A Twin C-Section Birth- June 13

 Tuesday June 13

Today, my peer and I went to the Jamestown Maternity Ward instead of the children's hospital. They have a few different wards, an outdoor seating area for mothers to wait to be seen in outpatient, and an operating room facility.

We met the doctor and first saw patients in the postpartum ward, there were maybe 6 mothers with newborns, it was maybe half full. The wards have hospital beds where the mothers stay, there is so separation between the beds and it's one big open room.

The main mother that the doctor checked on was anemic and had gone into shock after she delivered her baby on Friday. It’s harder to check paleness of skin on dark skin, so they checked by comparing palm color and inner eyelid color. She had two transfusions already and needed another one. Her baby was very cute.

We then went into another ward where we saw two pregnant mothers with gestational diabetes, one with anemia who was HIV+, and one with anemia and malaria. 

We then got a tour of the operating room facility and saw the theater, the anesthesia room, the recovery room, etc. It is air-conditioned and very nice. 

We put our scrubs on and got to observe a c-section of twins! The mother was about 36 weeks pregnant and the babies were transverse. In the room were two doctors, an anesthesiologist, and 4 nurses. We saw them put the epidural in and the anesthesiologist later said that they didn't use lidocaine to numb her back because they didn't have any, I'm not sure why. The mother then laid down and they put up a sheet so she couldn't see the surgery. They were using sterile reusable sheets, not disposable ones as used in the US. Also, they said their hand washing procedures before surgery were not as thorough as in the US (the doctor said in the US and Germany you have to wash for 5 minutes straight but here it was shorter, but still sterile and they worn gowns and gloves, etc.) 

We saw them cut through all the layers to get to the uterus which took maybe 15 minutes. There was a gush of amniotic fluid when they reached the sac, and then they pulled out a foot then a baby was out! A few minutes later the second baby was born. The nurses took each baby to a station where they rubbed their back until they cried then suctioned from their mouth and wrapped them up. They showed each baby to the mother. It took maybe about 40 minutes more for them to stitch up all the layers and they used different stitching techniques for each layer. 

It was a more casual environment than I thought, the head doctor talked to us a lot throughout and at one point we all had a long conversation about the doctor arguing that Ghanaian men were more romantic than Nigerian men. One of the nurses brought in a speaker and Ghanaian pop music played in the background for part of it.

They finished and wheeled her into a recovery room, the babies were laying in a cart in the hallway. 

The doctors talked about managing her risk of hemorrhaging especially since she'd had a C-section before. 

The doctors were very nice and encouraged us to ask questions. They preferred to call us by our Ghanaian day-born names, mine is Afia for being born on a Friday. 

We then went to the labor ward. They had 3 main rooms, one was for the early stage of labor and for mothers to recover after the birth, the middle room was mainly for nurses to chart and go in and out, and the third room was for the later stages of birth and delivery. One woman had just had her baby and was lying down with a nurse managing her bleeding and another nurse was with the baby at a station across the room. I asked if they did skin to skin or initiate breastfeeding soon, and the head nurse told me that they need to clean up the bed and the mom first. But, the doctor was standing on the other side of me and told me that that was a lie, he was saying in a somewhat joking tone but it's true that I saw the mom for more than an hour and they did not bring her the baby to do skin to skin or breastfeed. 

A chart on the wall shows some metrics they have for patient outcomes, and it says that 100% of babies started breastfeeding in 30 min but I wonder if that's actually true or not.

One woman came in and they checked her and she was only 3 cm dilated, so according to a chart they use to assess when to admit them, they sent her out to progress more before coming back.

Another mother in labor had food brought and ate which may be different than in the US where moms are often discouraged from eating during labor.

There were posters all over the walls with info on what to do in certain situations or measurements to take. 

We then went home and I took a nap then went out to Sandbox beach club for my roommate's birthday (it was her 21st but the drinking age is 18 here so it wasn't as big a deal). I had steak tacos which were good, it was my first time having beef here as it isn't as common here.