Newborn Notes: Childbirth Care at Tikur Anbessa Hospital in Ethiopia

 I have been focusing on training about early initiation of breastfeeding.  During midwife update-training on lactation we watched videos about breast crawl (babies are dried, placed on mothers’ abdomens and allowed to find the breast themselves with minimal intervention). At that point it became clear that no babies at the hospital were achieving breast crawl because all mothers and babies were being routinely separated after birth.

The initial reason had been that the delivery rooms were cold (ironically babies were separated to protect them from hypothermia) and there were no drying cloths or blankets. However, the practice of separating mothers and babies had become culturally entrenched with many midwives feeling that mothers ‘needed a break’ after labor. The baby was taken from mother at birth, swaddled and kept in a warm crib down the corridor for sometimes up to two hours if mother needed suturing.

As a result of these practices, hypothermia rates had rocketed, and the risk of infection increased. Breastfeeding initiation was being delayed and the risk that young, traumatized and impoverished mothers would abandon their babies rose since they missed a crucial window to bond with their babies after birth.

I began by raising a small amount of money from friends and family to buy enough drying cloths and blankets for the ward. Kind breastfeeding supporters in the UK knitted hundreds of tiny hats to stop heat loss while at risk babies do skin to skin. Then all staff on the obstetrics and postnatal ward received training about early lactation and neonatal skin to skin.

Once they understood the clear link between hypothermia rates and mother-baby separation, and had the resources to facilitate neonatal skin to skin, the midwives made sure it happened. Although room heaters are not strictly essential, I believe they will provide a safety net; they will make the experience of labor less grueling and help reassure mothers and staff about babies’ temperatures at a time of cultural change.

Of course since these deliveries are high risk, not all babies can immediately be placed next to their mothers. Some midwives and mothers still need convincing that babies are not ‘in the way’ if mothers need stitching etc. But slowly neonatal skin to skin is becoming part of the hospital culture, and staff are realizing that whether in low or high resource settings,  in almost all cases, the mother’s body is the best environment for the newborn.