Week 3: Maternity Ward

Okay. First thing I would like to say is GO GIVE YOUR MOTHER A HUG. Child birth is insane.

Second, sorry if this post is a little graphic, just describing what I saw.

This week I was at La Maternidad, the maternity ward of a large public hospital in Quito. This was my first solo rotation, so I was pretty intimidated Monday morning until I met my doctor for the week. Dr. Marquez could not have been more welcoming and kind. Every morning he would meet me outside the unit to lock my backpack in his personal locker and he was constantly checking in on me to make sure I was understanding what was going on and to see if I had any questions. He also spoke nearly perfect English which was a huge bonus! Lets just say, he was very refreshing after last week.

The unit is designed like a production line. As each woman arrives, she is brought into the "Labor Room" where about a dozen women are lined up on beds in various stages of labor. Here, the doctors and med students go from bed to bed monitoring the cervix dilation, baby's heart beat and head position, and mother's pain level. Once the woman has reached the second stage of labor she is wheeled into the "Delivery Room" where she gives birth. As they wheel her down the hallway all the nurses and doctors call out "Parto! Partooooo!" ("Birth! Birth!"), to notify everyone. After, the baby is immediately taken away to a different part of the hospital while the mother rests in the "Recovery Room" until she is able to get on her feet. Then she joins her baby in the post-delivery ward (the place where I spent my first week's rotation). Also, I should mention that these women are completely alone. No one, not even the father of the child is allowed in the unit. Seeing these women give birth without any form of support was shocking.

Over the course of the week I saw two C-sections, five abortions, four natural births and two episiotomies. The C-sections were fascinating. One moment you are watching the doctor cut through abdominal muscle then the next thing you know, they are pulling a human out of her stomach. SO COOL. On my first day I saw a laparoscopic ectopic pregnancy abortion. An ectopic pregnancy is when the embryo implants itself outside of the uterine cavity. It is necessary to abort because it is fatal for mother and child. Later in the week, I saw three D & C's, an abortion technique used during the first trimester. The procedure involves dilating the cervix and surgically removing the contents of the uterus by curettage. I also saw one woman who was having a spontaneous abortion. This is when the body terminates the pregnancy before 20 weeks, characterized by heavy bleeding, abdominal pain and cervix dilation. I'm usually not a very emotional persons, but seeing this woman in so much pain and sobbing for the loss of her child while alone in a room got to me. You could literally hear her crying out for God down the hallway.

 Abortions are illegal in Ecuador. In fact, last week the country was trying to pass a bill to legalize abortions in the case of rape. It almost went through until the President called his cabinet and threatened anyone who supported legalization would need to find another job. However, abortions are legal when they are medically necessary, which was the case in each abortion I saw.

 I didn't see a vaginal birth until Wednesday and I'm going to be completely honest. It was traumatizing. For each birth, I stood right between their legs, and every time was just as horrifying as the one before. Some people say birth is beautiful and makes them cry. Well yes I agree, its beautiful and incredible AFTER all the pain, blood and screaming. I am still in shock that this is the way the human body is designed. It seems impossible until its done. But, the two episiotomies were the worst to watch. An episiotomy is when they cut the woman's perineum during the second stage of labor as a preemptive action against vaginal tears. OUCH.

Dilation and labor reference chart

The conditions at La Maternidad were hard to believe. I have nothing bad to say about the doctors I met this week, but the practice here is so different, its hard not to judge. The ratio of med students/doctors to patients is overwhelming. And their lack of professionalism is awkward. There were several times when a pregnant woman would be escorted into the room and have to wait for a bed because all the med students (and even some doctors) were sitting on the empty ones taking photos of themselves and playing games on their phone. Also, there is no restriction on who is able to examine the women. Sometimes, four or five different people would check the woman's cervix dilation without instruction to do so. This involves inserting two fingers inside the vagina to check how open the cervix is. It is painful for the women, and extremely invasive to have multiple people do this when its is unnecessary. The beds were nothing more than a plastic mattress and each woman was given a pack of diaper pads to use as their pillow. Just like the weeks before, the sanitation was frightening. The doctors never washed their hands between patients and they replaced the women's diaper pads without gloves! Also, you can imagine what it would be like in a room with a dozen women in labor.... a lot of screaming. However, I never once saw anyone comfort a mother in pain. They all ignore the cries, even roll their eyes and tell them to be quiet. This bothered me a lot because some of these women were young teens and it must be terrifying for them to be all alone, in this much pain.

On my last day I ended up having a very interesting conversation with one of the med students, Catalina. She surprised me by agreeing that the conditions are poor and explained to me that although the doctors at La Maternidad do their best, the hospital just cannot afford the time or resources to make the conditions more comfortable. She told me that many reasons behind the treatment is just the culture here. 

This week really surprised me. I found everything completely fascinating and I couldn't get enough of it. If I have the opportunity, I would love to do a second rotation at La Maternidad with Dr. Marquez.