Hesperian Health Guides
What medical centers and hospitals can provide
HealthWiki > A Book for Midwives > Chapter 24: Getting medical help > What medical centers and hospitals can provide
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.
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.
An ultrasound fetoscope (Doppler) makes the baby’s heart easier to hear but does not take a picture.
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 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
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 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.
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.
Symphysiotomy
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 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
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.
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.
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 monitors and other measuring devices stick to the baby’s body to measure heart rate and other health signs.
Medical centers need community support
Every community should have a medical center with adequate supplies. At the least, a medical center should have skilled health workers and some basic tools for saving lives, including oxygen, certain medicines, and sterile equipment for doing basic surgeries. But sadly, most hospitals and health clinics do not have all the supplies they need.
Some communities do not have enough money to spend on hospitals or health care. And many communities choose to spend their money on making war or to benefit those who are already rich instead of meeting the basic health needs of the people.
Is there anything that midwives can do to change this?