Babies in Baglung

Babies in Baglung

We arrived in Baglung on Friday Feb. 13th by jeep from Pokhara. We first had to fly from Kathmandu to Pokhara. The journey in the jeep was a very scenic adventure up into the mountains along a partially completed road. 

We are working at Dhaulagiri Zonal Hospital, a public hospital in Baglung that serves a population of about 60,000, in addition to the surrounding villages. The head nurse of the hospital is a woman with a Bachelor of Nursing who will be leaving for Kathmandu soon to complete her Masters of Public Health. She has been working and collaborating with Cathy and UBC for several years. Her knowledge of the culture, health care system, and translation skills are invaluable.  Auxillary nurses are the ones working the maternity ward. Some but not all have Skilled Birth Attendant (SBA) training. The ward is also buzzing with 6-10 nursing students each shift, and 2 or more SBA students. The nursing students are very young, around 18-19yrs old. It can be quite overwhelming to have everyone in the room during delivery, but it is also wonderful to have so many hands and skills. 

Mount Dhaulagiri from the roof of our hotel

Day 1

We had an interesting first day on the ward. Cathy asked us to set some goals for ourselves and the list below is what Emma and I decided on:

• Learn how to document in WHO Modified Partograph

• Using the fetoscope
• getting to know the staff 
• learning some Nepali words and short sentences
• Learning how to apply clorhexadine to the umbilical cord

At 10 am a woman arrived in labour. She was pregnant with her 8th baby. We were surprised to learn that having many children is something that is frowned upon here. Nepal has worked hard to encourage family planning and many families are choosing to have only two children. However women from rural and remote areas, and/or women living in poverty are more likely to have more children as they may not have access to or information about family planning methods. This mother gave birth quickly and easily to a baby girl. The baby was born on the Nepali New Year and in the caul [in the sac of waters] both which are lucky events.

The maternity ward has two beds in the entry hall for women who are not yet in active labour. There are three beds in the ward room for women who are in active labour, being assessed, or being induced. A partition divides the ward room in half. On the other side or the partition is the delivery room. There are two metal delivery tables in the delivery room. There is also a warmer and cupboards with the supplies needed for birth.

Emma and I worked hard to hone our fetoscope skills. We are learning how to listen for the fetal heart rate with a great deal of background noise. Our ears are getting better every day.

Day 2

The morning was busy with women from Baglung and surrounding villages arriving for antenatal check-ups. Some were post-dates, others were in pre-labour. It was a great opportunity to practice our fetoscope skills and palpation skills, in addition to learning some of the hospital protocols.


After lunch we spent time practicing Nepali with the nursing students. We had just finished joking about how we would love a woman to arrive at 8cm, when voila, a woman arrived fully dilated. Continuing with some of the teaching about labour support we had done the first day, we worked with the student nurses to provide kind labour support. The nursing students helped us to comfort the client through Nepali phrases such as: ramro garnu bahyo ("you are doing well") and lamo sas phernus ("breathe deeply").

As we assessed her it became clear that her contractions were not adequate enough for pushing. After augmenting her contractions with a little bit of oxytocin she easily delivered a healthy 2.75kg baby boy. The babies are much smaller on average than babies in Canada. The average birth weight in Nepal is about 2.8kg, and the average birth weight in Canada is 3.4kg. Similarly, people here are smaller on average than people in Canada. The women here are so incredibly strong, with no pharmaceutical options for pain relief, they easily and courageously push their babies out.

Day 3:

Our Goals for Day 3:

• Deliver babies using slow delivery of the head
• Site IVs
• Discuss cases in terms of how we managed them here and how we would manage them in Canada.
• Continue to practice our Nepali.
• Prepare handouts for Midwifery Refresher and Respectful Care update course April 19 and 20th

We arrived on the ward at 9 am. We discovered that two women had given birth in the night and early morning. We checked on the baby that Emma delivered the day before. Both mom and babe were doing well. We practiced our Nepali with the nursing students who have been very helpful in many ways: showing us how to wash the cord with clorahexadine, how to hang an IV, translating for us, and teaching us more Nepali words and phrases to use with the women.

A young nulliparous (first pregnancy) woman arrived at 10. She had been seen earlier and was 4 cm dilated and appeared to be in active labour. We introduced ourselves and read her chart.

She had a number of women with her who we discovered were her relatives. They were doing such a great job providing labour support. She was very shy and preferred labouring in the stairwell because it provided her with  more privacy. She would come back to the maternity ward so we could check the fetal heart rate. According to the partograph her labour was not progressing quickly enough so the decision was made to augment her labour with IV oxytocin. Her labour progressed rapidly and she gave birth to a healthy baby boy. Cathy supported Jenny through slow delivery of the head.

It was so quiet in the delivery room as she pushed. There were a number of nursing students in addition to Cathy, myself and Emma, and the nurse and everyone was very respectful and quiet. It was a nice change from my first birth where there was lots of background noise and chatter. I think we were able to effectively model respectful childbirth practices.

We walked her over to the postpartum ward with her baby and helped her with breastfeeding.

Dhaulagiri Zonal Hospital

A second young nulliparous woman presented on the ward at about 16:00 in active labour. She too was supported by a number of women. It was so lovely to see how well supported she was. Her labour progressed quickly and soon she was pushing gently. In Nepal they anticipate birth of the baby within one hour of pushing. If a woman has been pushing for more than one hour the nurses consult with the doctor as it is considered a delayed second stage of labour. We consulted with the doctor and he came in. He was very lovely and agreed that she was having a delayed second stage and that we should get baby out but he encouraged us to continue what we were doing and told Cathy he was just here "to support us [the whole team]." The woman gave birth to a heathy baby and Emma caught her second baby in Nepal. We got mom and baby settled in the postpartum ward and went home for dinner. It was a long but good day.