Fieldset
“We had no idea what was coming”: My time on a maternity ward in Yemen

After an intense assignment on a maternity ward in Yemen, MSF midwife Tamara reflects on the meaningful and sometimes complex moments faced by the team at Abs Hospital

When the first woman arrived that day, we had no idea what was coming.

But then it was one woman after another. All of them were in labour. All of them had high-risk factors, and we didn't have enough beds.

Of course, you are not going to say to a pregnant woman, "Oh, the unit is full. We cannot accept you. You need to go somewhere else."

These are emergency cases. You have to find a way to treat all of them, in the safest way possible. Even though you don't have a spare bed or even a mattress.

We asked the rest of the departments in the hospital if there were any spare mattresses and then we put them on the floor and just started treating the women.

There is always a reason

This was just one day in Abs, where I was on assignment to provide training and support to the midwifery team. In Yemen, the local staff were really committed to what they were doing and some were really experienced. So, while I was teaching and supporting them, I feel like they taught me a lot as well.

It’s an emergency and you have to treat it as soon as possible or the baby will die

I learned that there is always a reason behind why things are done in a certain way.

Sometimes, there’d be things that we’d work on together and improve, and at other times, even if something was done differently from how I’d do it in London, I’d think “here, it makes sense”.

The midwife life

When we had done our morning rounds on the ward, I would go to the delivery suite and the labour ward. See how many women we had in labour, how they were doing, was there was anything we could do to prevent risks. I’d be really involved with the midwives as they were helping women give birth.

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An MSF midwife holding a newborn at a mother and child hospital in Yemen
An MSF midwife holding a newborn at a mother and child hospital in Yemen

While the day with all those emergencies was unusual, the hospital, in general, is really busy and really crowded. But we do our best.

In July, just a month after I arrived, it was 800 deliveries. That number of births for a month is quite a lot. It was stressful, but if you like being a midwife, then you enjoy what you are doing.

Every day was different. I wanted to plan and think “OK, Monday, let’s do this…” but by the end of the week you’d realise so much has happened and everything had gone a different way. That’s just how it is.

Consent and consequence

One case I remember was really hard. The woman was in labour and the baby’s cord was coming before the baby. It’s called a cord presentation or cord prolapse. It’s an emergency and you have to treat it as soon as possible or the baby will die.

But in Yemen, a woman is not in control of her own life or the life of the baby she is carrying. And this patient’s husband was not around to sign the consent form so that we could take her to the operating theatre. Her father-in-law was with her, and he wasn’t comfortable signing.

We faced a really tough decision.

Even though you feel like it’s the right thing to do, you can’t just do a c-section and save the life of this baby. The consequences of doing that would be really negative for the wider work of MSF in Yemen. And that work is providing life-saving healthcare to tens of thousands of people.

Quality of life

However, there were also times when male family members were able to really help us.

I remember a woman who was transferred to the hospital after giving birth at home. She was now suffering from heavy bleeding.

I think I never realised how really important my mental health was until then. But I needed those moments of peace.

After an assessment, we discovered that the bleeding was caused by a third-degree vaginal tear. This is less common and more severe than others.

She declined any kind of treatment, but these tears need surgery in order to avoid problems with bladder or bowel control. Could you imagine the quality of life for a woman living with incontinence in a place like Abs?

This time, it was her husband who immediately understood the importance of the surgery to her wellbeing. He helped us to explain the situation and convince her that it was OK. She got the appropriate care she needed.

Cases like this are difficult to approach, but we worked together to help the woman understand and make an informed choice about her health.

Moments of peace

When I first heard that I was being offered Yemen for my MSF assignment, my first thought was “this is going to be hard”. And I was right.

When you arrived at home each day, it was difficult to find a way to take your mind away from the hospital.

You’re not allowed to just go out for a walk outside the compound, so we used to do exercise together, three of the girls, watching YouTube fitness videos inside so we didn’t have to cover up. We also had a rooftop where we could sit and drink a Coke and watch the sunset and have just 10 minutes where you didn’t have to think about what was going on around us.

I think I never realised how really important my mental health was until then. But I needed those moments of peace.

I definitely want to do another assignment with MSF. But after Yemen, you need time. You have to look after yourself to do it.

It was really hard, really challenging, but it was worth it.

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Read more: Stories from Yemen

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