Ghana vs US: Midwifery Edition

Even without ever stepping foot into an American maternity ward, you could quickly tell that some things are very different in Ghana. From the women themselves to the delivery methods and behaviors, the labor ward is run quite differently than that in the US. Here are a few things I've noticed. 

Labor

• Women come to the hospital in labor, alone--without husbands or family members--to give birth. 
• They labor alone in beds in the labor and delivery ward, some more quietly than others. Their response to the pain of labor is different as well. While some women yell out, others remain silent. One interesting thing that I noticed is that many of them snap their fingers when in intense pain--certainly a different response. 
• There are no birth coaches, no familial support, just the woman and her contractions. 
• They labor in many positions, lying down, squatting, and standing. 
• They are only put on the fetal monitor intermittently, for about 20 minutes, when recommended by the doctor. Oftentimes, American women are hooked up to the fetal monitor throughout their entire delivery.
• They passively labor for longer--waiting to begin pushing until later, often only pushing for 10 minutes until the baby is born. This can also go badly, as some women don't make it to the delivery table before giving birth. Ha!

Someone had just given birth on the floor behind us!

Delivery

• As opposed to women in the US, who often deliver flat on their back, Ghanaian women deliver sitting in a semi-recumbent position. This allows for less compression of the birth canal and works with gravity instead of against it, presumably making delivery easier.
• Perhaps as a result of this, there are very few perineal tears (in comparison). Out of ~550 births in December, there were only 50 tears that needed repair. I think this speaks to the incredible competency of the midwives at KATH.

Superwomen.

• The mothers are told to buy supplies beforehand, and all come to the hospital with a suitcase stocked with blankets, pads, and a bucket. As they deliver, they hand the pads to the midwives as needed, something that I don't think would go over very well with American women. 

Suitcase with her supplies

• The midwives always pulled out the placenta. From what I understand, this can be dangerous if done too soon. In the US, I'm pretty sure midwives/OBGYNs wait until the woman delivers the placenta naturally, maybe pulling gently on the cord. 

Post-delivery

• After delivery, the women all seem to make Milo to drink. Milo is a very popular chocolate drink powder that you mix with water. They say that chocolate milk is the perfect recovery drink right?? Sometimes, they would also have a coke. 
• After eating, they would breastfeed the baby. There was little support with breastfeeding, though I didn't see anyone struggle. The midwives did recommend a minimum of 6 months exclusive breastfeeding, just like in the US.
• Finally, the women got up and walked out of the labor ward to move to the mother-baby unit less than an hour after their delivery. Ridiculously resilient.

Babies!

• All the babies had SO MUCH hair!

No bald babies here

• Average weight was about the same as American babies, probably around 8 pounds.
• Once born, the babies' airways were suctioned if needed and if not, they were left alone in the warmer, sometimes for upwards of half and hour until they were swaddled.
• After being swaddled, the babies were often left in the middle of a bed until the woman was ready to breastfeed, which could have been anywhere between 15 and 45 minutes. 

Trying to swaddle:

• The mothers did not show the same joy that is usually associated with birth, often not holding the baby until an hour post-delivery. I would assume this is just a cultural difference in expression and is not indicative of disinterest in the child. 
• To me, all the mothers seemed like naturals. :)

Who knew that such a common biological practice could look so differently in different cultures? I've loved observing and comparing, and the medical students love to hear about how we do things in the US. It's a learning experience for all of us!

 Be back soon with a wrap-up of what I've learned. :)
-Allie

The Day I Delivered a Baby

Happy day!

How do I even begin to describe the events of the day? It was just the perfect storm of events that I asked for that culminated in my first delivery.

I walked into the delivery ward this morning and immediately asked, "Sarah, can I catch a baby today?" Her positive response was all I needed to set the day off with a good start. The labor beds were all full when I arrived and my chances of a delivery soon were looking good.

I was paired with Sandra, one of the lead midwives, for the day. This made things so much easier, as Sandra is so knowledgeable and speaks the best English out of all the midwives. She was going to make sure I got to deliver a baby. Throughout the morning, I helped monitor patients, testing urine and checking IVs and the fetal heart rate. 

