Delivering Hope Amid Conflict: A Student Internship Story

Each Year 5 student training with Earth Mission spends around 6 weeks doing an internship at a remote clinic. This story is about the fabulous Naw Eh Sel Gay and her 2 fellow 5th years Naw Chu and Naw  Htoo Gay Wah.

Early one morning during their internship, a woman's husband came to the clinic in a panic. He said that his wife had been in labour for a long time and was trying to deliver at home but was having trouble. He needed them to go with him to the village. He said that the baby's head was coming down but couldn't come out. He didn't know about the cervix and so didn't know if her cervix was open or not, but she had been pushing a long time. All he could tell us for sure was that this was their first baby and he didn't think she had been to the clinic for antenatal care. Naw Eh Sel Gay was not sure what equipment they might need as they had such minimal information on the situation, so she went looking for delivery and episiotomy instruments. The local health worker wasn't sure what instruments were needed, so they quickly looked but what they found needed autoclaving. With no time to autoclave they took the items for a normal delivery and followed the husband.

It took over an hour by motorcycle to get to the woman's village and to her house. It was after 9am and an assessment of the woman showed mild contractions coming infrequently 1:10 minutes. This pain while infrequent had been happening for more than 12 hours now and the patient looked dehydrated, her mouth and skin were dry, and she had not been moving around during this time. As part of the assessment Eh Sel Gay attended a vaginal examination and found the cervix was only opened to 5cm, and the head was still a little high. She asked the woman to drink more water and to move around. Fetal Heart Rate was reassuring. On palpation the woman's abdomen palped at 36 weeks, and according to her dates she was 37 weeks and 2 days.

Over the next 5 hours Eh Sel Gay and the local health worker attempted to have the woman drink more, walk around and pass urine. The contractions did not increase in frequency or intensity. Recognising that this woman would need extra help they discussed with the woman and her husband and requested that she travel to the clinic. They agreed and arranged for a motorcycle to carry her the 1 hour 20 mins back to the clinic.

When she arrived at the clinic, they reassessed both mother and baby and were happy with their assessment. The fetal heart rate remained reassuring and on another positive note the contractions had started to increase. The ride on the motorcycle whilst one can't imagine how uncomfortable she must have been it had been beneficial. By 5pm the contractions were coming faster and stronger. They repeated the vaginal exam and found her to be 8cm dilated and the baby's head was coming down and the membranes were still intact. They were happy to continue to wait, she was progressing and everything continued to be normal.

At 8pm the woman had become very distressed, and the contractions were harder and more frequent. Her membranes ruptured and she started to push again. A beautiful baby girl arrived safely at 8:15pm.  Eh Sel Gay and her little team were both relieved and excited. A normal birth with no complications. The parents were so excited and in love with their baby.

It was decided to keep the mother a few days and keep an eye on her and help her with breast feeding and baby cares. On day 3 as is common the baby started to look a little yellow. They recognised that this was normal physiological jaundice and encouraged mum with increased breastfeeding and allowing the baby to have early morning and late afternoon sunshine. The yellow faded and the mum's milk came in.

The staff of the clinic are hoping to encourage more women to come to clinic for antenatal care and for birthing. To help them feel better prepared they requested the 3 girls give lectures on normal pregnancy, birth, hypertension in pregnancy, abnormal pregnancy and labour and PPH among other topics. Each Monday to Friday 7-8pm the girls would take it in turns to deliver lectures, talk through cases and answer questions. This turned out to be a fun internship for the 3 young women.

By Monica Parker

Maternal Health Co-ordinator