Nurse-midwife Bronwyn Hale has been with Médecins Sans Frontières since 2003 and is currently the Women’s Health Advisor with our Project Unit in Sydney. She has recently returned from the Central African Republic:
We have a project based in an area called Paoua, where Médecins Sans Frontières has taken on responsibility for the running of the hospital. I visited in March 2010 to assess the program’s progress.
Background
Before Médecins Sans Frontières was here, health posts in Paoua’s peripheral bush communities provided basic medical care and delivery care. Staff were trained, but not to the level of nurse or doctor. So basically if a problem arose before, during or after labour, adequately skilled people weren’t on hand to manage it. So now we ask them to refer women to the hospital instead, because that’s where the life-saving equipment is for a mother and her baby.
It can be a long way travelling in to Paoua, and the women have to come via motorbike. How it works is that once the decision has been made to refer, a motorbike takes her to the hospital – which can take anywhere from 30 minutes to one and a half hours.
Labour pains
The day I was visiting this particular health post in Guze, which is about 30 minutes by vehicle from the hospital, a woman had been waiting to be seen and was probably very close to her due date.
I was called over to assist. She was already in labour. I listened to the baby’s heartbeat and asked the mother what her pains were like. They were regular and close and strong. I also performed a vaginal exam to see how dilated she was – if we were going to transfer her, I wanted to be sure that she wasn’t 10cm and about to push her baby out there and then!
She was 7cm. Although it was her second baby and the heart rate was fine, we made the decision take her to hospital in our vehicle.
Within about 10 minutes of travel, her waters broke. The baby essentially whooshed out behind the waters. But he actually came out flat, quite limp and not really breathing.
So I dried the baby down with a towel and the mother’s cloth. And used this motion to stimulate the baby and try to get him to breathe.
But he was really struggling, he had a few gasps, his heart rate was really low, so I kept on rubbing him dry then did some mouth to nose. I did that for a couple of minutes, and the heart rate came up but not the breathing.
And you know, about seven minutes after delivery we got this weak little cry, and there he was. That was the strength of this little baby, he sort of pulled himself through those first seven minutes. And as soon as we got him to the hospital, about 20 minutes after the birth, we gave him much-needed oxygen and antibiotics. When he and his mother were dischargd from the hospital 3 days later, he appeared to be a well and healthy baby.
The thing is, if he’d been born at the health post, and not so close to the hospital, he may not have made it.
A classic example
This case highlights for me why we provide hospital-based obstetric care, because it’s a safe place to deliver. You just never know what’s going to happen – you would have thought looking at this woman that it’s her second baby, the baby’s heart rate is fine, everything’s going to be fine, she’ll deliver no problem.