BFFs

While I had my eye on a patient who was 7 cm dilated when I arrived, she had not delivered by the time the medical students began arriving around 10:30. All of a sudden, Sandra said, "She's full! Get dressed! Quickly!" Not willing to miss this for the life of me, I ran to get on the plastic apron, boots, elbow gloves, face mask, and goggles. I was sweating already.

Geared up and ready to go!

The next few minutes were the longest and shortest of my life. (Luckily, Sandra videoed the whole thing!) The midwives showed me how to protect the perineum and feel around the head, pushing it down to help it exit the birth canal. After 5 minutes or so, the mother gave birth to the head, which I quickly wiped clear. Sarah had me feel for the cord, which was wrapped around the neck, but apparently not tightly enough to need to be cut. The body came out all at once in a glorious mess. I helped guide the baby onto the mother's stomach and then clamped and cut the cord all by myself!

It's a girl!

I helped lift the baby to show the mother--it's a girl!--and then weighed her (3.1 kg ~ 6.8 lbs) and put her in the warmer. Afterwards, I delivered the placenta all by myself too! And it was all over--15 minutes after it began. And it was amazing.

And then I ate a PB&J. 

What a morning!

____

Not to be outdone, the rest of the day was just as eventful! 

A few hours later, a woman walked into the ward and laid down to be examined, but before the doctor reached her, she was pushing out a BREECH baby right on her bed! Instead of the usual cephalic (head) presentation, this baby was coming out folded in half, butt first. It looked so bizarre, but the midwives took it in stride. Sandra untucked the baby's legs then helped to pull his head out. Breech babies are dangerous because instead of the largest part of the baby (the head) coming out first, the butt or legs do, and the head can get stuck, the cervix closing around the neck. Because of this, Sandra pulled pretty forcefully to unlodge the head and the baby and mother were both fine. I am so so glad I got to see this, as breech babies in the US are usually delivered via c-section due to possible complications. 

Finally, another woman gave birth on the floor next to her bed. There seems to be a trend with people not making it to the delivery tables! Certainly keeps things interesting!

Goofs

Today was the best day by far and if I was ever unsure about midwifery before, there is no hesitancy now whatsoever. This was the first of many deliveries to come! Any takers? :)

Baby count: 11

Babies caught: 1!!!!!!

Adventures in the Delivery Room

I love the delivery room because it alternates between periods of major downtime (read: endless games of solitaire on my phone) and then high intensity action. And sometimes, you never see it coming. So exciting!

Croc party!

The past few days have been just that: so exciting! I'm making friends with the midwives! I think I serve more as a source of entertainment for them, but I'll take it. I'm like a little kid that they teach bad words too and then laugh at how I pronounce them in Twi. Their favorite is when they say "Ahhh, brunee" and I respond with something that means "White people have all the fun." I think it's awful, but they love it. They also love the little soft curly hairs around my face and to remind me that I'm too small to be 21. But I don't mind being teased because now that we're cool, they said that I can probably deliver before I leave---highly supervised of course, but I'll take it! Keep your fingers crossed for the perfect storm these next couple of days!

My favorite med students!

Aside from my social endeavors with the midwives, I observed a few more births since I've been here, and let me tell you, nothing seems to ever go completely normally. Here are a few stories:

Cervical dilation reference

I got to the labor ward early today, about 4 hours before any of the med students would be there to steal my chances, but unfortunately there were no patients. Womp wompp... So we all waited and chatted...well they chatted and I tried to look like I understood. By the time the med students arrived, there were a few patients laboring in the beds, but none ready for delivery. A while later, a woman who was only 8 (out of 10) cm dilated began waddling over to the birthing tables, accompanied by two students. There's no way I can describe her walk other than looking like she was about to poop her pants. And she didn't make it. Right before she reached the table, she was squatting on the ground and gave birth into the hem of her skirt. Amazing! 

I took a picture of the floor afterwards, but it kind of looks like a crime scene so I don't think I'll post it...I guess it is true when they say the second baby slides right out...Ha!

Gratuitous newborn picture

Later in the day, after hours of waiting around and a shift change for the midwives, another woman was ready to deliver. I only wish my midwife friends hadn't left because maybe I would have been able to catch this one, but then again, I'm glad I didn't...

