Obstetrics

VILLAGE BIRTH

Heather Harris is a midwife from Melbourne. She has been on five missions with MSF, two to Sri lanka and three to Cote d'Ivoire.

“Edda, the midwife want to see you.” The message is brought to me by the village matrone who is helping Pierrette, our midwife.  We are on a Mobile Clinic up the bush in  Cote d'Ivoire and as usual it's a hot, busy day.  It's the rainy season and we nearly didn't get here because of flooded roads and the red mud sticks to everything.

I make my way to one of the modest rooms - there are four nurses working in each of the others and there is one for the midwife.   Pierrette  is busily seeing the numerous pregnant women who have arrived today.  They all sit around on the concrete floor, waiting out of the hot sun.  There is much chatter.  As usual many will be sent away as there are too many to see in the short time available to us.  “There's a  primigravida in labour back there"   she says, pointing to the next room. 

I push the rickety door open and see a young labouring woman lying in semi-darkness on the floor.  Three other women sit quietly with her, murmuring to each other. It is her first baby and she rests on a clean cloth covering the dirt floor. I listen and hear a strong fetal heart.  Further examination shows she is progressing well.  She makes no sound even as another contraction rears her belly tight again. 

We have a set of sterile scissors and some clean string to tie the umbilical cord with when the time comes.  If pregnant women are in an isolated area, we issue them with a modest  birth kit which also contains some gloves, a square of plastic, a piece of new cloth, some tape for the cord,  a bandage for dressing the cord, and a new razor blade.  “OK Pierrette, call me when she's ready."   

I leave them to go back and make the second triage.  This time I can take some slightly older children but there are so many who will not be seen today.  There is no chance for any of the adults to be seen unless they are critically ill, and I know many of them have STD’s which will have to be endured for another week or more.  The STD rate is very high, especially among the pregnant women, with miscarriage and ectopic pregnancy, premature births a direct result of this. 

Another two hours passes.  I am called back to the makeshift stuffy hot labour room.   A ball of black hair is visible. I squat on the floor and the other women gather around, urging the young mother to push.  She sweats, squeezes her eyes shut and stays completely silent.  Soon her baby arrives.  Healthy, lusty, bawling.  I tie and cut her cord.   I inject some oxytocin and we wait for the placenta to come. 

Meanwhile the attendant women break into a quiet, joyous dance, shuffling their feet rhythmically, clapping their hands and singing “Merci, merci Dieu, merci.”  With the placenta now safely out they beckon to me to join them and we all sway together, relieved that the perilous first journey is over for baby and mother.  She lies on the floor tired and impassive, her baby blinking in the gloom – they both look a bit shell-shocked. 

Two hours later, the day is finishing and we pack up the Cruiser to head back home.  Tired nurses suck on local green-skinned oranges and spit the pips on the ground.  There is much laughter and general teasing as we all climb aboard and make radio contact to report our return.  As we turn onto the muddy dirt track towards home, I look over to see the new mother leaving slowly to walk back to her village 6 kms away, her own mother carrying the newborn and the other two women walking beside her.  She is 14 years old.

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