Godric Gryffindor

06/11/2022

The forgotten art of pain relief

The second stage of labor starts from the time the mother in labor is fully dilated to when the baby is finally delivered.

It's a very difficult and stressful period for both the mother and the baby. It had not occurred to me how painful this stage was until I had my own son.

Then it occurred to me how barbaric it was to do anything without pain relief. The fact that some midwives feel it's ok to give a woman a cut without analgesia because she is already in pain is absolutely unconscionable.

The fact that some doctors feel it's ok to do difficult instrumental and rotational deliveries with just Perineal infiltration is just absolute savagery.

That we have no concept of a trial of difficult instrumental deliveries in theatre where women get good pain relief before any manipulation is an area we need to honestly look into.

For 12 years in my training, I had not seen a single pudendal block for an instrumental delivery.

Pain is real. Women scream because they are in pain. Let's do the right thing.

06/11/2022

The Next Generation Partograph.

The air is stale and cold. It's been a wet day. I'm scrolling through my mail. I come across some old partographs from years long forgotten.

This particular labor ended up with a Caesarean section. Looking back, she didn't need one. She wasn't given a chance to labor. Another had her waters broken immediately she came into the labor ward at 5cm and had a hormone drip (oxytocin) started - absolutely unnecessary as she was labouring herself.

The use of partographs and the management of labor is one of the biggest issues in both midwifery and obstetric practice in Ghana. There are so many women in public hospitals who are barely monitored in labor. In many situations, fetal heart rate is not checked every 30 minutes as required, contractions are not monitored and maternal vital signs not checked.

In many situations, oxytocin is started and not regulated. The uterus goes into unrecognised hyperstimulation since no one is monitoring and babies go into distress or die.

All these make me wonder if the next generation partographs will really make any difference.

As we boast about producing nursing and midwifery staff in excess and exporting, we are unable to provide one on one midwifery care for most women.
Sometimes though, I wonder if the numbers are the problem. I've worked in a unit that had 3 midwives on duty and only one woman in labor - and yet this woman didn't get one on one care. He labor was mostly not monitored.

The idea of the WHO next generation partograph is great. It introduces the concept of a companion on the record, it removes the action and alert lines and allows individualized labor plans, it also introduces important features like fetal position and decelerations on the record.

To be able to implement it, we need to allow birthing partners into the labor ward. They are more invested in our success than we appreciate and their presence improves outcomes.

Midwives have to learn to be with women throughout their labor and not abandon them at the least opportunity to have a chat like we see on our labor wards. Stay with the women, monitor them and complete the partographs.

Nobody should be counting drops for oxytocin in 2022. Even if we claim we cannot afford perfusors (though I doubt this as we waste more money on unnecessary things), dorsiflows are cheap and allow regulation of this all important but dangerous drug.

We need to teach doctors too. I find that, in most district hospitals, doctors know more about Caesarean sections than monitoring labor and taking decisions based on the partograph. They therefore rely on what they know best and not what is appropriate for the woman.

I really hope labouring becomes safer, less painful and more enjoyable for Ghanaian families as we enter this new phase of labor monitoring.

06/11/2022

GHANA: A COUNTRY THAT PRODUCES SMALL BRAINS HAS NO FUTURE.
In 1956 something strange happened in Minamata, Japan. People started developing abnormal gait, some lost their eyesight, others developed severe speech and hearing problems, tremors, insanity and in many cases people died. Pregnant women started having babies with very small heads. Some of these children could neither walk nor talk by 3 years. They had developed severe brain damage.
It was later found out that this strange combination of symptoms was due to the release of industrial wastewater high in methylmercury from the Chisso Corporation. There were high levels of mercury in both the water bodies and in the fish which was the staple of the people. About 1784 people died and over 10000 people suffered various forms of brain damage due to mercury poisoning.
Artisinal gold mining (Galamsey) is prevalent in Ghana. Conservative reports say Ghana has an estimated 1 million small scale miners. These miners ply their trade both inland and along the banks of the Pra, Offin, Ankobra and Birim rivers. They mix mercury with the gold ore to create a gold-mercury amalgam and then burn the mercury off so the raw gold remains. Adults, Children as young as nine and even pregnant women are all involved in the trade. Apart from the chronic inhalation of mercuric fumes, the mercury contaminated water is often dumped into our rivers. Fish in these rivers eat contaminated vegetation and converts the inorganic mercury into the deadly methylmercury. Fish protein binds more than 90% of this chemical so tightly that even the most vigorous cooking methods cannot remove it.
Like the average Ghanaian, you may choose to sit in Accra or Kumasi unconcerned. There is however a catch here: you don’t know where your fish is coming from. Herein lies the problem. Methylmercury in fish readily crosses the placenta and damages the fetal brain. Babies are often born with microcephaly (small head/brains). They subsequently develop cerebral palsy, mental retardation and seizures. In a study by Voegborlo et al at KNUST in 2010, 31 species of fish samples from James town and the Tema fishing harbour all had safe levels of mercury. You and I however do not know how much of the fish we consume is coming from the polluted freshwater inland rivers.
On the 24th of September 2014, Ghana became a signatory to the Minamata Convention on Mercury. Article 7 of the convention states: ‘Each party (member state) that has small-scale gold mining within its territory needs to reduce the use of mercury and mercury compounds in mining and processing.’ If I am not grossly mistaken, the situation in Ghana has worsened since 2014.
The water research institute estimates that in 14 years (by 2030) if we do not halt galamsey, there will be no treatable water source left in this country. Since we are exposing our children to so much mercury, we will have mentally re****ed adults faced with water shortage. Surely we will all die from thirst in our old age.

