In the times of modern medicine, women should have the right to opt for pain relief during labor. Approximately 90% of my patients back home opt for an epidural to ease the pain of contractions and the “ring of fire”. An epidural is not an option here – not for the poor Tanzanians and not for the Tanzanians with money. Women are forced to undergo natural labor. Back home, women usually choose 4 support people to coach them through labor and delivery, in addition to a dedicated labor nurse and either a midwife or a physician. Here, women deliver alone. In the cases that I have observed recently, women are left on the exam tables to cry, moan, and scream as they wish. The nurses rarely pay attention to such howls except if they become too loud – then they are told to stop. One nurse told a woman that the baby was about as big as her breast, so just squeeze the breast and breathe. Since the nurses do all of the vaginal deliveries here, they have an air similar to many attendings back home: they don’t care much until the baby is crowning.
No support from the nursing staff
no midwives
no doulas
no family members or friends (the lack of family and friends I imagine to be cultural, but perhaps that too is a product of the hospital system).
And, most importantly no option for pain relief.
Therefore, I have sought to accompany the women in most need of labor support. What does that mean exactly to accompany a woman through labor? I stand with her, rock with her, let her squeeze my hand, or slap my arm in some cases. I coach her to breathe through contractions; I massage her legs and back. I accompany her through her suffering without any harsh words or disapproving looks.
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Today I accompanied a primigravida. I heard her pleas and screams when I first came into work. I took an extended break for rounds (which take forever) and at 2pm, my heart sunk to see her still pregnant. I had had enough and I asked a nurse for lidocaine. I was grasping at ideas for pain relief and I thought perhaps I could give her a pudendal block. The nurse seemed confused at first since the woman was still pregnant. I informed her that it was to help reduce some of the pain. She replied, “we aren’t allowed to do that.”
When I finally left for the day, she had endured 10 hours of excruciating labor pains. I advised the nurse to start oxytocin and IV hydration as she was starting to fall off the labor curve. Yet, her cervix was starting to swell as well, likely due to her high stress and inability to relax during contractions. She will likely have a cesarean section and only then with the help of spinal analgesia will she be free from her suffering.
The world of the poor and the world of the wealthy is a stark dichotomy.
The strength that I have witnessed is remarkable. Yet, suffering through labor in the era of modern medicine is not health equity. Why is it that the poorest of women who suffer from chronic ailments of economic and political instability are forced to suffer through the birthing process when a great majority of wealthy women have the choice and choose not to suffer?
… When I returned the next day, she had delivered vaginally 🙂
