no go for most families.

Unfortunately lack of contraception is not just a financial issue, its also due to cultural and religious reasons which are far harder to overcome. How you actually go about doing this I don't know. I'm not usually a tub-thumping feminist (maybe a gentle tapping instead) but this is a situation where women's role in society is costing them their lives. Liberia is slightly unique in that their president is a woman, but I doubt that equality trickles down to ordinary women.

margels agree BUT with the current lessening the on the midwives by reducing the hUGE number of unwanted pregnancies this would happen naturally

instead of delivering 5th and 6th unwanted babies

Education of women is always key in developing countries. General education as well as reproduction specific.

I thought Suzanne was brilliant. Why would you think she was naive? She is a midwife in the UK, she would have little or no idea what conditions were like in Liberia unless she had previously been there. I was shocked, does that make me naive?

The basic conditions were appalling. To not even have clean fans in the wards, they were filthy and blowing dirt and germs around, surely even the basics in hygiene could be implemented. It may be something small and many might consider it insignificant but basic hygiene would be something!

We are very lucky to have the care that we have in this country. I'm 26wks pg with my second and my first, my DS, is 13 and there are many differences just in my own experience so far.

Overall, the programme left me feeling very sad and shocked for these women.

I remember one year of my Midwifery training a Midwife came to talk to us about Midwifery Uganda and showed us a video. It was so shocking.

Most women have to walk miles to the hospital, one woman had walked 20 miles in labour. Some on a scooter. They take their own sheets, and have to make makeshift cord clamps along (usually bits of cloth). Simple drugs we take for granted here for 3rd stage of labour and PPH like Syntometrine are not available.

If a woman, or baby (or both) had died they were put by the back door for the family to collect. The midwife told us it was a daily occurence to step over bodies on your way in or out.

Tonight made me feel very humble again. Not just as a Midwife, but as a mum.

They are no different to how we used to be years ago before the NHS decided to stop treated pregnancy like a disease.

I found that woman to be slightly racist the way she kept saying she expected that culture to be more natural in it's approach with things about natural birth they could teach us.

Left me sitting here thinking she was expecting them to have the baby in a hollowed out sacred tree stump and then have a zulu dance round it after. she was in Africa, not some bloody forgotten tribe in the rain forest.

Much the midwifery and obstetric practice in the Liberian hospital would be influenced by the teaching of the missionaries. Not a criticism as such, just an observation.
I have colleagues who have worked in Haiti since the disaster there, and they said the babies were wrapped and popped on shelves too.
The delivery room made me smile. Kind of. I gave birth to my youngest in a European hospital where there were 3 beds in one delivery room and 2 in another. In 2004. So not that long ago...
That said, I'd have had access to antibiotics for infection and oxytocics to stop me haemorrhaging...

sorry - yes was liberia - was watching libya on the news so mis-typed...

have sky+ to watch later!

I found this programme heartbreaking. When you think of all the threads we read and contribute to on here about the smallest aspect of maternity care, all we take for granted (rightly so) and compare it what those poor women go through. Couldn't help thinking about all those TTC-ing on here and desperate for babies, when that poor woman had more than she could cope with and wanted to give some away

The girl who gave herself an abortion and died in the process, slowly and painfully, totally abandonned, without even an aspirin to ease the horror. Made my heart ache.

I felt extremely humbled by this. I haven't had the nicest birth experience but this programme puts things into perspective. I won't be moaning about the NHS again.

It's never as simple as just giving out contraception though. There are many cultural reasons as well why contraception in Africa is considered wrong - in many of the african cultures the man needs to father as many children as he can with his wife - that's just how it is. You can't seek to change someone's cultural values for the sake of our westernised ones and what we believe to be the right thing.

Plus on a more basic level mortality over there is so high that there's almost a need to have multiple children, because there's a better than average chance that the majority of them won't make it to adulthood, and with one in twelve women dying in childbirth, you need to ensure the population, as it were. It's a bit simplistic but it's a bit like going back to the basics of nature and pro-creating to ensure survival of the species almost. You can't seek to change that principle until you change the conditions the people are living in.

