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Cambodia Blog(4) Jealousy and a Reality Check

October 26, 2014

Well here I am in cloudy UK reading about Clare Murphy and her blog after completing her month in Cambodia. Please read it is a Great blog

I am picking up pictures on Facebook from Joy Kemp RCM enjoying her visit to Cambodia and meeting with the Cambodian Midwifery Council and Catherine and Jan. I am jealous. I want to go now!

Paula, Pippa and I (Cambodian Triplets to arrive Jan 2015) are arranging to meet up in December prior to our trip to create our action plan and share ideas, anxieties and tips.

My friends and family are anxious. The latest “Have they got Ebola there?”  Not yet I said, but it is kind of inevitable that there will be Ebola cases around the world, as people move from country to country just getting on with their normal lives.

Then I got to think about Universal Precautions.

When I started Midwifery we had to gown up and glove up to do a normal birth. Birth was seen as a near surgical event that must be kept as clean as possible at all costs. Episodes of “Call the Midwife” on TV confirmed the basis of this, as historically births moved into hospital.

Then there was a bit of a revolution about trying to make birth “normal” in the 80’s and 90’s.  Home from home rooms emerged in many hospitals. These have grown into birth centres either attached or outlying.  The emphasis was making birth a natural phenomenon not a medical event. So no gowns, but we still had gloves. We used disposable plastic aprons for the actual event that were disposed of later.  I remember a few births that happened before I had chance to get my gloves on, let alone my apron.

Then HIV came along and there was greater emphasis on Universal Precautions. Midwives were encouraged to wear goggles at birth to avoid splashes from amniotic fluid and blood. The masks during Caesarean had plastic screens attached to reduce the risk.  Many midwives balked against the idea of wearing masks and goggles as they felt it put a barrier between themselves and the woman.  I wear glasses and felt that I was a little protected if splashes occurred but I know many midwives who have swallowed or inhaled a small amount of amniotic fluid as membranes have exploded unexpectedly.

Midwives have a risky job when it comes to bodily fluids. We expose ourselves every day. Just yesterday my naked hands were on a sheet before I realised that it was stained with blood. The intention to care, sometimes blocks our brain from self- protection. But if we don’t protect ourselves today, we might not be there tomorrow to continue.

I observed the pictures from Cambodia of birth with gowns, gloves and masks. It felt like a return to an older Western Medicine time, but actually it was a reminder that birth does expose us as carers to blood born viruses of all kinds.  Yes the basic washing of hands before and after procedures is a basic. But this basic is often not available or easy, in the Ebola hit countries.

Gloves are essential, taking care when removing not to contaminate your clean hands, remembering to thoroughly wash afterwards, to clear any residual. Keeping your mouth closed when SROM anticipated. Wearing splash goggles and masks available to you, especially when in known likely, infectious or high risk contamination circumstances.

Yes, birth is natural and should be encouraged to be so in as home like a settings as possible. But if the home setting has no water and little protection from infection it is you the carer who is at risk.

We don’t know the individuals who may carry blood born viruses. I worked in Saudi Arabia where often women had no antenatal care. There were no blood tests to either reassure or create action plans for care.  Women arriving in clinics from outlying areas of the countryside in nations with only burgeoning health care systems need to be welcomed, respected  and cared for, but we need to care for us as professionals too. If we want to care tomorrow we have to care for ourselves today.

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