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