Last year, over 30,000 babies were delivered at Mulago hospital, giving it claim to the top position of the busiest labour wards in the world.
Dr. Evelyn Nabunya, a consultant at the obstetrics and gynaecology ward, says the hospital’s labour ward attends to an average of 80-100 mothers a day. This includes about 20-25 mothers undergoing C-section. Violet Nabatanzi and Gloria Nakajubi find out how the facility manages
It is a mixture of baby cries and groans of pain from expectant mothers at the labour suite at Mulago Hospital. After every few minutes, an expectant mother is rushed in anticipation of a new born.
It is a bee-hive like activity as midwives, doctors and caretakers run through the corridors for every minute here counts on the safety of both the mother and the baby.
In an interview with New Vision, Dr. Evelyn Nabunya, a consultant at the Obstetrics and Gynaecology ward explains that the labour ward at the hospital, attends to an average of 80-100 mothers a day.
This includes about 20-25 mothers undergoing Caesarean procedure (C-Section).
According to the hospital records, there were 31,201 babies born in 2010, 33,331 in 2011, 33,231 in 2012 and 31,400 in 2013.
She says the hospital has three labour suites, upper Mulago, new Mulago and the private wing and these are run by a staff capacity of just 46 midwives.
The consultant explains that just last year, the hospital recorded an average of 1,922 deliveries every month in just one labour suite with an increasing number of mothers undergoing caesarean procedure after being referred from other health facilities.
Nabunya explains that to ensure a steady presence of personnel at every labour suite, the midwives work in shifts of 5-6 people distributed in the three shifts that run a day.
More so, they ensure that more midwives are attached to the labour suites than other sections since this requires more attention.
N a k iwo lo ( l e f t ) a n d N a k i m e r a ( r i g h t ) wi t h t h e i r b a b i e s at m u l a g o h o s p i ta l’ s l a b o u r wa r d . t h e m i dwi f e t o pat i e n t r at i o at t h e fa c i l i t y i s 1 : 1 5 a g a i n s t 1 : 6 r e c o m m e n d e d by WHO. PHOTO/ Vv i o l e t N a b ata n z i
The unit also has what are termed as senior house officers, who are resident doctors supported by interns and other specialists. So in a day, up to 10 medical officers are at the ward at any given time.
“There is no labour suite in the whole world that delivers as many babies as we do at Mulago because from available records, most of the said busy hospitals are way below our fi gures,” she says.
The busiest hospital in the Philippines, Dr. Jose Fabella Memorial Hospital in Manila, recorded by The Daily Mail as one of the busiest maternity wards in the world is said to deliver an average of 60 babies per day, whereas the third largest hospital in the world, the Chris Hani Baragwanath Academic Hospital in Soweto, South Africa, records an average of 65-70 babies, Pamwani Maternity Hospital, the largest public maternity hospital in Kenya registers 50-100 babies daily.
All these are below the numbers at Mulago that stand at an average of 80-100 babies a day. As Nabunya explains handling this kind of traffic comes with a number of challenges ranging from space, personnel and medical supplies.
“Old Mulago for example was built in 1962 and up to now the space has not increased in tandem with the increasing number of mothers who come to the hospital every day,” says Nabunya.
She says although they draw budget estimates, especially for the supplies every year, the numbers tend to be overwhelming, but they have to make sure the mothers and their babies are safe.
Currently, the midwife to patient ratio is way below the rates recommended by the World Health Organisation.
It stands at 1:15 against the recommended 1:6 in low resource countries.
The equipment at Mulago Hospital, as the consultant explains, often breaks down due to over use. For example, the blood pressure machines have had their life time reduced due to the large numbers.
Interventions from local non-government organisations largely supplement the Government’s efforts to provide better services at the ward.
Recently, the hospital received an Autoclave machine from PACE, an organisation that supports health services, to help in the sterilisation of equipment used at the ward so as to prevent infections.
The women’s hospital According to Mulago Hospital’s executive director, Dr. Baterana Byarugaba, the construction of a women’s hospital scheduled to start in March, will partly solve the problem of congestion in the labour ward.
The 320-bed capacity, modern national maternal and neo-natal referral centre to be constructed at Mulago Hospital complex at a cost of $34.14m (about sh91.5b) will handle high-risk maternity services.
Mulago was built in 1962, when Uganda had only eight million people, but the population has since increased to over 34 million, without significant expansion at the national referral hospital.
Mothers share experiences Miriam Nakimera happens to be one of the mothers on this particular day to be holding her bundle of joy. It is her second child, but also her fi rst-born was delivered at the same facility.
“We are many, but the midwives here try to do whatever they can to help every mother who comes in. So, I always know I am safe at Mulago, not any other place,” she says.
Nakimera had a Caesarean procedure (C-Section) for this particular baby, but all that seems trivial as she slowly strokes her little baby.
Another mother, Olivia Nakiwolo, has also just had her second baby and it is a second C-section for her.
“The situation is not that good, but in all this craziness, the medical offi cers here try to do their best for every mother who comes in,” she says.
A midwife’s experience at the labour suite With an experience of over 13 years, Sulphine Twinomuhangi has lost count of the number of babies she has delivered at the Mulago labour suite.
“Athough I have to go through the formalities of weighing the baby, nowadays, it comes natural that I can tell a baby’s weight by just lifting it in my hands,” she says.
Until three years ago, when she was assigned more administrative duties, Twinomuhangi was just like any other midwife at the labour suite. She says on average, a midwife can attend to eight mothers a day and this involves monitoring the progress from the time she checks into delivery and after.
Monitoring as Twinomuhangi explains, involves taking the mothers’ blood pressure, respiration rate, temperature, foetal heart rate, contractions, among others. This, she says, is supposed to be done hourly or after every four hours depending on the stage of the labour.
So, during that time, there are those delivering which takes attention off the mothers that are still progressing.
‘‘You deliver the baby and immediately show it to the mother for sex identifi cation and to determine whether it’s dead or alive.’’
Sometimes, even before the midwife finishes up with a given mother, another one is calling out as the baby is due. So she has to sometimes abandon the first mother before even delivering the placenta to save the new baby.
Every delivered baby has to be taken for weighing and labeling and then given Vitamin K to guard it from bleeding disorders and tetracycline eye ointment to prevent any infections.
The morning shift of the midwives starts at 8:00am and runs upto 3:30pm, but as Twinomuhangi explains, most mothers deliver in the night.
Working within the means
The head of the Gyneacology and Obstetrics section, Josephat Byamugisha, explains that they have come with a number of measures to ensure a proper flow of activities and safety of both mothers and children.
He says the delivery register is used to record all the details concerning the mother and the nurse that delivered them. This helps to track the patients from the time they check in to the time of discharge.
Byamugisha says the number of babies delivered has been increasing over the years from the 20,304 in 2000 to over 30,000 today.
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Mulago: the world’s busiest labour suite