This woman was tiny with a huge belly and as the baby began crowning you could already tell that the baby had a massive head. Not only that, but once the head was delivered (painfully I imagine), the midwife checked the baby's neck and found that the umbilical cord was wrapped tightly around it. I swear this is better than primetime. I was holding my breath watching this, but the midwives remained so cool and collected. They managed to clamp the cord, but did not have time to cut it before the baby's body was delivered. He was all wrapped up in his cord and the midwives had to untangle it before the baby tried to breathe. So intense, but they are so good under pressure. The baby (though blue) and the mother were both fine. :)

Stay tuned for a post I've been working on about the differences in a Ghanaian labor and delivery room!

-Allie

Baby count: 6

Babies caught: 0 (keep your fingers crossed!)

What I've Been Eating

(Alternate Title: Carb-loading in Ghana)

So many of you have asked about the food in Ghana that I decided to devote a whole post to it! Eating when traveling is always interesting for me because I eat differently than much of the world--no meat, eggs, or dairy. While veganism is becoming more prevalent in the United States, the same cannot be said for other countries, especially lesser-developed countries like Ghana. Because of this, I have always been fairly flexible about what I eat when I'm traveling--within reason. 

While on this trip, I have been eating a lot of eggs. I was hesitant at first, as I'm approaching 3 years of no eggs, no dairy. But everyday, I see the chickens walking around freely outside and I have no moral qualms about eating the eggs because the chickens seem happy, albeit a little dirty (but so is everything else). Dairy is still a no-go, but luckily I found soymilk! Huzzah!

Lifesaver

So my experience with the food here is definitely not the norm. I have yet to try some local specialities like Fufu or peanut stew. Ghanaian food--from what I've experienced thus far--involves a lot of rice, plantains, and meat--with less vegetables than I had hoped. My host has been exceedingly accommodating, and while I certainly have not gotten the full culinary experience, I don't think I'm missing out on the meat skewers I see cooking on grills on the side of the road. 

A typical day of eats for me looks as follows:

Breakfast is the easiest for me and usually involves cereal, toast, or some type of scrambled eggs. Sometimes Dora makes me tea, too, which is really strong and delicious.

Lunch and dinner are pretty interchangeable in regards to the food I eat. It's usually some combination of the following. 

• Rice: Once again, there is a lot of rice. Some fried rice, some white rice, and a West African dish called Jollof rice. Jollof rice is cooked with tomato paste and a mixture of spices and reminds of an African version of Spanish rice...if that makes sense. 

Fried rice and vegetables

Fried Rice with Tomato sauce?

Rice and Scrambled Eggs

• Beans: Dora cooks me a lot of beans, which I love.

Where are the greens?

• Eggs: Mostly scrambled with onions, tomatoes, etc.

• Plantains: Coming into this trip, I didn't like plantains. Many of you know that I can't stand bananas and I always say that plantains are just bananas trying to disguise as potatoes. For the most part, I still believe that, and the first time I had them, I only choked about half of them down. The second time, though, I couldn't taste the banana-y flavor as much and enjoyed them much more! They might just make me a fried plantain convert! (But don't think this means I will ever like bananas)

Plantains and beans

• Yams: At home, when people say "yams" they are referring to sweet potatoes. But here, that is not the case. Yams are basically HUGE starchy potatoes and while they're tasty, they're not too exciting. 

Real Yam
(Source)

Fried yam, beans, and eggs

• Vegetables: I have really enjoyed all the vegetables that Dora has cooked for me with eggs or rice. And I even had a salad once! Despite everyone's warnings not to eat raw vegetables, I survived.

Jollof rice and the salad that could have ended badly

So overall, I've been carb-loading over here in Ghana with huge plates of rice, fried plantains, and potatoes. I even had spaghetti one night! While I am definitely not going hungry, I can't wait for a huge plate of vegetables when I get home. And maybe I'll buy some chickens so I can get my own eggs... haha!

Oh, and of course, I've been steadily making my way through the peanut butter I brought with me. Why did I only bring one jar?!

Only a few more hours until lunch. I'm hungry!

UPDATE:

Just tried some of Dora's fufu and it was so good! Fufu is made from mashed cassava and yams that forms a sticky ball. They serve it with a spicy soup and usually some sort of meat. While I ate mine (sans chicken) with a spoon, Dora and Romeo used their hands like real Ghanaians...

Like a dumpling!

Let There Be Babies!

