10.07.2016 - 10.07.2016 26 °C
Neonatal care is somewhat different to our model!
Firstly, here we are often not knowing what to expect when the baby arrives. There is no such thing as a CTG and the baby is monitored in labour using a doppler (assuming it is working, otherwise a good old fashioned pinnards!) Meconium is common, although it seems more related to the high incidence of post-term (yes, actually post-term and not post-dates) rather than fetal distress. Despite this, relatively few babies come out flat and rarely do they require active resuscitation. The commonest intervention is suction with a most unusual plastic apparatus. I couldn't find one today to photograph but this is the 'resus cot':
The baby is generally delivered onto the mother's abdomen; but really only for convenience rather than any attempt at 'bonding'. There is no delayed cord clamping, although I have seen the occasional midwife strip the cord towards the baby which I guess has a similar effect. It is whisked off to be checked, weighed, given Vit K and then has tetracycline ointment rubbed into its eyes to prevent a gonorrhoeal or chlamydial infection. It's wrapped in a colourful blanket and given to a family member until it's mother is back in her bed on the ward. I'm thinking this type of practical management would not appear in one of our extensive birth plan at Murdoch?
Despite all this, the baby is usually on the breast within 1/2 hour and generally seems to suck happily from the outset. I will talk about breastfeeding in a future post. The baby is then cared for by the mother and family members, although the midwives keep an eye on it, do regular obs and assist with breastfeeding if necessary. The baby stays swaddled and sleeps in the bed with its mother. They all co-sleep!
I've fortunately not been so far involved in many neonatal resuscitations. The equipment is basic and there are no facilities to provide ongoing care for sick babies. These babies are shipped out to the nearby government hospital which I'm told also doesn't have much to offer.
Recently we had a baby born initially healthy but required oxygen to stay pink. The mother's 2 previous babies had died at 4 and 5 days of age from an unknown cause. We sent the baby off and it lived at least 5 days before we lost contact with the mother. Obtaining any ongoing information is very difficult.
As most women are discharged after 6 hours, there is little followup for the babies. I gather the mothers are encouraged to return on 'vaccination day' and then the babies can be checked if necessary. Small babies such as my 1.7kg twin will not be discharged until breastfeeding is established and the baby has gained weight. Sometimes babies are brought back for checking if they are at risk. I am rarely consulted with regard to neonatal issues (which is probably a good thing!).
Sorry not many photos today. But here's a horse that happened to be wandering up the street as I walked home:
On a personal note......last night on my way home from the restaurant, I tripped and covered my newly washed (and ironed) trousers in mud. Not happy Jan!! So, I have made use of the sun today, boiled the kettle and found some Omo........who is impressed?
After a lot of creative investigation, I have discovered that some of my friends were on the right track with the Facebook issue. I will not go into it here but, suffice to say, I seem to have got around the problem (at least for now). Sadly, my other issue (cold shower) is not solved. I'll keep you all posted but I'm not expecting a miracle!
And so endeth my first week alone in Barhirdar! I have survived relatively unscathed. Although the hospital has been overall busy, my services have not been greatly needed and there have been no major disasters. I admit there have been some stressful moments and times I would have loved some advice or reassurance. But, overall I am coping well and feel confident about the coming week. Having said that, I'll be very relieved to see Marjolein return on the 18th!