A delivery at Patan Hospital

Very interesting day today. Yesterday I had spent a morning going round the maternity wing of Patan hospital with Rashmi and observed one normal delivery. It was very busy and I wondered how the staff felt about some random person turning up but they were all very friendly and I was with Rashmi who is obviously very respected. The delivery was different from current UK practice, though perhaps more like UK practice 30 years ago. When a woman reaches second stage she is taken though to another room for the actual delivery. Only nurses were in attendance, no doctors as the woman was a multip and low risk. It was all very orderly, the woman got onto the delivery bed (scary looking iron thing with a hole at the end) and was told (not unkindly) to start pushing. Concepts of privacy did not seem to be considered very important as there were a lot of nurses and students in the room and the door was left partially open. It made me wonder whether this is in fact something that is important or whether, since they were all women, this was something that everyone felt comfortable with in Nepali culture. While the nurses were very directive the atmosphere of the room was quite friendly and relaxed and the woman was given some kind encouragement (ekdum ramro, very good). The baby came very easily though the nurse conducting the delivery put her hands inside and onto the baby's head shortly after crowning to help it out, manually restituted it (!) and then pulled it out without waiting for the next contraction. That did make me wince a bit. Syntocinon was given but there was no waiting for signs of separation just very quick CCT which again made me wince a bit. Baby was dried immediately, weighed and wrapped and put in a cot. Of course being English and having the ethos of skin to skin drummed into me day and night I wanted to take her to her mother but that occurred after suturing was completed. The nurses then assisted the mother with breastfeeding which they told me they always did prior to transferring the woman to the postnatal ward. I also asked about episiotomies which I had been told were very commonplace but the senior nurse told me at Patan they tried not to do them unless really necessary.

Me and Rashmi then went off and had roti and dahl in the canteen with the obligatory little cups of very sweet milky tea which I am becoming slightly addicted to.  The problem is its more like having a shot of tea so I want about 3 which Rashmi find hilarious. I would like to go back to Patan and observe a bit more to get more of a feel for the place.