I went to the Government Hospital in Makeni as an observer and to see how the student midwives I will be teaching are getting on in their placements. There were about 10 pregnant women all sitting on benches under a corregated roof with poles supporting the roof. The ages of the women were from probably about 11 or 12 to 30's. Some of the women do not know their birth date and so it is difficult to know quite how old some of the women are.
The antenatal clinic started with a short talk by one of the student midwives about looking after their health in pregnancy and caring for their baby afterwards. Looking for signs of infection, premature rupture of membranes, sexually transmitted diseases. The women are advised to plait their hair tightly - so as to prevent wee beasties making their homes.
This talk (no questions asked by the women)was followed by prayers - both christian and muslim - all women partook in both religous activities without any conflict.
The pregnant women had blood pressure taken and this was put on a small piece of paper, then the same happened regarding their weight - so by the time the women got to have their pregnant uterus palpated they had collected various bits of paper. These bits of paper with various recordings on them were then handed to a clerk who recorded the information in a large A4 size record book. Very scant information was held in the maternal records - which are held by the women.
The examination of the mother was I thought brusk - women are not asked permission to touch their bodies or thanked afterwards. No questions seem to be asked by the women - their abdomens are briefly palpated - many women do not know the date of their last period - so dates for when babies are expected - is quess work by using fundal height.
Twins are more prevelant here - but twins are not always seen as a joy as in the developed world. Sometimes a weaker twin does not survive beyond a few weeks if that long - many twins die at birth or one does not survive the birth - more about this in another installment.
Women are seen four times during pregnancy, they are tested for HIV, STI's and have tetanus and malarial treatment as a routine. Rhesus negative women are not given anti D and there is no test on the baby to see if it is rhesus positive.
Women do not appear to have any privacy, several student midwives, State Enrolled Child Health Nurses, nursing aides are all present whilst a women has her teashirt pulled up to check her breasts and her skirt pulled down to check presentation of the baby. Fetal hearts are listened into using a Pinnard's. A scan costs money - so generally women do not have scans. Most women are anaemic but at the moment I'm not sure of the uptake of iron tablets or how they are obtained.
Men do not figure in any of the antenatal care.
Women are however referred to medical care if there are any abnormal findings.
Urine is not tested unless there is a specific reason, blood pressure is taken and attention to hair, eyes, mouth and any lymph nodes around the neck are checked so too are the legs for any swelling. I'm not sure how much women know how to look for early pre-eclampsia signs in themselves.
Next installment - a day in the delivery unit.