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Obstetricians workshop

Today was a very productive day at the workshop. We spent a lot of time exploring the practicalities of natural labour versus managed labour, challenging some entrenched practices and applauding some good management strategies.

On the plus side, pregnancy care is comprehensive and up-to-date and epidurals are rarely used in labour for easing pain. The hospital we are in has been designated as Baby Friendly since 1992, which is terrific. On the minus side, the induction and augmentation rate are at almost 100%, as hospitals struggle to manage large numbers of women through overcrowded, shared labour rooms. No privacy, shaving, enemas, restrictions on food and drink in labour, lack of a birth companion, routine episiotomy, lithotomy, and frequent separation of mother and baby at birth are common in all labours.

We spent time trying out comfort positions, using a chair, birth ball, and mat, the only equipment that would fit in the available space in most first stage rooms. Ideas for managing posterior labours were tried out (again not easy due to the coats and hijabs) and we explored how hot water in the form of wet towels could be utilised to ease labour pain. Most hospitals have no baths and showers are in short supply. Hot packs and hot, wet towels are a simple substitute.

The implications of the active management strategy being used here were also examined in detail, first using the “cascade of intervention” activity from the Essential Educator Kit and following up with group discussion around reasons for induction.

Second stage involved talking through normal physiology and demonstrating birth positions.

Here are some photos that Kirsten took yesterday and today:

Front entrance to the hospital with an orange banner announcing the new prenatal classes they have set up for pregnant women.

Workshop participants

Demonstrating how the pelvis works

The new labour and birth room. This room is not quite finished, and is due to open next week. The pool is terrific and there is plenty of space in each of the two birth rooms. An en-suite toilet and shower are also tucked into a corner. The lighting is very bright and will be replaced with dimmable lights (we were assured) and the flimsy plastic curtain separating the two rooms is to be replaced with a door to give better privacy.

The plan is that tomorrow we will try and facilitate a birth in this area as a demonstration to the group. We are hoping that a multip will be available in labour and be willing to give birth in this new area. Kirsten will supervise a couple of the midwives who will assist the woman, while a video camera feed to an adjacent room will make it possible for the large group to see what is happening without disturbing the labouring woman.

We also saw the regular labour rooms today, but were asked not to take photos. It was a dismal, old, cramped area with conditions that would be unimaginable in any hospital in Australia. There were three first stage rooms each with either four or five beds close together, with no curtain to provide even a modicum of privacy. In second stage women are moved to one of two rooms that have three delivery beds side by side in each. This is a Baby Friendly Hospital so at least mothers and babies are not separated at birth and spend either 24 hours together before going home (vaginal birth) or 48 hours in the hospital following a caesarean.

Tomorrow will be most interesting – I wonder if we will be able to show these obstetricians how natural birth can be achieved?

Posted by andrea at November 01, 2007 01:06 PM