THE BIRTHING UNIT FIRST TRIMESTER.
- Published: Wednesday, 22 August 2018 10:08
First trimester... Lets tell the world
As we approach the completion of Ruben Clinic’s first three-month period of its birthing unit operations, I find myself as engaged as ever in the daily events of the unit. It has been a sharp learning curve for all involved in the venture into the provision of free, safe and dignified birthing experience for the poor mothers of Mukuru slums,
All that has been achieved despite being quickly abandoned by the authorities. The sub county health manager had pestered the Clinic to start the birthing unit for years, and a big part of the pestering was the support we would receive including help to have the unit receiving the birthing rebate from the National Health Insurance Fund.
KSHS 3,500/- (A$ 50) would be refunded to the Centre for every birth of a mother with a National I D card. Three months on, not a shilling, nor the software needed to complete the forms, has come our way and the extra costs ( five nurses, three nurse aids, drugs and one ambulance driver ) associated with a 24/7 birthing unit continue to threaten our budget.
Three months in and I interviewed Cecilia our birthing unit coordinator, to seek out her feelings and thoughts about the Birthing unit and record her surprises associated with this three months. She began by saying, “Frank there are no guarantees with any birth, let alone well over 120 they have had in this time.”
When asked about surprises that she has encountered, she quickly unleashed a volley of them beginning with yesterday’s day at the office. Two of the seven mothers arriving to deliver had turned up with just inquiries as to how to book in a place when they would need it.
A quick examination revealed that both were in the second phase of labour and within the hour had their own babies. The mothers’ confusion stemmed from the fact that both women had had urinary tract infections and our very own clinical officer had identified the issue correctly but both women didn’t have the money to buy the prescribed antibiotics. Their infections and pains continued but for them they didn’t pick up on the change of the pain’s source. Clearly labour pain had replaced urinary tract infection pain, but all was well and they both got healthy babies and free antibiotics thrown in.
“Poverty and low education can readily play out a fatal dose of death, “ she says.
She then went on about how one young expectant mother of nineteen years of age was a part of this past 24 hours. She too was in pain and when questioned about her situation and history around the pregnancy, offered only conflicting answers to the questions posed. What became very clear was that she was totally alone in this world at this crucial moment, but unfortunately not so clear at the time was the finer details of her life and how she had come from the rural outskirts of Nairobi, that she had been disowned by her mother when found to be pregnant, was HIV+, and that she had taken some ‘medication’ about six days previously.
Quickly our staff delivered a ‘few days dead wee baby’ and now were dealing with very sick young woman.
I got involved at this stage as staff sought some tips on their next moves. “Go to our police and record a statement and then search for some next to kin of the mother.” I suggested.
A few hours later and no luck with relatives, the decision was made to call the ambulance driver and have the mother and nurse take the baby to the morgue and pay the $20 fee for body disposing. It was peak hour traffic conditions, so I told our driver to use his lights and siren when necessary, to which he informs me that it is illegal to carry a body in an ambulance.’ The police are never going to know the baby is dead, ‘I said confidently only to learn the body was in a cardboard box. “ Well take it out mate,’ is my response. The ambulance succeeded in its mission and on return we continued both the treating of the mother and the search for some relatives.
Another surprise for Cecilia is the ignorance of these soon to be mothers. Many, she says have little understanding of what is happening to their bodies once pregnant, and new mothers have even less understanding of the birthing process. Many arrive to the unit either well before their time or in the last minute, (one only got to the Centre gate) while others refuse to push and seem too confused to cooperate with the nurses.
in good time this woman: Extra bed very welcome
The extreme case was that of one expectant mother who had to be escorted to the clinic by Community health workers; because she was insisting she only had worms and was not pregnant.
Our conversation continued and I added my own real surprise and it is the unpredictability of each birthing unit day. Some 24 hours pass with out a hint of a baby, all contrasting with the events of yesterday where seven women came to give birth. At one stage I was running around looking for some stored away beds, while all the time assuring the anxious looking mothers that all would be fine, telling them,“ It won’t be like Pumwani public hospital, where regularly up to three women share a bed,’
Extra bed on the way
The next morning was Saturday and when I arrived to check on the unit, five mothers and babies were there looking fresh and relaxed, and testimony to their wellbeing was that when I returned three hours later, all but one had been discharged. Among the discharged, the young mother of the dead baby. Apparently one relative had tracked her down and taken her away.
About the referred case, this mother aged 30 years, gestation of 38 weeks came at our facility with complaints of lower abdominal pains radiating to the back increasing in intensity and frequency, cervical dilatation of 3 CMS.The mother was admitted for labor monitoring. The birthing process stalled and the baby showed signs of stress. Suddenly the mother’s blood pressure went up to 150/100mm/hg , and she complained of dizziness, poor maternal effort, dry mouth which indicated maternal distress. The team saw the danger of the mother and were able to promptly refer her with the Centre’s ambulance to Mama Lucy Kibaki hospital where a healthy baby was delivered after a cesarean section.
Among the babies one was very small, only 1.8 Kgs and the mother was showing no signs of milk. Kangaroo Maternal Care (KMC) was initiated. Both mother and child were monitored and within a few hours the baby was feeding. They needed a longer stay than the average which is about 12 hours.
Also yesterday three women had come for consultation and a check ups, only to be sent away with the assuring words,’ not yet mama just be ready and know we will be here for you. I was shown a small bag of clothes, ‘ Look Frank, this one will definitely be back as she lives nearby and she left her bag as a measure of her confidence in the birthing unit. ‘
Is this the John’s gospel words ‘I have come that they may have life and have it in its fullness?”
I could only wonder.
Among the surprises even to the mothers; Twins (2 sets) but only one set of clothes but who cares-- they are alive
The experience and the knowing at a deeper level the joy of living the gospel in this slum and shouting out loud today’s psalm
“Taste And See the Goodness of the Lord.”
Thanks donors for making it all happen.
(See the data in details of these three months)
Birthing unit statistics first Trimester
Date opening 23/5/2018
Hours operating 24hours
Mothers presented 155
Male 63 Female 70
Neo natal deaths Meconium
Macerated death 1
Consultations with mothers about
their pregnancy. 76
Average stay of mother and baby 12 hours
Time of birth 6.00am – 6.oopm 46
6.00pm – 6.00am 62
Transfers to hospital 29. 7 babies and 22 mothers.
Number 1 reason Failure to progress due to obstructed labour and fetal distress
Hospitals used for transfer.
(Kenyatta, Mama Lucy, Pumwani
Outcomes of those referred All babies successfully delivered.