Where Children are born!

Im sure many have seen the photos commissioned by Save the children with the theme ‘where children sleep’. The photographer was supposed to come up with a theme that reflects the disparity of life and standards of living amongst children everywhere.

I can come up with another theme: Where children are born!

 I have supervised births in rural health centers in Africa and Ill paint a view for you. The room was small and clean, the delivery couch bore witness to the numbers of mothers who had climbed up on the couch. Thanks to an International Organization there was one tap with running water just beside the bed. One red bucket converted to a trash can. A shelf that held hospital supplies, syringes, needles, a table with sterilized equipment for deliveries and vaginal exams. The window shutters opening to the streets where the dust billows some settling on the doctor and the patient. The heat in the room is unbearable and temperatures reach 40 degrees in the middle of the day. No anaesthesia, an abundance of ‘pele pele’ anaesthesia which consists of me rubbing the womans back and whispering ‘pole, pole’ as the contractions bore down on her! There is a manual suction machine whose suction powers are wholly inadequate! The machine has seen better days.

A few minutes before I asked the traditional birth attendant who had spent the night with the woman and had her views on how the birth should be handled to leave the room. She was present again at another delivery a few days later and we have become friends sort of. I respecting the fact that she has handled more deliveries than I have and she realizing that at the hospital, she does not take any deliveries.

We listen to the Fetal heart beat with a fetoscope whose use in the developed world is probably as a showpiece in a medical museum. No charts, no proper records exist. Her gestational age is lost in the mystery of where the earth began. Estimates are not in days but in months, a lady is 4 months pregnant here not that she last saw her period on the 9th of May 2011. This is her 10th pregnancy and she has 7 surviving children, any discussion of family planning is moot!

She groans and I rub her back whispering ‘pole, pole’.  A few hours later the head is at the perineum and my assistant (a CHW) dons the only pair of boots. When I ask for mine, I am told that there is only one pair. Luckily I have an apron and sterile gloves and so she pushes and I encourage her until at long last the baby is in my hands, bawling his lungs out.  I clamp the cord, the nurse cuts it and I hand him over to the nurse who weighs him on a scale that is lined with the inner paper of my gloves. He wraps him in his mothers extra wrapper and puts him in a crib I would not dream of letting my first born spend any time in.

I make the CHW remove the boots he has put on so I can deliver the placenta without spilling any blood on my toes! We clean the woman up and transfer her to a room that is as bare as the room she has just left. No bedsheets provided by the health center only a blanket hurriedly gotten from home. We urge her to spend one night and she obliges, the next day she leaves with her precious child.

Compare that to a hospital room somewhere in the United states.  I observed a birth in a room that could pass for a hotel suite. The mother lies comfortably in a bed with different levers to lift her head or her legs or lower it depending on what her mood is. She has been given an epidural so feels no pain and she lies in a bed with several pillows around her.

There is a resuscitation tray for the newborn and the mother in case there is an emergency. The lady’s belly is strapped to a Cardiotocograph which measures the childs movement and heart rate every second the straps are attached to the mother. Any change in heart rate is immediately noted and the mother can be wheeled straight to the theatre if there is a need for an emergency cesearean section. The room is airconditioned, there is a television whose volume can be controlled by the mother if she wants to watch TV. Her husband is in the room with her and he watches the TV while his wife waits for her baby to come.

There are at least 3 nurses in the room and when it is time for her to push the baby out, the doctors are called. They all don disposable aprons, shoe covers, sterile masks and gloves. Her bed is quickly converted to a delivery table and the baby arrives to the adulation of the nurses who ooh and aah and wrap him in clothes- new and swaddle him in the standard white shawl with blue and red stripes which decorate the edges. (I identify children born in the US on my friends facebook pages by the shawls they are wrapped in if the pictures of their first days on earth are postedJ

In a few minutes the after birth and all signs of labour are gone, the mother is back in her bed with monitors connected to her. All is well.

Both children are born! The circumstances of their birth does nothing to prevent this. One is born surrounded by the wealth of his nation, the other surrounded by evidence of his countries misplaced priorities and poverty.