Up until now, I've seen three live births in my life: one with an obstetrician, one with a midwife, and a c-section. Well today, I doubled that number in a matter of hours.

Today had a rocky start, as I didn't sleep much last night and woke up to shower and be ready by 7:30. Once we got to the hospital, the woman we were supposed to be meeting wasn't going to be in until 10 and then (at 10) called to say that she didn't know I was coming today and we would have to wait until Monday. I was not pleased. I didn't realize that coming around New Years would be such a problem and I've had to wait until everyone returned from vacation. (Since when do hospitals take vacations?) Needless to say, I was frustrated and emotional and questioning why I came. But they found a doctor to "show me around" before Monday and he introduced me to a bunch of the residents and then basically dropped me off in the labor and delivery room with the midwives. Was that so hard?

Delivery tables

Despite my excitement to meet the midwives, they are kind of like an exclusive club--a club that only speaks Twi, -sigh-. I resigned to just smiling and nodding and convinced myself that I was fine with silence and observation. 

After sitting for a bit listening unintelligibly to the cool kids talk in Twi, I was approached by a young man--the only male in the ward--who introduced himself as Ben, a medical student. Ben is 22 and went to high school in North Carolina, meaning his English is the best I've heard. Ben became my ticket in. 

Ben and a midwife

He told me all about the ward and patients who were currently laboring, and which would probably deliver next. After an hour or so, it was go time. A new woman was escorted into the ward in heavy labor and ready to go. She literally walked in, put her bags down, pulled her dress up, and gave birth. Boom. 1 baby down. 

I like to think I'm fairly well-versed in most aspects of the labor and delivery process, which is probably an overstatement, but I know what's going on. As the woman was giving birth, a gross, green substance was coating the baby. Though I had never seen it before, I knew it had to be meconium--basically fetal poop that is released if the baby is in distress. It's extremely dangerous because it can easily be aspirated once the baby is born and begins to breathe. And sure enough, when I asked Ben afterwards, he said that this woman's water had broke ON MONDAY and she didn't want to come in. If i was that baby, I would be distressed too. 

Once the baby was born, they had me rub and try to stimulate the baby, but with so much meconium, they needed suction and further assistance and transported him the MBU (mother-baby unit).

What a rush. 

Just as this baby was whisked off, a woman that had been laboring since I arrived moved from the labor bed to the delivery chair. 1, 2, 3, baby. These women make it look easy.

Baby 2

Finally, an hour or so later, the final baby of the day. A woman walked into the ward well into labor. And her stomach was huge! I said to Ben, "Do you think it's twins?" and he said, "I really hope not." While she was completely dilated, her water had not yet broken, so the midwives decided to rupture the membranes. As one of the midwives inserted the metal pair of forceps to break the amniotic sac, a drizzle of water appeared and I said, "Yay!" Nope. A few seconds later, WHOOSH! Fluid flew out of that woman and all over the floor and Ben's feet. Glad I was off to the side. 

The baby followed soon after, accompanied by another tidal wave that soaked Ben. So in conclusion, it wasn't twins, just a single baby in a sea of amniotic fluid. Mmm....

Ben had to leave to go change and shower, so I took this as my cue to leave as well. What a day! And I was feeling so great that I knew I could make it back to the house by myself. 

I took the tro-tro and a taxi all by myself! I could tell that the tro-tro attendant was impressed, if not just amused. Ha! And then a man in the taxi tried to convince me to pay his way, but I set him straight. Zing!

Feeling great and can't wait until I go back on Monday!

Maybe if I make more friends, I won't have to take so many selfies...

Baby count: 3 

Babies caught: 0 

Blood pressures taken: 1 (killed it) 

Abdominal examinations: 1 

Times soaked by amniotic fluid: 0

Until later, 

Allie

Ghanaian New Years, Happy 2014!

Here comes the rain

I've only been in a church a handful of times in my life and one of them was for my own Bat Mirtzvah. If that doesn't indicate how unorthodox my experiences at church have been, I don't know what does. Well, we can certainly add New Year's Eve at a church in Kumasi to that list. 

We headed to the church around 10 and right when we arrived, I knew this was going to be different. You could hear the people from the street. 

Once inside, I realized that this was no church, this was a party! Everyone was so excited, dancing and singing so passionately. The sermon was more like a pep rally, with a hip hop dance performance complete with Michael Jackson single-gloved dancers. I kid you not.

