University Teaching Hospital
by Analeta Peterson, Meharry Medical College
April 12, 2010
Experiences on the Maternity Ward
I was initially blown away at the number of delivery rooms when first arriving on the labor and delivery ward at University Teaching Hospital (UTH). There were no less than 20 beds for mothers who were in labor or those who were pregnant and very ill. The monitors, such as those used to assess fetal heart rates found in most U.S. hospitals, were absent. As were bedside sitting areas for patient's family and friends, likely as a result of limited space.
Five to seven midwives provide ongoing care to each patient. Their responsibilities include monitoring the progress of labor, delivering the neonate, and immediate resuscitation of any newborn in distress. Resident physicians decide who is admitted to the ward and also monitor the progress of each patient. I mostly assist with the admission process. Many of the patients are referred from clinics within the community that are unable to adequately care for severe cases. A small number come directly from home with symptoms of labor; occasionally they have given birth at home with a family member or friend providing assistance.
There is a constant flow of patients to be assessed and cared for, at times leaving staff overburdened. In a 24 hour period 60 deliveries were completed and others were either sent home with a diagnosis of false labor or admitted to a different ward for medical therapy. An average 10 operations, including cesarean sections and removal of ectopic pregnancies, are performed by the senior resident physicians in this same time period. The operating theater is continuously in use throughout the night.
A number of the women are HIV positive and receiving appropriate therapy. The primary diagnoses I've witnessed excluding normal labor include preeclampsia and cephalopelvic disproportion (the maternal pelvis is inadequate to deliver the fetus). These patients receive the standard of care and leave the hospital in good condition.
I am very impressed with the outcome of care on the maternity wards at UTH despite the lack of expensive equipment. The Zambian women are incredibly strong and very cooperative. I'm looking forward to my next few weeks here where I will be spending time in gynecology and visiting a rural clinic.