On day four of my second maternity week, I started the morning with a presentation at the doctors’ meeting on one of my favorite topics- natural family planning! There was a lot of interest in the topic, and I was asked to present again tomorrow for some of the midwives and nurses. During working hours, I decided to focus on experiencing vaginal deliveries. The midwives manage labor and deliver the babies in uncomplicated vaginal deliveries. Labor management here adopts a very hands off approach compared to my experience on the labor and delivery floor in the US. If the mother is not on any labor augmenting medication, then they are monitored on the maternity ward with hourly vitals and fetal heart rates. If the mother is on labor augmenting medication, then they are brought to the labor suite, and they are placed on continuous fetal heart rate monitoring. As there is no central monitoring, the midwives check in periodically every 20 to 30 minutes and the goal is to make sure there is no sustained low or high heart rates. Regardless of how the labor is managed, mothers will deliver their babies in the labor suite which is a separate area of the maternity ward that consists of four hospital beds separated by curtains. There is no coaching on how to push with contractions as most of this is left up to the mother’s attendant that accompanies them to the hospital which is usually their own mother or a close relative who has delivered a baby before. One of the most striking contrast between here and my prior experiences is that the labor suite is a relatively quiet area. Women are encouraged to be as quiet as possible when laboring and are somewhat discouraged from yelling out or groaning with contractions. For someone who wanted to observe this process and does not speak the local language, this made it very hard for me to know how patients were progressing. I accomplished my goal for the day though and was present for several vaginal deliveries. It is hard to believe but only one working day left. I am sad to see my time in Kiwoko coming to an end.
Lugandan word of the day: omulenzi (“oh-moo-len-zee”, noun, boy)
Medical learning point of the day: Because HIV is stigmatized, an alternate naming convention is used when communicating results among healthcare providers. TR is HIV negative. TRR is a new diagnosis of HIV. TRRK is known HIV positive. Lastly, TRRD is known HIV positive on antiretroviral therapy.
