Handling Complicated Births in Remote Wardher, Ethiopia – A Midwife’s Story
“I worked in Wardher, a remote area of Ethiopia in the Somali Regional State, where there are no fully-equipped hospitals, surgeons or operating theatres. A stethoscope and a few sterilised instruments are the tools I work with in my job as a midwife with Médecins Sans Frontières (MSF). When a pregnant woman comes in with birth complications that could risk her and her baby’s life, my team – made up of national and international staff rely on each others’ experience and skills to assess how best to make each delivery a successful one.
“One night, I was woken up by a call from the clinic. A woman had gone into labour and was experiencing complications. The birth had come to a standstill and in the time that it took me to reach the delivery room, nothing had changed. I examined the mother only to discover the baby was stuck in her pelvis with its hands and arms in front of its head – a position which would not allow the baby to pass through the birth canal. In Germany, where I come from, a doctor would have performed a Caesarean section immediately. Here, in Wardher zone, a violence-affected area, health services are limited and there is no operating theatre, surgeon or anaesthetist, so a C-section is not an option.
“In this case, I had no choice but to perform a procedure that was extremely painful for the mother: to push the baby back into the womb. After I did so, the baby was then free to move its hands again and 20 minutes later, I was holding a healthy newborn in my arms. Since the mother was doing well, she was able to return home after only a few hours.
“In this isolated zone, only 3.8 per cent of women receive antenatal care (compared to 42.1 per cent nationally) and only 2.6 per cent of deliveries are attended by a health professional (compared to 12.4 per cent nationally). Most women deliver their babies at home. If they come to the clinic, it is only after they have gone into labour and something has gone wrong. We have been promoting antenatal care in our outreach programmes and we have been seeing more and more pregnant women coming for pre-natal examinations because of this. At these consultations, our team of five midwives do general antenatal check-ups and examine for hypertension, give nutritional support and treat illnesses.
“Part of my job during the five months I worked in Wardher was to organise workshops with traditional birth attendants, who handle the majority of births. These workshops are always a rich learning experience for all. There’s a hands-on component where we practised how to feel the baby in the womb; how to help the mother deal with contractions; and we share tricks on altering the position of a baby. We practise quick response to emergencies, for example, if the baby´s shoulder is stuck to the pelvis, then you can do different – very practical and easy to learn – manoeuvres to get the baby in the right position without pulling its head.
“Here in Wardher, where there is a scarcity of health services, many women suffer unnecessarily from high-risk births due to a lack of antenatal care and medical assistance for complicated deliveries, as well as with a variety of health issues. Our clinic is a small effort to fill the large gap. I was glad to have this experience.”