Thursday, May 28, 2015

Maternity Ward Observational


During my two week stay at the maternity ward as a clinical instructor, I had the opportunity to note some interesting cultural observations.

Day after day, I'd arrive at the maternity center with students in tow to find a number of first-time mothers in labour. Usually, the first-time mothers laboured the longest, while the multigravidas (aka: women pregnant for the second or more times) came much later in labour.

One G2 (aka: mother for the second time) came striding in, calm as the sea after a storm, only to discover she was fully dilated. She delivered (to my and my students dismay) while we were out of the room. It took her less than five minutes from beginning to end.

But labours like hers were not the norm. Most of the women who laboured and delivered there were first-time mothers-to-be. They arrived after the first or second contractions and then stayed until the baby was born.

For some this was quick. However more often than not, they were there for the long haul. One young girl (having more than likely braxton-hicks contractions) had arrived three days before. She had not had contractions in over two days, but she was not discharged nor did she seem interested in leaving. For the life of me, I am not sure why.

Several women came in at 1 or 2 cms dilated and chose to stay. The maternity ward was bustling but they did not seem to mind. They waddled around and watched as others delivered around them one by one.

When it was their turn to push, they were watched as well.

A lot of the first-time moms had hypertonic (aka: abnormally strong) contractions even though they were only 2 cms dilated.

After talking with the staff about it, I discovered that it was common for women to try and induce labour by drinking traditional herbs. These herbs cause painful and frequent contractions that don't always dilate the cervix. I saw similar things in the Philippines.

One nurse tsked their use of herbs, explaining that usually the ineffective contractions led to exhaustion, an inevitable referral to the hospital, and an (avoidable) cesarean for fetal distress. 

I also saw things done by the staff that caused me to pause.

One nurse sutured a woman up without using local anesthetic. Naturally the woman cried out in pain with each stitch. Meanwhile the nurse yelled and berated her for making so much noise. I didn't stay to watch. I couldn't.

One day while evaluating one of the labours, I noticed her family had purchased cytotec. When I asked her about it, she informed me the nurse had insisted she buy it. The nurse denied this since she was already well advanced in labour. However when I inquired the woman's family about it again later, they presented me with the prescription the nurse had given her. I never saw what the nurse did with those drugs but they were certainly not for the woman who purchased them.

I also saw a nurse be given a 'gift' of a capulana (a traditional cloth) at one point. She hurriedly rushed to put it away in her purse as the gift-giver went back to her friend in labour. I had been told that such 'gifts' were expected by the nursing staff but I confess I was still disappointed to see it.