Thursday, 18 April 2013

Cape Town & Obstetrics

So..... we have arrived in beautiful South Africa and received into the waiting arms of our loving family. There is nothing quite as special as returning home!

What I have learnt so far from maternity statistics in South Africa has made me incredibly sad when I am not just hopping angry. 

There is a 90% cesarean section rate in Cape Town within the private sector (can anyone say obstetric malpractice). I refuse to belive that all these women choose major adbominal surgery and accept all asociated risks with complete and ethical informed choice.

Within the public sector there is a 20% cesarean section rate wich is concidered normal in Europe, although the maternal and infant mortality rate is sky high. 

In Africa: 
280 000 women die annually during birth! 
10 million die due to pregnancy, or due to post partum complications. 
3 million newborns die annually, many from infections.
2.6 million stillborns annually. 

So these issues flag up two huge healthcare needs in South Africa both envolving EDUCATION, EDUCATION, EDUCATION and RE-EDUCATION. Being just one intrepid midwife in a land as vast and diverse as you can imagine, I feel this not a burden but an opportunity to engineer change, to be part of progress and a future with better maternal and neonatal outcomes. 

No-one disputes a woman's right to choose how to deliver her baby. However, making an informed choice regarding an elective cesarean section means taking an objective look at the risks. According to a study led by Alan T.N. Tita, assistant professor in the UAB Department of Obstetrics and Gynecology, "Women who choose to have their babies delivered via repeat cesarean at 37 or 38 weeks without a medical or obstetric indication, risk serious complications for their child." 

 Cesarean Section Neonatal Complications &  Risks include: 
 Premature birth when the delivery date is not accurately calculated. 
 According to a recent study, cesarean section neonates may not have the same beneficial gut bacteria at birth as babies delivered naturally. This may cause immune related troubles to develop later in life. 
 Babies born by cesarean section are more likely to develop breathing problems like asthma and allergies later in life. 
Cesarean section is known to raise a child's risk of diabetes by 20 percent. 
Lower Apgar scores at birth. 

Cesarean Section Maternal Complications &  Risks include: 
Major abdominal surgery. 
Surgical wound complications such as adhesions that can cause bowel obstruction and chronic pain. 
Resultant placenta accreta or percreta in subsequent pregnancies. This can result in complete hysterectomy to treat major haemorrhage after delivery of the placenta.
High risk of DVT - anti-thromboric medication should be prescribed, this is in the form of subcutaneous injections which sting and depending on risk may be required everyday for up to six weeks.
Loss of sensation at incision site.
Six weeks of no driving or lifting any weight heavier than the baby. In South Africa where nothing is accessible without a car this may lead to isolation and/or dpression. 
May affect breastfeeding success. 
May contribute to postnatal depression
May affect maternal-neonate bonding
Dramatically reduced incidence of skin to skin resulting in system and hormonal consequences both for the mother and neonate.

Monday, 8 April 2013


Postnatal home visits
To end this blog is too sad, it brings a tear to my eyes and a lump to my throat and therefore I am not going to end it. This intrepid adventurer is headed to beautiful South Africa in an attempt to carry on humanitarian work in the land of her birth, so stay tuned for further developments.

This journey has taught me to be still, to be grateful and to accept the tides that is our life paths. I have learnt about myself that perhaps I am not the spoilt princess I had thought and that I can be happy sleeping on the floor and that running water and electricity are not necessarily the trappings of a life fulfilled.

I have shared knowledge with the local midwives of Cambodia and in doing, have found a connectedness and camaraderie in woman-ship that has lit a fire in my heart. South Pacific Asia and the amazing,  resilient women of Cambodia will always hold a very special place in my heart and I will carry with me, this experience, their beautiful smiles and wisdom until the end of my days.

It has been hard, it has been raw and at times I wasn't sure if I had what it took to make a difference, yet through this, through the struggle I found myself again. My strength, my gift, my faith...........

I bring merely kindness!

To leave behind fear, and have the courage to walk the road of ones hearts desire is no small task. The prayer I whisper to the wind, is that I may have the courage of my convictions to journey to a place were there is peace in my heart, love at my side, kindness on my lips and caring in my hands.

Beautiful midwives

To all my wonderful family, friends and husband: Your love, support and donations have brought education, medical supplies, sanitation and safe medical practice to some very remote rural areas of Cambodia. You should all feel very chuffed with yourselves for choosing this worthy cause and I want to again reassure you that 100% of your donations has gone directly to the cause.

Weighing the baby

Birthday en-route

Up eeeeaaaarly to catch our flight from Phnom Penh to Singapore, wouldn't be so bad except we were all sleeping so badly with poor Emma suffering the worst. 5 hours a night was considered good and of course our last night in Phnom Penh was no exception.

