Another Alice - On the delivery ward in DRC

Alice is a midwife working in the Democratic Republic of Congo, a country that has been badly affected by conflict.

Going to work in sub-Saharan Africa, everyone told me about the many baby Alices that would be born. Many international staff midwives came and went before me in the project and had heaps of babies named after them. Yet, after having met the second baby Alice that was born since I arrived here in DRC, I can say that I feel honoured and proud.
One of our Congolese doctors explained to me that the naming of a child was a very important thing here, mothers and fathers choose the name hoping to give a direction to the child's life. Thereof, by naming these children Alice, these two mamas made a wish: they would like their daughters to grow up to be like me. Just like some children are called "luck" or "patience" or "happiness", these little girls were called Alice. I am truly touched and honoured. 


The second baby Alice was born to a very anxious mother. Although this was her fourth pregnancy, she had no living children. She suffered a late miscarriage at about seven months pregnancy, a full-term stillbirth and lost a son at one week of age. Faila (name has been changed to protect confidentiality) comes from Misisi, a mining town some 12 km  away from Lulimba. 


Misisi is bustling with private health centres and dispensaries of better or lesser quality, and has one state health centre, which we, MSF, support. The tiny crammed compound of the health centre is always buzzing with children's cries and laughter, full of life and full of disease. There, we treat and fix almost anything and everything. Malaria (mostly), flu, broken bones, cuts, pneumonia... You name it!
The difficult cases at the Misisi health centre get referred to the hospital in Lulimba, about 45 minutes drive's away. If they are lucky or very urgent, the patients can hitch a ride with us. If not, they get on a motorbike for what I can only imagine being an extremely uncomfortable trip (especially when sick).
Photo: Alice Gautreau / MSFPhoto: Photo: Alice Gautreau / MSF
The maternity unit is tucked away as you enter the compound to the left. It has two delivery beds, two labouring beds and fourteen postnatal beds. And the midwives work without rest to safely deliver around 2,000 babies per year! As with every maternity ward, the babies come in batches: there will be times when five babies will be born in two hours and the beds will barely be cleaned by the time the next one pops out (as it actually happened one time I was there!). There again, difficult cases will be referred to the hospital; although the team, allying the practical knowledge of the lay-midwives and the technical one of the qualified midwives, will be able to manage pretty much everything (manual removal of placenta, twins, breeches...)


Women get their antenatal care in a little haven of peace called Jamaa Letu ("Our family" in Swahili), built by MSF a few hundred yards away from the busy health centre. There, a team of enthusiastic nurses and midwives run antenatal care, maternal education sessions, family planning, STI clinics and special clinics for the many sex workers who live in a mining town like Misisi. Each day has its own clinic: old and new antenatal cases on different days, family planning and sex workers on Fridays. 
At the antenatal clinic, the nurses detect high risk cases and advise them to give birth in the hospital. Women then go to the hospital in Lulimba where there is a special "ward" for them: just eight beds and a few shelves to stack cooking pots and a few belongings. This is where they will live and wait for labour to start. All sorts of women get referred there, all of them high risk: previous cesarean section, very young new mums (under 18), women expecting their 7th child or more, unstable or difficult presentations (like breech or transverse), etc...


I met Faila there. She was waiting for labour to start and had been referred to the waiting ward by the Jamaa Letu team. Her second baby, the stillborn one, was delivered by cesarean section which put her at high risk of complications during the birth of this one. She stayed in the waiting ward for about three weeks and I saw her week after week, scanning her baby to check how she was doing. At my last check, I noticed that the fluid around the baby had significantly reduced. Faila also said that her baby wasn't 'playing as much now' and was 'sleeping more'.
Alarm bells rang in my head as I discussed my findings with the hospital doctor. Induction of labour is very rarely used here as there are very little means to assess foetal well-being except by Pinard fetoscope or Doppler ultrasound. Moreover, considering Faila already had a scar on her uterus, inducing her with misoprostol was calling for disaster. However, the doctor was still reluctant to C-section her before labour, he wanted to give her a chance, even if it were a tiny one, to deliver vaginally.
The doctor and I agreed to plan her cesarean the next day, providing nothing happened over night. I was secretly hoping she would not labour, as I doubted this baby would do well under the pressure of labour and was trying to stop imagining what her CTG trace (which we use to measure the foetal heartbeat) would look like... 


Faila went into labour that night. When the day doctor arrived at 8am, there was already quite clear foetal distress and labour was not progressing well. But Baby Alice was delivered promptly by cesarean and, despite needing a "bit of help" to breathe, she did. I am happy to say she is still doing very well.
Alice and baby AlicePhoto: Photo: Alice Gautreau / MSF