That's me now two thirds of the way through my mission in Bangui.
There has been fighting between different groups in the east of the country, but things remain calm here in the capital. I hope it stays that way.
Here in Castors we are delivering about 700 babies / month. The Caesarean rate is between 10 and 15%. In the UK it's about double that.
A mother leaves the maternity hospital in Bangui. Photo: Borja Ruiz Rodriguez / MSF
In Britain most women only want two children and as the operation has become safer and safer the threshold for doing a Caesarean has fallen. So safe that we do fewer and fewer complicated vaginal births such as breech or twins. Increasingly we do Caesarean sections on request when there is no medical reason. This amazes my African midwifery and medical colleagues.
Here wound infection rates are higher and women want the option of big families as many children (about 20%) don't survive until their fifth birthday. A Caesarean means a scar on the uterus and a high risk of uterine rupture and death in the next pregnancy if the labour is not managed well.
The risks increase with each Caesarean – so the threshold for doing a Caesarean is higher here. We carry out Caesareans when the mother’s life is at risk. We deliver breeches (when the baby is lying sideways in the uterus) and twins and preterm babies here by the normal vaginal route. These are becoming lost skills in UK maternity units. Sorry if this is all getting a bit technical - but - bottom line: we are trying to keep Caesarean rates from rising to European levels by practising good old fashioned obstetrical and midwifery skills in order to improve women's health and reduce future complications.
I think in my hospital in Scotland in the last 10 years I delivered one breech baby – and that was because it was coming so fast there was no time to get the woman to theatre to do a Caesarean! I have successfully delivered four breeches by the vaginal route here in the last two months.
On a slightly different note – we had an interesting chat with the local doctors who work in the unit. There are 11 of them and they're all male. My female paediatric colleague, who’s from Norway, suggested that it was time to appoint a female doctor. The reaction felt straight out of 1976. "A female obstetrician - whatever next!" "Who would look after the children and make her husband’s dinner when she was on call?" "Maybe a part time job in a paediatric clinic." We had a discussion about how women's roles in society and medicine have changed so much in Europe over my working life - and that Africa is sure to follow. Get used to it boys!