Fri, Oct 06, 2006 - Page 9 News List

Same world, yet worlds apart for giving birth

For mothers in Niger, giving birth to a child is a leap of faith, as they get precious little support from husbands or the healthcare system. The contrast with what's going on in Sweden couldn't be starker

By Joanna Moorhead  /  THE GUARDIAN , LONDON

And its maternity service is second-to-none. Antenatal care in Sweden is free. Women have a legal right to take time out of the working day to attend appointments and take-up is almost 100 percent. Mothers in labor are looked after with every high-tech advantage possible; the fetal monitoring system here is among the most advanced and sensitive in the world.

Dr Pia Axemo, the senior obstetrician at Uppsala, explains how pethidine -- still used in the UK as a form of pain relief during labour -- is deemed obsolete in Sweden.

"Around 31 percent of mothers have epidurals but these are mobile epidurals and they can still walk around," she says. "But we feel strongly about women being supported in labor and we encourage them to try other sorts of pain relief -- massage, a shower, acupuncture -- before opting for an epidural."

The impression you get as you chat to mothers in Uppsala is that they feel remarkably well looked after, cared for, listened to and supported.

It is not just about technology and machines. in a confident, well-developed, successful maternity unit such as this one, there is a generosity of resources that makes the mother-to-be feel individually cared for. It is something Gunilla Hallberg, the doctor who heads the unit, is particularly proud of.

"What makes us successful is that we put women at the center of what we're doing," she says. "We have everything technology can offer but, even more importantly, we treat mothers as individuals."

Individual care isn't a phrase you feel gets bandied about much at the main regional maternity hospital in Zinder -- the Maternite Centrale, a blue-and-white painted building in the centre of the city.

This is what passes for high-grade care in Niger, but it is pitiful in its privations. Where Uppsala's hospital is white, clean, spacious and calm, Zinder's is dirty, cramped and chaotic. The corridors are crammed with dusty, ancient-looking equipment.

There are open bins and swarms of flies in the quadrangle, and cats roam free. The paint is peeling, there is no air conditioning despite temperatures of 40oC and more, and everywhere you look there are people.

Because, it transpires, when you come into hospital to have a baby in Niger, your relatives come too: they sleep on the floor by your bed, they help look after you and your baby, and they are here, too, to donate blood if you have a postpartum hemorrhage -- you only get blood if you bring your own donors.

It is hard to imagine the hell into which Zinder's mothers-to-be descend if they end up giving birth here: but if your imagination isn't up to the job, a tour of the delivery facilities brings sound effects to ram the point home. It may be the tradition in Niger to bite your tongue through contractions, but the women whose complicated labors have forced them to seek help here are clearly past caring about niceties such as protecting their honour. They scream, they shriek, they moan, they writhe: and they do it two to a room because there is no such thing as private delivery space.

Nor, for the most part, is there any such thing as pain relief -- a trip around the dispensary reveals empty shelves. Only women who have a cesarean are given anesthetics.

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