Even though I understood very little of what was said (they spoke mostly in the local Twi (pwee) and switched to English near the end) it still had a great message: holiness before power (I think). However, by the time we left (2 and a half hours later) I was more than ready for bed. Reverend looooved to talk. 

Also, I have undoubtedly never been more of a minority than I was last night. In a room full of at least 300 people, I was the only "bruni" (white girl--i hear it echo after me down the street). Everyone is super polite, but you can always tell what people are thinking reflected by the children. They stare at me and when I wave they grin and giggle and look away. I'm a one-woman show! 

The little boy sitting in front of me was having a field day!

____

Backtracking a bit to earlier in the day, I had my first experience with more local children. Romeo, Mammia, and I were playing soccer (ahem, football) outside when a bunch of neighborhood boys came to play. I stole the ball from them once, but it was definitely a fluke. I couldn't beat a bunch of 10-year-old Ghanian boys in flip flops playing soccer if my life depended on it. So I was the ball girl. Maybe someday they'll let me play... Haha!

After they finished playing and realized I was harmless, they all crowded around me and tried to speak to me in Twi at 100 MPH--all 8 of them. It was a game and they thought it was hilarious. They would speak to me in English and I still wouldn't understand, then switch to Twi and I would be so confused. Bullied by a bunch of 10 year olds... ;) 

Tangent: Somehow, Mammia found my belly button ring and all the kids were fascinated, if not a little horrified. "Did it hurt a lot?" they asked, wincing and grabbing their stomachs. "It's just like an earring," I said, "but in my belly button."  "But why?" And then I didn't know what to say...

Overall, I think I'm in with the kids and I had to promise that I would see them again tomorrow, after telling one of them that I couldn't get him a passport to the US...they start young. 

___

As I write this, I'm relaxing on this lovely New Year's morning with a bowl of corn flakes and soy milk (yes!!) I won't start at the hospital until Friday and it can not get here soon enough!

I hope you all had a great start to 2014!

-Allie

In Ghana, Finally

These past 48 hours have been ridiculously long and absolutely nonstop, but I'm finally here!

Last night at about 8 PM I landed in Accra. Immediately upon exiting the plane, the rain started. Welcome to Africa? Ha! Because the rain was so unexpected, the people at the airport didn't know exactly what to do and it took upwards of 2 hours for all the luggage to come out. Not to mention, there was major leakage from the ceiling until the rain stopped. It was a mess.

Thankfully, I got both of my bags and found the person waiting for me with my name on a sign (don't you love that?). We headed back to a house in Accra that I was to stay for the night. I was exhausted and nervous and they fact that I was staying in a room without a lock in a house with three strange men didn't help either. But at this point, nothing was keeping me from sleep.

We left Accra early in the morning. He had emphasized that we were leaving at 4:30, so I was up and ready to go (to the sound of roosters, mind you). But naturally, I was the first one up. When he came into my room around quarter of 5 and saw I was up, he said "You're ready, God bless you." That's me, always early! ;)

So we  boarded a bus from Accra to Kumasi, a ride that took another 5 hours. The bus was sweet, sort of like a coach bus, but pimped out in the most 70's way possible. There were colored lights lining the aisle and pink seat covers and fancy trim on the windows. The best part though, is that it was air conditioned and I easily slept almost the whole ride. 

In Kumasi, I met Dora, who is hosting me, and her children Romeo and Mammia. Romeo is 12 and Mammia is almost 3. I already have a little shadow and I love it. 

I took my first shower in what felt like forever--with water from a bucket. It was actually really nice and 

there is no way you can lack water pressure when you're pouring a bucket over your head... Efficiency!

First real meal in what also feels like forever was beans and plantains (YES PEOPLE I ATE THE PLANTAINS!). But anything besides the plain bread I've been eating would have sufficed. 

Sorry for the lack of interesting pictures, I would have taken more, but I spent most of today sleeping and I think I'm about to go do it again.

Tonight is New Year's Eve and Dora is taking me to church. I'm actually pretty psyched. We don't have WiFi in the house so I'm not sure when I will post this or others, but I'll try my best to keep you updated!

Happy New Year!

-Allie

P.s. just because I thought it was funny: 

 P.p.s. The frizz in my hair is outrageous.