Having a baby in Madagascar

My partner’s step-sister had her 2nd baby today at Antsiranana hospital It has been interesting to see the similarities and differences between her Madagascar experience and my British one.

Complicated birth

We were all a little nervous leading up to this as she lost a healthy baby last year due to strangulation by the cord during the birth. She’d gone well past full term again this time and her belly was still very high and didn’t show any sign of the baby dropping into position.

It sounds like she had to take control of the situation herself. She waited until the day that ‘the good doctor’ was at the hospital and went with her bag and money (for treatment and medications) all packed. She took herself to the testing centre, in town not connected to the hospital, for another ultrasound which told her she still had a week to go.

Dissatisfied with this information she went back to the hospital for another ultrasound (remember she has to pay for all of these and they’re not cheap) and was told that there was only a little bit of amniotic fluid left in the womb and that her baby had probably been suffering for some time (not sure this was helpful information).

They wanted to induce her but she insisted on a caesarean, mindful of her experience last year when she was also induced. The surgeon agreed. She was offered epidural or general anaesthetic and opted for general – didn’t want to hear the clinking.

I went to visit her in the evening.

The maternity ward

Diego hospitalTo get into the maternity ward in England you had to get past the security coded doors, the disinfectant hand pumps and the reception desk staffed by midwives (in fact a host of different staff in different uniforms that I never worked out who they were).

In the Maternity ward at Diego General Hospital, you just walk in to a room with open windows to some regulation hospital beds and people sat around everywhere.

In Madagascar you have to supply your own food, linen and anything else that the mother or baby needs (this is the same for any hospital stay – or prison stay for that matter). So, by default nothing is sterile.

She’d been advised not to breastfeed until her milk came in, which is contrary to the emphasis that the UK midwives put on the importance of the baby breastfeeding the minute it pops out and getting that colustrum over the first 3 days. So, a friend of the mother was feeding the baby sugar water with an unsterilised spoon which she put in her mouth before giving to the baby.

As with many things in Madagascar my immediate reaction is horror and then you realise that the world doesn’t fall apart when things aren’t done the vazaha way. This isn’t to downplay the infant mortality rate here or what I suspect is a poorer rate of healthy outcomes from hospital stays but, in general, everybody stays alive. And, they’re not worried about our super hospital infections here – I’m not sure if that’s because they’re not here or because it’s more pressing to worry about cholera and amoebic dysentery.

I experienced more horror the next day when half eaten food on the bedside table was teeming with ants.

The Mum doesn’t have a nice electronic bed to raise her up so she’s lying prone unable to do much with her baby. He opens his eyes for the first time whilst I’m there so I raise him up for her to look at. She’s very slurry so I presume she’s still on some kick arse pain killers.

But despite the differences I was strongly reminded of being that new Mum with my own new little baby. As I heard the newborn cries and the mother turn her head away into the pillow a bit emotional, I felt tears well up in my eyes. And she looked so happy as the baby stopped crying just because he was laid next to her. And I felt myself falling in love with the little baby, just as I saw other experienced mothers do when I was out in public with a very small Fred. We really are programmed to love little babies.

You need family

There are nurses but the primary care of the mother and baby are done by friends and family. A woman has stayed with the new Mum all the time. Although I think that it would be great to have more midwife and nurse care, the system doesn’t work well in England either, due to the same shortage. I would have loved to have had a friend or family member with me who could help me out with all the little things. Pressing a button and waiting 40 minutes for a frazzled midwife to turn up once the need has passed didn’t provide me much support.

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Minor annoyances of Madagascar

Munched linen dressCloth eating bugs

Sorted through a bag of clothes I’d left here yesterday, to discover that they too had been decimated by some clothes eating bugs.

I’ve no idea what they are so I attach a photo so that someone can tell me. Whatever they are I watched with smug satisfaction as the ants cleared away dozens of them in less than 3 minutes – ant Christmas apparently.

Luckily the orange dress that they were most partial to was one I got made whilst recovering from Chikungunya (type of Dengue Fever) so it was much too small. Especially as I got pregnant a month later and, unlike Malagasy mothers, gained some pounds (see post You are so fat).

Cloth bugs and ant

Power cuts

It’s been a bad week for power cuts. Saturday evening we lost power at 6pm for the next 13 hours. Sunday it cut at 7am for the next 25 hours. Last night we lost it at 6pm and it’s still not back on at 7.15 the next morning.

And the internet café was off yesterday at different times when I went up there so I had 2 wasted trips.

I don’t suffer too badly because of my laptop which has a decent battery and contains my music, films, games and writing. And we go to bed here so early (mixture of having a baby and natural rhythm with darkness) that the lack of light isn’t a disaster. However, I don’t like waking to breastfeed a baby in mosquito filled darkness.

Flip flop wounds

Two days ago I was delighted to get a rare chance to walk somewhere without my son but disappointed to get blisters on the top of both feet from my supposedly sensible flip flops (thongs to Americans).

Being the tropics, both of these minor afflictions are now infected and oozing puss and blood. Out comes the betadine (iodine). I was told it is best to dilute iodine rather than use it neat otherwise it kills all the white blood cells trying to fight the infection. Not sure that science is correct but less is more was the conclusion.

[Note (added November 2007) it took 2 months for these wounds to heal and have left sensitive ‘stains’ on both feet so I still have to be careful with shoes that touch the affected areas.]

You are so fat

A big topic of conversation has been how FAT I am… Some people have said it to my face and others have said it to Jean.

“Oh she’s been eating cake” “Oh she’s been eating too much sawaba (sweet dish with coconut milk)”.

It doesn’t really work to say “Well I’ve had a baby” as local women don’t tend to get fat. I noticed a local woman breastfeeding her baby, 1 month younger than mine. She pulled up her top to reveal a flat stomach. I chose breastfeeding tops that open only at the breast to keep those rolls of fat covered

To put this in perspective for Westerners I am at most a stone (14 lbs or 6 kilos) heavier than when I left. This is not unusual for Western women who have had babies.

But a splendid source of conversation for Malagasys.

Most English women would be horrified for someone to say this about them. Luckily I am used to Malagasys commenting on weight and am not sensitive about it. If Malagasys come into contact with Westerners a lot, someone normally needs to point out that it’s not acceptable to talk about someone as fat.

It’s not that fatness is revered here – people appreciate a fit, slim figure in both men and women. It’s just not seen as such a highly sensitive issue. Also people point out things that are obvious but undesirable (such as spots).

Getting fatter
I expected to lose weight here but I seem to be gaining it. This is a mix of not being very active, Jean cooking big meals and me sucking condensed milk out of the can. I read today that condensed milk has 8 tablespoons of sugar in one can.

Can I possibly claim that I’ve just swollen up with the heat?