I’ve been really lucky to spend 2 full weeks of my time here at Kiwoko on maternity (including labor and delivery, antenatal and postnatal ward rounds, gyn clinic, and the OR). Though women’s health and the labor process is mostly the same, there are a few major differences that I’ll highlight here.
Prenatal care: Although Kiwoko Hospital offers a daily antenatal clinic for expectant mothers, the cost and travel distance make it impractical for many women to come regularly, if at all. The prenatal testing that is done is also much more limited for the same reasons (GBS swabbing, Rh testing, and anatomy ultrasounds are beyond the scope of this clinic, while testing for HIV and other STIs remains standard practice). In the U.S., most women receive 10-14 antenatal visits with regular monitoring of fetal heart tones and more lab testing.
Setting: In the U.S., each patient has her own labor room (or suite, really, with a pull-out bed for the partner and a private bathroom). At Kiwoko Hospital in Uganda, there are 8 labor beds separated by curtains in a room that’s probably the size of 2 labor suites in a typical American hospital.
Supplies: Similarly, in the U.S., each labor suite has its own neonatal resuscitation and all labor supplies are at bedside. In Uganda, the women come with two plastic sheets that cover the labor bed (one for during delivery and a clean one for after), a roll of tearable cotton that is used to clean and as a pad for bleeding, two pairs of sterile gloves, and a razor blade for cutting the umbilical cord.
Pain control: In Uganda, there is no option for pain control during labor (but they do have epidurals for C-sections thank goodness!); in the U.S., the vast majority of women opt for an epidural (though natural labor seems to be on the rise).
Labor management: While nurse midwives still play an active role in managing labor in Uganda, the soon-to-be mother’s family members (usually a mother or sister) do the bulk of the care during labor. In the U.S., nurses do the nursing and family members (most likely the partner) is there primarily for moral support. Labor also tends to be much more medicalized in the U.S. with continuous monitoring for fetal heart rate and more frequent examinations. In Uganda, fetal heart monitoring is done intermittently on everyone except those patients receiving pitocin for augmentation of labor (and even the continuous monitoring is less well monitored as there are no computers to watch the contractions and heart rate together so monitoring depends on someone being at bedside to hear and observe the heart rate).
Delivery practices: In the U.S., we deliver breech presentation in one circumstance only: a second twin. Even fully dilated patients with breech presentation typically go for emergency C-section rather than breech vaginal delivery. Here in Uganda, most breech presentations are allowed to labor and attempt vaginal delivery with one exception: primigravid mothers.
At the end of the day, despite these differences in setting and practice, everyone is thrilled when a healthy mother delivers a healthy baby!