Ilukui

Hello everyone, Ali here!  This past week I got the opportunity to work in the labour and delivery department.  Although I have learned and studied the theory behind labour and delivery, I have had only one day of practical experience before this week.  During my one day of practical experience in Canada, I saw one c-section and no vaginal births so the morning before my first Zambian shift, I was eager to help with as many births as possible.  Altogether, I saw one c-section (or "Ceasar" as the Zambians call it) and twelve vaginal births - a very busy and exciting week!

I found it interesting that although the biology of pregnancy and the birthing process is the same, the social factors vary widely between Canada and Zambia.  For instance, mothers in Zambia are entitled to only one ultrasound during their pregnancy, prenatal care is not readily available to most mothers, and no visitors are allowed on the ward.  Another obvious difference between the Canadian system and the Zambian is that in Zambia, mothers must provide all of their own supplies (bed sheets, food, water, cleaning supplies).  It made me wonder that if a mother does not have any of her own supplies, she may choose to give birth at home instead of being embarrassed in the hospital.    It was evident through my practice that the combination of these social factors play a huge role in infant and maternal health outcomes when any sort of abnormalities occur during pregnancy.

Although each birth was exciting, two births really stood out to me during the week.  The first was a mother who was pregnant with twins.  One twin was a spontaneous vaginal delivery with no complications while the other did not seem ready or able to come out.  After some tme waiting for the second twin, it was determined this mother would need a C-setion.  Ideally, this mother would have had a C-section soon after determining that one was needed, but instead we had to wait three hours before an operating room was ready.  The operating room was ill-equipped with only one anesthetist for two simultaneous surgeries and a very limited supply of blood and IV fluids.  The combination of unfortunate factors led to poor health outcomes for both the mother and the baby.  During the surgery, the mother's blood pressure dropped so low that she began losing consciousness and needed a blood transfusion.  Although there was very little available blood, the healthcare workers were resourceful and used hydrocolloid solution as a fluid expander which was able to raise her blood pressure a little. The mother left the surgery alive but with a very low level of consciousness.   The baby was not as lucky and came out with a very hard time breathing which led to its passing.  I was surprised to see a lack of urgency in the resuscitation efforts with the baby, but with further reflection, I am thinking that this lack of urgency has a strong correlation with the lack of resources available.  It felt to me that even if this baby was able to be intubated, there would be subsequent breathing issues with this child and I wonder if there would even be resources to deal with these subsequent problems.

The second birth that really stood out to me was a vaginal delivery.  The mother who spoke fluent english and loved to chat.  It was easy to build a good rapport with her and feel connected.  When it came time for her birth, I was amazed how little she complained about pain even without any pain medications.  After the delivery of her healthy baby boy and when Alana, the other student, and I had some down time, we went back to check in on the mother and baby.  When we asked what the baby's name was, the mother told us she wanted us to name him!  It felt like such an honour and compliment.  Alana and I chose a traditional Lozi name, Ilukui which means fierce one in English.  We thought that was a very fitting name because even with no prenatal care, this baby came out healthy and kicking!

I am excited to see what my last week holds,
Ali