Birth in Port Vila Central hospital

OK here is how a typical birth here goes…

A woman comes in and we do an initial assessment.

• Length of labor


• Status of membranes (amniotic sac ruptured or not)


• 20 minutes of fetal monitoring as long as everything is normal


• Blood pressure and pulse


• Belly palpation


• Cervical exam

If she is 6 cm or more and her bag is intact her amniotic sac is ruptured. If she is less than 6cm she is encouraged to walk around. If the baby’s heart rate is anything other than reassuring we may keep her on the monitor longer or recheck in an hour. We might call the on-call OB or might not. We go through the same steps of initial assessment about every four hours until the mom tells us that she wants to push.

Once the mom wants to push we take her into one of two delivery rooms. Here cervix is checked to ensure she is ready to push and her amniotic sac is ruptured artificially if it has not already happened. The moms lie on their backs and push their babies out. I tell the truth – the average Vanuatu woman pushes her baby out in 5 to 15 minutes even if it is their first baby! 10 IU of Pitocin is injected into the mom’s thigh with the birth of the baby’s head. You wait for the baby to restitute and then the mom pushes out her baby. The cord is clamped and cut. The baby might be lifted up to be viewed by the mom and then is taken to the warmer. Babies are routinely suctioned with an electric suction unit with a tube in their noses and mouths. To our dismay it seems like the goal is to suction all the way to the intestines. How far does that tube need to go in? The placenta is born quickly often with no pushing just controlled cord traction. The mom’s BP is checked and if it is not high she is given an injection of Ergo/Methergine in her thigh immediately after the birth of the placenta. If her BP is high she is given a second dose of pitocin. Any tear is repaired. (There is lidocaine thankfully although sometimes the midwives will try to talk us out of using it).

The baby is taken to another room where he/she is weighed and given a Hep B vaccine and a Vitamin K injection. Although we have been told by the British medical students working in the antenatal clinic that nearly every woman has some kind of STD there is no erythromycin ointment for the babies’ eyes and we have not seen any eye infections. We have not heard of any STD caused blindness either – fascinating! The baby is brought back to the delivery room and put in the warmer to be dressed. The baby is then given to the mom for its first feeding. Sometimes the moms will say that they need to rest and are not yet ready to hold their baby. Amazingly despite all the interruption the babies almost all nurse very well.

One hour after birth the mother is wheeled to her postpartum bed. She is basically left to the care of her extended family at this point. If it is daytime her baby is then taken away for a bath but if it is after 5pm it is considered to be too cold for baths (Of course I am still sweating) and the bath waits till the following morning. The mom will most likely be discharged the following morning after her baby gets a TB vaccination, a second weighing and a quick newborn exam.

So that is how we are supposed to do it. We have managed to eek out delayed cord clamping most of the time. In one case until after the placenta was born! We avoid the suction unit pretty well if there is no meconium and the baby breathes right away. We have tried to get moms in other birthing positions but mostly they look at us like we are crazy. Occasionally the mom will sportingly get into a different position and then as soon as her contraction begins she will invariably flop back onto her back and push. We have encouraged moms to touch their baby’s heads and a few moms have reached for their babies. This delights us and we eagerly pass them their babies. It is clear that the midwives think this is foolish but so far they have put up with it.