Today we visited the labor and delivery floors at a private hospital with a midwife. You can view all the photos if you like. Did you notice I say the L&D floors – as in plural? The private hospital has two pay levels for birth. You can have a private room or a semi-private. A private room is very similar to giving birth in the United States. One woman to a room, and you give birth in the labor room. The semi-private is duplex (two women) labor rooms, a separate delivery room and then recovery areas which are side areas on the floor with four areas partitioned by curtains.
In the private hospital a midwife might be responsible for five or six laboring women at a time. The doctors are not on the floor, they only come if there is a problem. But still it was obvious the midwives did not feel empowered to practice as they desired. In the hall was a water therapy tub to use in labor, installed by the hospital as an incentive to potential women. However the tub has never been used. Our guide explained that for some reason, the midwives did not feel empowered to use the tub. Perhaps this is due to the sheer volume of work their job is, and the lack of assistance. How can you be acting as nurse and midwife for 5 or 6 women, catching five or six babies, complete your paperwork and still have time to fill a tub? The hospital midwives are not the same midwives from the antenatal clinic, although you can make a special request and the midwives will try to work it out. Postpartum care is done by another midwife/nurse (remember, in Kenya all nurses are also midwives).
The hospital had all the nurse/midwives attend a lactation course through a free program several years ago. Despite this additional training, our guide explained that the breastfeeding support in the hospital is minimal. This confused us. The women are in the hospital for three or four days. It is possible the nurse/midwife working the postpartum area is responsible for the nursery and the babies do not room in, meaning it is again an issue of too low staffing levels. But this is just speculation based on what we saw. We will ask the midwife for more clarification tomorrow.
In the public hospitals, labor and delivery is laid out as a ward with rows of beds in a large room for all the laboring women. A midwife could be responsible for 10-30 laboring women at the same time. If you know anything about birth, you have probably guessed that means the midwife is not able to attend all the women while they are pushing. This puts a new spin on that statistic of 44% of Kenyan women give birth with a skilled birth attendant. Can you really count those 10-30 women as attended in labor? Needless to say this is a very stressful job with high turnover rates. The nurse/midwives adopt an abrupt manner because they have to, and the women often feel like they are mistreated.
As part of our visit to the antenatal clinic we were able to see the offices for the WHO program tracking prenatal growth in Kenyans. This is part of a global strategy to create culture appropriate prenatal and infant growth charts for use around the world. Our midwife guide had been a worker in the program a few years previous. The data collection portion of the project should wrap up next year. It will be exciting to see the new tools that come from this research.