by: Mandy Olive (Monday, May 16, 2011)
According to the information given to us by the Secretary of Public Health in the department of Atlantida, Tela is the area with the highest maternal and infant mortality rates. A major cause of this is the lack of formal education for the rural midwives. For this reason, we are hoping to work in Tela with the healthcare system and with the midwives to give them support and further education so that they are better prepared to deal with complications during labor and delivery.
For our first trip to Tela, Susan (a Doula from Canada), Silvia and I (MPH and medical student from the U.S.) went to their hospital to post some educational materials in the labor and delivery waiting area. We also wanted to observe the practices within the hospital and eventually give support to the women in labor. Our experience there was a very surprising, yet extremely positive one.
From the moment we entered until the time we left, all of the staff at the Tela hospital were very welcoming. After hanging up the educational materials in the waiting area (whose walls were previously relatively bare), some of the women started to get up and read them right away. Silvia had asked beforehand if any of them knew about ‘dilation’ or what it meant to be at ‘2 centimeters’, and none of them knew. For this reason, having these materials available is very important and can provide a new level of understanding and comfort for the expecting mother. This was a great start to our day, and it only got better from there.
First, the head nurse, Orphelia, in the labor and delivery area welcomed us and gave us a quick tour of the area. We immediately started asking general questions about their usual practices there, and quickly discovered that this was going to be a very positive experience for us. We found out that they allow the women to lay down, sit up, stand or walk around as desired, with no unnecessary restrictions of movement. They are also encouraged to use the bathroom as needed, and are NOT forced to deliver in an uncomfortable chair after laboring in the bed. They are free to delivery in their bed if they are more comfortable there.
Before the room became too busy, Silvia spoke with the nurses about what a “Doula” is, their responsibility in supporting and comforting the women, and some of the benefits involved. Silvia demonstrated some new positions for the nurses to try with the women that can aid in easing pain during labor and can also help to reposition the baby when needed. She also educated them briefly on massage techniques and Susan showed them how to do hip compressions to provide counter pressure. The nurses were immediately interested in receiving further education, and we could hear them saying the word ‘Doula’ throughout the morning. The head nurse also started to educate some of the women who were in the early stages of labor about what to expect and what was happening to their bodies by using the materials that we brought for them. It was really beautiful to see the excitement they had about learning more and educating others. Silvia scheduled a return date in which she will spend four hours educating all of the Labor and Delivery nurses on the techniques and benefits of acting as a Doula by providing support and promoting relaxation.
We were surprised to find out that the nurses here are also responsible for the entire delivery process (start to finish) unless something arises, in which case there is a Gynecologist on staff ready to respond. This contributes a substantial amount of flexibility and empowerment to the nurses’ decision-making skills and their ability to connect more deeply with the women. Upon meeting the Gynecologist, we were even more impressed with the department. He addressed each woman by their first name, spoke to them about what he was about to do, and helped them relax by encouraging them to trust that he would not hurt them. It was really wonderful to see how well he was able to relate to each woman.
While we were there, a young woman had gone to use to the restroom and realized suddenly that the baby was coming. The nursing staff responded quickly and in a very calm manner to the situation, returning the woman to her bed and guiding her through the very quick, efficient and peaceful birth of her daughter. The nurse delivering the baby handed it directly to the mother before clamping the cord, and the woman was NOT given an episiotomy, nor did she require stitches afterward. Although she was given oxytocin following the delivery, the nurse injecting it explained what was happening and why they were injecting it. Unlike the usual rushed, loud, and panicked responses that we were used to seeing, this was a really beautiful childbirth experience.
Before we left, we asked why there is such a difference between this hospital and most of the others in Honduras. We were told that here in Tela they take the changes in the laws (Normas) seriously and implement them right away. They are very open to change, and are even willing to work with the rural midwives, educating them and allowing them to be present with the women in the hospital if they desire to be. Although there were still some things that will need to be addressed in the future (no privacy curtains ), this hospital is truly a standard for care among the public and private hospitals alike. On our way out the door, we could already observe the nurses practicing the massage techniques they learned, and we knew that this was a place where real changes can happen.
So where do we go from here? The next steps will include Silvia’s return to the hospital to present to the Labor and Delivery nurses, and spending some time at the local healthcare center. Here, there is a clinic for pregnant adolescents, and Silvia hopes to encourage the staff to provide prenatal classes to these young girls (they currently do not receive any prenatal education). She will also be bringing educational materials to hang up in the healthcare center that will help the women understand what is happening in their bodies. Of course, there will also be a continuous need to return to Tela and assist in the education and collaboration with the rural midwives and healthcare staff. This would be another great opportunity for an experienced midwife to share their knowledge and experiences with the people of Honduras and create lifelong changes here.