I was sick yesterday (good ol’ whatchamacallit’s revenge….) so I missed our official first day on labour & delivery of Gandaki Hospital, a Western Region Referral Hospital (fyi – the levels of hospitals are: National Referral Hospitals, Regional Referral Hospitals, District Referral Hospitals, Primary Health Care Centres, and different levels of Health Posts.) I made up for it today though – by noon we had witnessed 7 births! We are still only allowed to observe at this point, but we are using this time to become familiar with the local practices and get to know the nurses and nursing students.

The birth environment here is so different than at home. Women labour in the “first stage room”, which has about 8 beds/benches. When they are fully dilated and ready to push they are brought into the delivery room which has three beds. The beds have rusty frames with black plastic cushioned tops that get wiped down between women. The walls are lined with supplies and there is a table in the corner where the nurses sit to record details from the birth.

The most shocking part (to me) of the delivery room was the number of students crowding around each woman as she pushes. At one point today I counted 18 student nurses – not including us! For three women! We are so accustomed to protecting women’s privacy during birth, and it feels unusual (and to be honest, a little uncomfortable) to see so many women crowding in to watch a woman birth, and stare in between contractions. The other shocking part is that all the women who birthed today received an episiotomy – some with analgesia, some without – but none were clinically indicated. The Nepali government policy is that episiotomies should be restricted to those cases that require it (ie. emergencies or with forceps). Unfortunately, this hospital (and many others we are told) does not practice according to updated guidelines, and every woman is cut. The women were pushing beautifully. Babies heart rates were fine. Jacquie took on the role of “suturing doula”, tending to women while their epi’s (as the nurses like to call them) were sutured. Four other aspects of labour care we would like to challenge are the fact that the nurses do not wait for restitution and pull on babies heads at birth, babies are not kept skin to skin with mom, breastfeeding does not happen within the first hour, and delayed cord clamping is not carried out.

We can’t wait until we are allowed to be “hands on” so we can demonstrate a more “hands off” delivery technique. We’re feeling pretty passionate about no episiotomies unless clinically indicated! But, babies were healthy. So that is great.