My African Experiences: Pre-Eclampsia

During my pregnancy with Little Miss, I spent 7 weeks in Africa.  As part of my medical studies.  Gaining an appreciation of medicine in a different setting, in an impoverished country.  And that is one thing I certainly did.

The area I spent time in has a birth rate of 32 per 1000, with a population of 1 million.  So around 32000 births a year.  The hospital I spent time in seemed to be the main focus of where women attended.  However, in times of need the mothers could be sent to another facility in the area.

There were never enough beds, the women shared a bed.  In a unit of approximately 20 beds, or 40 women, there were only a small handful of midwives.  The women were unable to go to the delivery room until they were fully dilated, then they walked, with all their belongings, to the delivery room.  Many never made it and delivered on the floor.  If all three beds in the delivery room were in use, then you had to deliver on the floor.  An hour after having baby, still born or alive, you had to leave the delivery room.  The only exception I saw, was one mother who was having a blood transfusion after having a still born.  She was allowed to complete her blood transfusion in the delivery room.

What was more shocking than this, was the lack of modern medical and midwifery care that was available.  The stark differences between care of a pre-eclamptic woman in the UK in comparison to the region I was in.  In the UK I was monitored twice weekly, Little Miss and I were hooked up to monitoring, and my blood pressure would be taken. I had scans every other week, checking for growth and blood flow to the placenta.  I was given anti-hypertensives and two steroid injections to help Little Miss's lungs to develop.  Once they were concerned they took me into hospital and monitored my blood pressure hourly, and finally every 10 minutes, before getting me into a HDU room for medications to stabilise my condition and for an emergency c-section to deliver Little Miss.  Little Miss was put into an incubator and was able to have an NG tube to bed fed with formula milk.

Had I been in the unit I visited, it would have been a different story.  I would have chosen how often I wanted antenatal care.  I would have chosen, and paid for each scan I wanted.  My blood pressure may never have been picked up on.  If I was lucky enough to have visited the hospital/antenatal care and found to be pre-eclamptic I would have been put in a bed, and they would have waited.  No monitoring, just waiting to see what would happen next.  They had magnesium sulphate, a life saving drug.  But it was in the 'emergency use' box, and pre-eclampsia was common place enough that it wouldn't have been seen as out of the ordinary.

I never once saw antenatal steroids given.  But I did see them given to the babies in SCBU.  I never once saw a c-section for pre-ecampsia.  I did see eclamptic fits.  They gave paracetamol.  The mother, and child would invariably die.  If Little Miss and I had been there when things went wrong, that would have been our fate too.