Ryoko thing is that there are parts of Africa where women do give birth out in the fields and then essentially put the baby on their back and continue on with the day's work. I grew up in South Africa which comparitively is more 1st world, and even over there I knew of black women that had a baby one day and came to work with it on their back the next. I don't think that's racest at all. when you live in a country where you have nothing, then the natural assumption is that you will take the natural approach because there isn't an alternative.

I had some horrible births within the NHS and 2 late losses, also a life threatening PPH and sepsis after a late loss. But I really can't complain after seeing what these women go through in Liberia. Absolutely heartbreaking. I was thinking afterwards how it is so unfair really and why some parts of the world have so little and life is so very hard. I felt so sorry for the woman who had tried to abort.

Will be watching OBEM from a completely different angle tonight....

People need to have reasons to use contraception though, availability alone is not enough. If you know you will have to rely on your family to look after you if you make it to old age and the infant mortality/stillbirth rate is high, people will prepare for that with more pregnancies than they might otherwise have.

If children bring money into the household because they work from a young age rather than being able to attend school for free, then this choice is reinforced.

on the one hand, I thought the UK midwife to be v good at just mucking in and not looking overtly shocked.

However, I thought her very, very naive. Did she not read the title of the programme she was appearing in...........erm, 'The Worst Place in the World to be a Midwife' - did she honestly think she was going there to watch natural,safe birthing at its best?

Her comment of being angry at women demanding epidurals in the UK was outrageous. Making birth as traumatic and painful as possible/adopting a paternalistic attitude to women does help reduce maternal and neo-natal morbidity and mortality in developing nations.

I missed it as thought it was tonight. Is it being repeated. My BBCiplayer is shit

Agree that the situation in Liberia appeared shocking but wanted to say I thought the British midwife was amazing. For someone who had only left the UK once alone maybe she was a bit naive but her attitude was fantastic. She was so open to it all and so good natured and willing to pitch in. I would have been crying as soon as they served me any of the food they showed.

Ryoko, i think you're overreacting. She expected it to be more natural/ less medicalised down to there simply being less medical assistance/supplies and a stronger tradition of home births due to rural locations etc. It would seem logical for a nation where there is such a strong community of (non qualified) birth assistants (as the women who greeted her with the dancing) to have passed some of the more natural and traditional aspects of childbirth into the hospitals.

I too would have expected the approach to be less medicalised and more about letting time progress things - obviously I didn't realise the strain on resources and sheer volume of patients!

Highlander- she didn't say she was angry with people for wanting it, just resented the fact we're able to make demands for things so sophisticated when she has experienced women dying due to lack of the basics. I can totally understand that. She isn't saying we should be denied epidurals, just that we often do not realise how good we have it, and how lucky we are. We could easily have drawn a different straw in life, been born in Liberia, and ended up on one of those bare beds, on our backs in agony...we're lucky.

Time, resources and the focus on maternal health is certainly needed as the programme showed.

Some of you may be interested in the new report that is going to be published on precisely this topic in June 2011. it is covering up to 60 coutnries with high levels of maternal deaths, and Liberia is featured in that. See: - www.who.int/pmnch/media/press_materials/pr/2011/201101_midwiferyreport/en/index.html

• with a PDF fact sheet available on www.who.int/pmnch/media/press_materials/pr/2011/sowm_report_pres.pdf

We are looking for web developers and designers to help us bring the data into an interactive online resource that helps get the focus and resources flowing to this much needed area. There is a long weekend development session taking place in Exeter at the beginning of April, if you know anyone who can help contribute to this, please do let them know or get in touch: forward25.eventbrite.com/

i thought she was rather naive to think that the births in Liberia would be natural, as in peaceful, natural with lots of deep relaxed breathing etc, primitive, brutal and matter of fact, was the first thoughts that came to my mind as soon the programme started, and as for some of the women not being heartbroken when a baby was stillborn, to be honest they probably had far too many kids already and for them it was one less mouth to feed, sadly, i think she thought herself to be quite worldly, but actually she was very blinkered in her experience of the world i thought,