Most Acholi women who give birth at Ot Nywal Me Kuc have beautiful, natural births – and no tears. Midwives pride themselves on almost never cutting an episiotomy and on guarding the perineum during birth to help prevent tears as the baby’s head is born. But sometimes, regardless of care given, tears happen.
Tears are characterized as first, second, third and fourth degree. First-degree tears are shallow and often heal on their own without stitches; second degree are deeper; third degree go through the vaginal mucosa to the top of the color; fourth degree tears go all the way through the colon and/or anus and require major repair. Fourth-degree tears can lead to fistulas and incontinence, a common problem in those places where “cutting” (female genital mutilation or FGM) occurs. The scarring caused by FGM almost always leads to bad tears in childbirth because the skin cannot stretch as it naturally would when the baby’s head emerges. Fortunately, cutting is not an issue among the Acholi we care for. Nevertheless, recently we had a woman who experienced a third-degree tear from the birth of her child and required suturing.
Midwives are used to suturing second-degree tears, but not third degree, as these (fortunately!) happen rarely in healthy women. Our certified nurse-midwife Stephanie has excellent training in suturing, but she thought perhaps we could refer this mother to a nearby health center so a doctor could help. However, when two of our midwives took the woman in for an assessment, we discovered just how brutal medical care can be here.
The medical staff there inserted a speculum over the third degree tear without giving the mother any painkiller. They pulled the cervix down to examine it for tears (which it did not have) – also without painkiller. They then discharged the mother back to us without suturing.
So midwife Stephanie brought her back, gave her rum and valium, used a lot of lidocaine locally, and did the repair herself with midwife Rosie’s help.
The mother is healing.