The girls got me a beautiful hand made silver box from duty free for my birthday which was very sweet and unexpected. I love you guys, THANK YOU:-)

Arrived in Singapore too early to check into our hostel to we dumped out bags and went shopping which was fun. Singapore Slings at Raffles long bar, dinner at our street restaurant and dreams of an early night, but of such luck. Group of very noisy boys kept us awake and then eeeeeeaaarly wake up to catch flight from Singapore to Heathrow were I finally made it into the waiting arms of my gorgeous, amazing husband and promptly burst into tears of exhaustion, happiness and relief. I had not fully realised how much I missed him........He is my centre, my love, my life, my guiding star without whom, non of this would have been possible, without whom, I could not be everything I can be and without whom, life would have no meaning of purpose. Thank you my love!

Duped again

So....getting back to Phnom Penh

This time we though we would be very clever and procure our clever little selves a "barung bus" (bus for soft Westerners with mod cons like air con and a toilet. During our conversation with the travel agent, we learnt there are 3 choices:

1. A local bus (like we got before) noooooo thank you.
2. A VIP bus (air con, toilet, refreshments cart and non-stop)
3. A luxury bus (Wi Fi, air con, toilet, refreshments cart and non-stop)

Being very clever, and dead set against repeating our previous experience we decided to go for the VIP bus as Wi Fi is doge at the best of times and therefore deduced that paying and extra $7 would not be worth it.

Picked up from the hotel by mini bus and started thinking....."now this is more like it" until of course the minibus started picking up locals who got on the mini bus with their lunch. This consisted of a live chicken tide up with strips of plastic bags with chop sticks stuck on its back (well how do you suppose lunch would stay fresh in the stinking heat)?

Any-hoo, the bus did turn out to be air conditioned, however it it also made unscheduled stops to drop of and pick up passengers on the way which would not have been so bad if there was in fact a toilet and a refreshment cart. Refreshments turned out to be 500ml of water thrown at us on departure and that was all she wrote. Journey took 7.5 hours and wasn't so bad as we weren't melting. Sat next to a stinking German man who kept falling asleep all over me and his hair tickled my nose. So I was very mean and would sit forward quickly which would cause him to fall into my seat and wake him up for 10 mins at which time he would relocate himself into his designated space until our little game started all over again, and again, and again:-) quite entertaining and funny.

Arrived in Phnom Penh in a torrential down pore, left the girls huddling under a shop awning and made my way to the guest house solo as was popping for the loo. Got lost and tormented by naked teenagers dancing in the rain in the street  Had to seek refuge in a shop as they got quite bold circling me and touching me despite my angry "no's".

Found the girls and the guest house in the end, watched the prostitutes from the balcony on the 3rd floor. I think the building across the street was a brothel. Must have been a slow night as we didn't see much of interest.

Travelling by Tuk Tuk to rural villages for postnatal home visits

Back when Tuk Tuks were still a novelty:-)

Tuesday, 2 April 2013

Temples of Siem Reap

Siem Reap is beautiful,  I'm so sad we do not have more time here.

Early morning excursion to the gorgeous temples.

Angkor Wat
We decided to see Bayon by elephant - amazing, incredible,  awesome
I am so grateful, it felt like a spiritual experience
Trees at Ta Promh
Ta Promh - nature reclaiming the stones
Ta Promh my very favourite temple
Temple sculptures at Ta Promh
Incidentally, this is were Tomb Raider was filmed.
More pictures to come...


Whole day travelling from Takeo to Siem Reap.

Taxi at 05.30: Takeo - Phnom Penh (2hrs)
Local bus 12.30: Phnom Penh - Siem Reap (7.5hrs of stinking hot, destroying travelling)

Bus dropped us off in the pitch dark, out of town, hounded by tuk, tuk drivers.

Ravenous, dehydrated.....beautiful hotel, with a pool:-)

Monday, 1 April 2013

A trip down memory lane.

Angies' s photos.
Our first speed boat trip to Koh Rong
Beautiful Song Saa

Food market - Takeo
Museum on the way to Borie temples
No comment
Con (state appointed midwife), took me for a ride on her scooter
Health centre, midwives office - waiting for a labourer
Washing day
Postnatal home visits

On the move.

Nothing much going on.... visited two health centres today....

Hence, we are going to Siem Reap to look at Angkor Wat (temples) tomorrow, plan is to stay for 2 nights and then 1 night in Phnom Phen so that we can catch our early flight to Singapore on Friday.

Health Centre midwives we visited today
Interesting traffic today