JoAnn: Giving Birth in EG

The post-partum room at the hospital.

The labor and delivery room at Malabo Regional Hospital is extremely basic. Three stainless steel birthing chairs are lined up against one wall. Running water only comes for two hours a day, so each morning the nurses fill up large plastic barrels (with no lids) and use a bowl floating in the barrels to dispense water throughout the day. Two metal carts in the middle of the room hold the surgical instruments used during deliveries.

The door to the delivery room is usually closed and a curtain hangs in front of it to give the women a little privacy, but other than that, the women are completely exposed. Also, the women often deliver naked, because there are no hospital gowns, and they don't want to stain their clothes.

At around 9am, a fifteen-year-old was escorted into the L and D room. This was her first pregnancy, and she was clearly in a lot of pain, but here pain relief drugs are reserved for only the most severe cases. Her cervix was completely dilated but her water still hadn't broken.

The nurse poked around with a probe of some kind, and soon the floor was flooded with a brownish watery fluid. Uh oh. Meconium. The baby had had a bowel movement inside the womb. This usually is not too dangerous, but it can be harmful to the baby's lungs.

In the US, the neonatologists would have been called to stand by and check on the baby once it was born. However, here in Guinea, the obstetrician hadn't even arrived, and mom was ready to start pushing. This girl's contractions were coming hard and fast, and the nurse told me that we would have to deliver the baby without him.

"Es su primero. Tendremos que cortarla," she told me. It's her first baby. We'll have to cut her.

In the US, episiotomies, simple procedures in which an incision is made in the opening of the vagina to make more room for the baby's head, are always performed by doctors, and usually only after a women has tried to push for a while and failed. Here it seemed like they do them with every first pregnancy.

After numbing the skin of the vagina with an injection of novocaine, the nurse picked up a scissors from the instrument tray. It had been sitting out on the tray for the entire time I was in the room (probably about half an hour) so if it had ever been sterile, I'm fairly certain it wasn't anymore. Then she began the episiotomy.

Right away it was clear that the scissors was not nearly sharp enough. She was cutting through the poor girl's skin with all the sensitivity of a five-year-old trying to cut through a stack of newsprint.

After the episiotomy and a few strong pushes, the baby was out. A little girl. The one nurse had to take care of both mom and baby, so she plopped the wet newborn on the instrument tray and spent about a minute making sure that mom wasn´t bleeding too badly. Then she used one of those little suction balls to clean out baby's nose and mouth. Finally, the shivering little baby was dried off, wrapped in blankets and handed over to me.

"Vestela, por favor." The nurse asked me to dress the baby.

It had been a while since I'd held a newborn and I was a little nervous, but after some gentle wrangling, I got the baby into her little sweater and pants. With that sweet little baby sleeping in my arms, I quickly forgot about the horrors of the delivery. A little angel. I carried over to meet her mom. For the first time in hours, the new young mother smiled. "What are you going to name her?" I asked. "Valentina," she responded.

Mom had to be stiched up after the episiotomy, so I took little Valentina out into the post partum room to meet her aunties. They were excited and proud, but there was a certain hesitancy to their celebration. Fifteen-year-old moms are pretty common in Guinea, but it's still considered pretty young. The aunts thanked me, and I headed back to L and D, because there was another baby on the way.

"Es un caso de Retrovirus," the nurse informed me. HIV positive.

International experts estimate that the rate of HIV infection in Guinea is between five and ten percent. The government has faced the AIDS epidemic with an attitude of denial and continues to claim that less than two percent of the population is affected.

Because the government refuses to acknowlege the problem, distribution of antiretroviral therapy for HIV-positive patients has been slow to catch on. Further, there is still tremendous stigma against HIV patients. The nurses treated this poor lady with palpable distain.

In the US, HIV-postive moms who receive good prenatal care almost never pass the virus onto their babies. They take antiretrovirals throughout the pregnancy, and the dose is upped right before delivery. The deliveries are done by C-section under "dry" conditions, with very little blood. Then baby is given a regimen of antiretrovirals, and fed formula to prevent transmission through breast milk.

Luckily this mom was on antiretrovirals, but the baby was a month early, so pre-delivery dosage increase didn't happen. Also, the whole dry C-section procedure is not done in EG, so baby was delivered vaginally, also by a nurse. This birth was not complicated, no episiotomy. I got to dress this baby, too.

I carefully looked her over for abrasions, or any places where blood to blood contact could have been made, and didn't find any. Depending upon mom's viral load (which I'm not even sure they have the technology to test) baby could have as high as a one in three chance of contracting HIV.

I took baby out to meet her family. They had been given a prescription for antiretrovirals for the baby. I talked with them about how important these drugs were, and they assured me that they'd fill the prescription. I'm sure they did that day, but these drugs are extremely expensive, and eventually, families reach a point where they can't afford the drugs. Extremely sad.

It's pretty sickening to know that the technology exists to prevent perinatal HIV transmission, but for political and economic reasons it's not happening.

Seeing these births was a bittersweet experience. On the one hand, new life is always cause for celebration. However, the incredible disparity and injustice in the world is pretty shocking. I don't know what the solution is going to be, but we've got to find one.