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What medical centers and hospitals can provide

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HealthWiki > A Book for Midwives > Chapter 24: Getting medical help > What medical centers and hospitals can provide


In this chapter:

Hospitals and medical centers have life-saving tools, equipment, people with advanced training in medical skills, and medicines that you may not be able to get at home. Most hospital procedures are very useful when they are necessary. And sometimes these procedures and tools are the only way to save women’s lives.

In this chapter, we list some of the types of help you may be able to get at a medical center or hospital. We give ideas for when to get help and how to work with hospital staff and other health workers.

Remember: For most labors, advanced medical tools and procedures are not needed. In many hospitals, these tools are used much more than they should be. For example, pregnant women do not usually need to have a sonogram (a picture of the baby inside the womb). But at many hospitals, every pregnant woman is given one. Hospitals and doctors may do procedures that are not just unnecessary but also dangerous. For example, doctors may do an episiotomy (cut the vaginal opening) at every birth. This is not needed and can cause infection and other problems after the birth.

Contents

Lab tests

Laboratories have tools, such as microscopes, and people who are trained to test blood, urine, stool, and tissue for sicknesses and other health conditions. Sometimes a lab test is the only sure way to know what is causing a problem. For example, lab tests can show you if a woman has anemia, a bladder infection, or HIV.

Sonograms, Dopplers, and x-rays

Some medical centers have a machine that can take a picture of a baby inside the womb. This is called a sonogram or ultrasound. You might want a sonogram to find out if a woman is pregnant with twins or if her baby is breech.

using an ultrasound machine.

An ultrasound fetoscope (Doppler) makes the baby’s heart easier to hear but does not take a picture.

using a fetoscope.

Another machine uses x-rays to take pictures of a person’s bones inside of her body. This can show you if a bone is broken. X-rays cause damage to cells inside the body. A few x-rays will probably not cause problems, but being x-rayed many times can lead to cancer. Pregnant women should never be x-rayed unless it is absolutely necessary. If a pregnant woman needs an x-ray, her belly must be covered by a lead apron to protect the baby.

Medicines

a woman in labor lying in a hospital bed while fluid drips through a tube into her arm.
oxytocin drip
With careful monitoring and access to surgery, oxytocin can be safely given in an IV.

A careful and well-trained doctor in a well-equipped medical center can give medicines that would not be safe at home. For example, midwives should never give oxytocin at home to start or strengthen a labor. But oxytocin can be given safely in a medical center where the mother and baby can be monitored closely, and where the baby can be born quickly by surgery if something goes wrong. If a woman has been in labor for too long, oxytocin given at a medical center may help her deliver the baby.

At a medical center or hospital, you may also be able to get medicines for a sick baby. Medicines are often too dangerous or difficult to give to a baby at home.

Tools for labor and birth emergencies

We explain some procedures here that may be used in a medical center to hasten labor or get the baby out quickly. These procedures save the lives of babies who are in distress, and of mothers who have been laboring for many, many hours, or who are at risk of infection.

Breaking the bag of waters

amniohook — a tool for breaking the bag of waters

When a woman has been in labor for many hours but she is not making progress, some doctors (and midwives) use a sterile tool to break the bag of waters. This will often bring the baby’s head down hard on the cervix and speed labor.

Breaking the bag of waters increases the chance of infection and can stall
a labor if the head comes down fast in the wrong position.

Instrument birth

A baby who is stuck in the vagina can often be pulled out using forceps or a vacuum extractor.

Forceps are used to grab a baby’s head and pull him out of his mother’s body.
A vacuum extractor attaches to the baby’s head and uses suction to pull the baby out of the vagina.

Forceps and vacuum extractors are rarely necessary and are much too dangerous to use at home. But if a baby is at risk of dying (and in some other emergencies), these tools are the best and fastest way to help a baby be born.

Note: Instruments should be avoided with a woman who has HIV. Using them increases the risk of HIV infection for the baby.
"a doctor pulling a baby out of a woman's belly as she lies on a table.
cesarean surgery
Cesarean surgery (cesarean section)

Rarely, to save the life of a baby or mother, a baby must be born by surgery. For example, if the baby is in an impossible birth position, surgery is the only way to get the baby out. Surgery is also necessary when a baby and mother are in immediate danger, like when there is a detached placenta or a prolapsed cord.

Surgery is sometimes used to deliver the baby of a mother with HIV. Being born by surgery makes it less likely the baby will be infected with HIV during birth.

However, cesarean surgery can cause serious problems. For example, the woman may have an allergic reaction to anesthetic. The cut in her belly may not heal easily or may get infected. The woman may have trouble breastfeeding or caring for her baby because recovering from surgery is more difficult. A woman who has a cesarean birth needs extra rest, care, and help.

Note: Cesarean surgery is used too often! Some doctors prefer cesarean surgery because they can choose the time of birth themselves, or because they charge more money for it. In some places, most women have babies by surgery. But cesarean surgery should only be used if it is needed for the health of the mother or baby.


Symphysiotomy

illustration of the below: where the pubic bone is cut.

Symphysiotomy is a cut in the middle of the mother’s pubic bone. It is used to open a pelvis that is very small so a baby can be born vaginally. It is easier to do than a cesarean, but it is only done in a few places in the world because it does not always work. It can also cause problems, including a cut in the bladder or lifetime disability.

Transfusion (giving blood through an IV)

a woman lying down while blood drips from a bag through a tube into the back of her hand.
When a woman has lost a lot of blood, a transfusion may save her life.

A woman who bleeds heavily after a birth or from other problems (like an unsafe abortion) may need to be given blood through an IV. In some places you must bring a family member who may be able to give blood for her.
Transfusions should only be used in emergencies, because blood may carry infections like hepatitis and HIV. If a woman gets blood from someone with an infection, she is likely to get that infection too. In most places, blood is tested for serious illnesses, but there is always a small chance of getting sick from a transfusion.

Tools for helping sick babies

incubator

In places where there are few medical services, many babies who are born sick cannot get help. But a well-equipped hospital will have some resources for helping sick, small, or early babies.

An incubator is a box to keep a small or sick baby warm. Like many medical tools, it can be used too often. Most babies are best kept warm in their mother’s arms, next to their mother’s skin.

respirator

An oxygen tent or oxygen hood gives the baby extra oxygen. This can help a baby who is having trouble breathing.

A respirator helps a very sick baby breathe.

feeding tube

A feeding tube runs down a baby’s nose and into her stomach. This is used when a baby is too weak to breastfeed. The hospital may give the baby formula through the tube, but usually breast milk removed by hand is better.

heart monitor

Heart monitors and other measuring devices stick to the baby’s body to measure heart rate and other health signs.


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