October 22, 2002

Midwifery in Uganda

I had a wonderful phone call this afternoon from Julie Green at the Hull Maternity Unit. She is one of the Midwifery Managers there and came to an Active Birth Workshop that I ran last May in Hull. She phoned to confirm some details for another program I am presenting there next week and she told me about her wonderful holiday from which she had just returned.

The last two weeks she had spent in Uganda, working with the midwifery staff in a hospital that catered for 5,000 births each year. She told me that she had learned an enormous amount and had put everything that we have explored in the Active birth workshop to use. She was astounded to see how easily women gave birth when left to do it themselves and it enabled her to see how far we had strayed from “natural” birth in the west. The baby’s heart beat is rarely listened to, yet the babies have high Apgar scores. Meconium abounds but is left to drain and the babies do fine. Women deal with the pain without drugs and “get on with it”. They only had 3 delivery packs with which to manage these 5,000 births, so Julie said to not worry - all they needed was a sterile razor blade, which were in plentiful supply.

Julie was surprised that episiotomy was very commonly done (with those razor blades!) and that women were giving birth on the beds. She hopes that she has encouraged them to avoid doing episiotomies but the bed is another problem - giving birth on all fours, or on a mat on the floor was seen as a retrograde step because women didn’t want to give birth “like they do in the villages”. She showed them how to encourage a left lateral position for birth and hopes that this new fangled idea will be seen as the “next fad” from the west and therefore desirable.

Western medicine has done such a lot of damage to traditional birthing practices around the world. It is heartbreaking seeing women in these developing countries trying to emulate our fancy hospitals, with their limited or non-existent equipment and supplies. Yet they have a lot to teach us. Seeing how women given birth especially in those conditions proves that nature has got it right and that we meddle at our peril. The poor outcomes that do occur in countries like Uganda are the result of things like poor transport to hospital, poor nutrition, and local cultural practices that are not always helpful.

I don’t think we have much to boast about in the west. Our birth practices are appalling by most standards and we could learn a lot from women in these developing countries. I am glad that Julie has had the chance to see for herself how it works and that I have a colleague who can spread the word both here and in Uganda. Good luck to her!

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