Dominican Republic

At the end of February I went on a medical mission trip to The Dominican Republic as a supervising midwife to 7 student midwives. Two other certified, licensed midwives also served as preceptors to the students.

The trip was organized by a midwife friend who has her own midwifery school and it was coordinated through a medical mission organization MMI that has sites set up all over the world. For this particular trip we worked in a large maternity hospital in the DR capital, Santa Domingo. We stayed at the MMI camp in La Caleta, a suburb of the city. The camp was basic and accommodating with a friendly staff and cooks who provided our meals.

The hospital, on the other hand, was archaic and appalling, making American hospitals look like palaces. I imagine their conditions and birth practices are similar to what our hospitals were like in the 1940s and 50s. Women labored together in one room with about 20 beds under the supervision of several doctors and nurses who mostly ignored them. They all had IVs and their amniotic bag was ruptured upon admission or soon thereafter. If the beds had sheets on them at all it was one thin sheet that was soon wet with fluid—no absorbent pads. There was no air conditioning (a good thing in my opinion) and no screens on windows so flies and mosquitoes were abundant. The bathrooms never had toilet paper and the one hand washing sink (a pipe coming out of the wall that was turned on with a wrench) was shared with the custodians and their bloody mops and there was never anything to dry our hands with.

Once the mom was ready to push she was moved down the hall to a delivery room that had four tables with stirrups. She delivered with the help of loud verbal abuse, an episiotomy, and sometimes fundal pressure. All moms were unmedicated (sometimes got lidocaine for epis) unless they went upstairs for a surgical delivery. They did receive pain meds for suturing which was done overly efficiently (to put it nicely).

Baby’s cord was cut immediately and baby was whisked over to the adjoining nursery (a room the size of most of our closets) that had 4 baby beds with bare bulb lamps over them. When things got busy (this hospital does an average of 70 births a day) there were 2 or 3 babies in each bed which was fine as the babies probably enjoyed the company. (Wish I had a photo of this–so cute!)

After delivery mom went back down the hall to the early postpartum room where she stayed for at least 2 hours. In this room she could take a “shower.” Actually, there was a bucket of water in the shower stall that she used to wash off—no actual water spraying from a shower head. After about an hour baby was bought to her when the nurse came into the room and called out mom’s name (baby did have a bracelet with mom’s name). Mom would raise her hand and get her baby.

The moms wore their own dress throughout the entire process. Of course it was soaked with every bodily fluid by the end. After being stable for 2 hours in the initial postpartum room she was moved upstairs to a 4 hour postpartum room before being released. It was in the second room that her family was finally allowed to join her and bring a change of clothes, food and drink. This was the happiest room to be with them.

I’m writing about the negative conditions we observed, however there were some good aspects too. The c-section rate at this hospital was fairly low; about 18% as compared to over 30% in some U.S. hospitals. Most deliveries were unmedicated and the normal process of labor was not interrupted in the ways they are here (inductions, monitors, catheters) though actual deliveries were not allowed to progress normally. The women had no physical or emotional support during the labor but by the end of the week we noticed that inattention seemed to work well for them. The sanitary conditions and issues of security were vastly different than the US, but again their way worked fine. Infection rate appeared to be low and apparently no one was stealing babies that didn’t belong to them.

As with every birth I attend I learned something new. I learned a lot there. I learned some techniques for better assisting third stage labor. I knew, but was able to witness the fact that cultural beliefs and customs have a major effect on how women birth. I figured out ways to be a better teacher next time. This was my first experience supervising more than one apprentice at a time and it’s much different doing it in this setting than in the home environment. I am filled with gratitude that God allowed me to serve in this way and I pray for more opportunities to do so.

We also had some down time. Wednesday was the country’s Independence Day and we went to the beach and did some souvenir shopping.