As I walked through the reception area of our office in Bungoma last week, a shocking newspaper headline caught my eye - The Hell that is Delivery Rooms.’
While The Standard article’s title was sensational, I turned the page and found that the substance was very real. The article is based on a recent scientific paper http://bit.ly/2nfFmAB published in the journal BMC Pregnancy & Childbirth, about the manifestations and drivers of mistreatment of women during childbirth in Kenya.
Now, although I work in this field, have extensive professional training and understand these issues from our work in Kenya, the quotes from women interviewed for the story, brought tears to my eyes.
The authors have mined their existing data to tell us more about a reality we would rather not talk about: majority of women are abused, neglected and detained all across Kenya when giving birth. They are slapped for not pushing hard enough, verbally abused for being from the ‘wrong tribe’, and ignored completely for being too poor. To add insult to injury, both nurses and women give reasons to justify this behaviour, indicating that these things have become normalised in the health system.
Here is one of the quotes that brought tears to my eyes, from a female study respondent about being abandoned:
“... That was after the cervix had opened up and the baby had started coming out. So they were telling me to stop pushing and wait for the doctor yet the baby had started coming out. Like you may be feeling pain and you are calling out ‘doctor, doctor’ then they just say to each other ‘leave that one alone we are used to her’. So by the time they come the baby may have already come out”.
Contrast this to my experience of giving birth to our first child in a Canadian public hospital. My labour took 14 hours, fairly standard for a first delivery. And I was never alone, not for one second... During the hardest parts I had three caregivers with me. If someone needed to leave the room, one of them would always remain behind.
Childbirth is amazing and beautiful. It is also totally overwhelming. It is not something a woman can or should do alone, in any country. This is not about being strong or weak, rich or poor, Luo or Kikuyu. This is about the right (that we celebrate once a year on this day) that all women have to dignified, quality care during childbirth. And this is the standard we must reach in Kenya. All Kenyan women have the right to never be abandoned during childbirth, and we must do better.
Here is a second study quote, this time from a healthcare worker that brought tears of anger to my eyes:
“The issue of mothers saying nurses are bad must be dealt with in the community. They should be informed that nurses are not bad. Ideally any mother who has delivered in a hospital is slapped on the thighs to facilitate or encourage her to push because if the mothers do not push the danger is obvious”.
This perspective is combined with research findings that women themselves believe that physical abuse is justified to make women ‘cooperate’ and ‘focus on the birth process’. In other words, physical abuse is acceptable and is in the interests of a safe delivery.
This is ridiculous. Those of you who have delivered a baby will agree that when you are in labour, there is absolute nothing else you are capable of focusing on – other than the birth process. It’s preposterous to say slapping someone doing the hardest job of her life will in any way help her to do that job.
Unfortunately, this mentality is widespread. The justification of slapping women during the second stage of labour, or to comply during vaginal exams, has emerged as a common theme in the training we’ve provided to health workers in Kenya on a rights-based approach to maternity care.
Last year on this day I called on all of us to recognise that failures in the health system play a role in creating the working conditions in which health workers mistreat their clients. This remains true.
This year, I would like to call on my fellow nurses to think deeply. We must stop hiding behind excuses, and we must hold each other accountable. I believe that deep down, we all know that it is wrong to slap or pinch a woman in labour. This is not how we were trained.
The writer is the team leader for Options in Kenya working on improving access to quality maternal health services.