The clinic that I worked at this summer does assembly line prenatal care for 100s of women but in a very non-assembly line way. Each woman does get one-on-one care from the midwives. There are 3 prenatal days, and each day sees 20-50 women.
Here is a typical prenatal visit by "Ketut" at 34 weeks along: Ketut walks into the clinic with her husband and approaches the intake desk. She hands over her special green government card that her pregnancy stats are kept on, takes a number from the pile, and sits down to wait. When there is a seat available at the intake desk, the Indonesian student midwives take her card, find her prenatal form, check the pregnancy wheel for her current weeks of gestation, and weigh her.
The foreign student midwife (me for the 1st hour most days) takes her blood pressure, attempts to speak with her just a little, even if just to ask her name again and how many children she has. Ketut then goes to sit and wait until her number is called from the prenatal room. When she enters the room, there are 2 beds for 2 appointments to happen at once. There are 4 senior midwives and usually 2 student midwives. The student asks the mother to lay down on the bed, measures the fundus, palpates for position, listens to the baby, checks for swelling, checks the eyes for anemia, and asks a few questions.
The student relates the info to the senior midwife who records it. If the student is unsure of position or has another question, the midwife will help out. Urine is not checked unless there is reason to suspect that something is up. Ketut sits up on the bed and talks with the midwives for a few minutes, either chatting about life or discussing issues that need covering. If she hasn't gotten a tetanus shot this pregnancy, she is required by the government to have one done right there. She is then given a tiny ziplock bag with prenatal vitamins. (A one month supply if coming 1x a month, 2 week supply if coming 2x a month, and 1 week supply if coming every week). With no more questions, she is on her way until her next appointment. As she leaves the property she puts a small donation in the box, usually around 20-50 cents.
Of course this type of appointment could be better but in this setting, it's so much better than any other options. The mothers sit together and chat about their pregnancies. If they come on an acupuncture day, they may be sent to acupuncture for breech baby, high blood pressure, or something else. If they come on a prenatal yoga day (the most popular day!), they can participate as much as they can.
For me as a student, I went in thinking I would just be a beginner. But taking blood pressures was no big deal. Palpating, which was totally self-taught, thanks to my many pregnant friends who let me practice on them, ended up being a great skill of mine. The senior midwives actually let me teach the Indonesian student midwives! If I ever had a question about head engagement, or baby position, I would call someone over to double check for me. My favorite prenatal was when a twin mom came in. I got to palpate the twins and find their heartbeats. I ran to the office to get my own twin-birth pics and ephasized that yes she can birth them vaginally and breastfeed them too!
Prenatal days were whirlwinds of activity. Some nights I walked home with aching ears from using the stethoscope for 2 hours straight! Some women I would see more than once, and some up to 3 or 4 times. If I was lucky, I'd be on shift when they came in to birth. With a relationship already made, the mother would feel comfortable having me at the birth.
Labels: Indonesia, midwifery, pregnancy