04/03/2018

It's a gender equality issue. Couples should be able to decide how many and when....choice not by chance....

04/03/2018

Too many women are having complications from pregnancies they did not plan. Reduce maternal mortality..Be in charge of your womb.

28/05/2017

07/02/2017

Having a child before 9 months can be a disaster. When I met her, her tiny baby had been in the Incubator for 3 days. He looked like he was panting; chest heaving heavily. He was on a ventilator. The tiny baby had an IV line which was as big as his hand. He had not developed the ability to swallow so was on IV fluids. He was on a lot of drugs. His cry was such a painful shrill. He died 2 days later. Preterm labour can be a disaster. Here are some tips on preventing preterm labour:
1. Smoking and intake of hard drugs can precipitate preterm labour. Smoking cessation and avoidance of hard drugs are key in prevention.
2. Research has shown that working for more than 42 hours/ week, standing for more than 6 hours/day and having low job satisfaction are all associated with preterm labour. Getting a paid leave or changing your schedules may be very helpful in this regard.
3. Diet rich in Omega 3 (sardines etc.), fruits, grains and vegetables are very important. The Cardiovascular Risk Reduction Diet in Pregnancy (CARRDIP) trial reported a diet low in saturated fat and cholesterol and enriched with polyunsaturated fatty acids (fish, low-fat meats and dairy products, oils, whole grains, fruits, vegetables, legumes) markedly reduced the rate of preterm birth.
4. Spacing pregnancies by more than 6 months is also very beneficial.
5. Regular ANC visits and routine urine checks for infection also reduces the risk.
6. Weak evidence suggests that having your teeth cleaned by a dentist before getting pregnant may reduce risk.
Preterm labour can be a disaster. If it is at all possible, we should all do the little that we can to avoid it.

01/02/2017

MURDER BY THE LETHAL BURGER
Its 10pm, I’m heading back from work through East Legon. I’m driving my old rickety 2005 wine Chevrolet sedan. It’s a clear night. I’m listening to some expert on BBC describing the terror of ISIL in detail. I’m famished. I’ve been driving for close to 2 hours. My wife has called me 10 times already. I wouldn’t want to wake her to get me something to eat this late. I make a quick stop at the fastfood joint to catch a burger and a coke. Guess what, I have to wait in traffic just to make it to the ‘drive thru’ to order my burger. There are so many people like me, heading home late, who need to catch a burger and a coke before they get home. I eat my burger while driving, bad habits die hard. I have to quickly brush my teeth when I get home, take a shower and crawl into bed. I know my wife would be furious if she knew I had a burger and a coke at 10. It dawns on me; I have done this 3 times already this week. I haven’t even exercised all week. How is my body going to handle all this bad cholesterol? The biggest health disaster of our time happened when the fastfood giant decided to site their outlet on that convenient stretch. It’s ideal for the business. A lot of middle income earners, bachelors, spinsters and even families. You have corporate executives, people who work late all needing to catch a snack just before bed. All the cholesterol and salt; what are we even going to do with it. It is estimated that over the next 10 years the disease burden of the country is going to shift to the noncommunicable category. The hypertensions, diabetes, heart diseases of our time are going to hit the roof. Its mass murder in the making, but it’s going to take some 10 years of slow death. Anyway I’m done with my burger. It was quite tasty. God save us all.

31/01/2017