Saturday, May 23, 2015

Traditional birth attendants training

I don't have any good pictures for this post because the TBAs (traditional birth attendants) seem to hate it when I bring out the camera so you'll just have to tolerate these internet ones.
This post is about the most recent training. The TBAs have no problem telling me they think I'm FoS sometimes and this week was no exception. But it is good because at least I know where I'm at with them. The topic was measuring fundal height to estimate fetal age, or "counting the belly to know when the woman will produce" which is roughly how it was translated. The very first thing I needed to establish was that all pregnancies are nine months long. Nope. I clearly have no idea what I'm talking about. 30 minutes and two personal accounts of pregnancies of 11 and 13 months later, I finally just moved on.
We discussed how at 4 months the top of the uterus is two finger widths below the belly button and how each month adds two fingers. I had wandered the village before we began and asked 3 pregnant women to join us. They practiced on these ladies and got it with no difficulty. Then I took it one step further and explained that because we know they will be pregnant for 9 months, when they measure 8 finger widths above the belly button the baby is about to come. They were still not convinced. I suggested they watch the women we measured and see if I was close to right. Next training we will discuss.

But I took it one step further and got out tape measures and told them they could get even more specific. That women gain 1 cm per week and that the numbers correlate so if a women measures 28 cm she is 28 weeks (+/- 2 weeks). Clearly I'd lost them and suddenly it hit me why. "Who knows how many weeks are in 9 months?" Blank stares. "How many weeks are in a month?" Some discussion in Kjung. 2 to 5 depending. Ummm. I tried explaining there are consistently 4 weeks in a month. They didn't completely buy it but they let me continue. I tried explaining that pregnancies are 38 or 39 weeks long so that a woman who is putting on weight normally can be expected to deliver when she is about this size. The whole purpose of this training was to help them see that if they are measuring women over the course of the pregnancy and they are not growing as they should they need to refer them to the clinics. I'm not sure they completely got my points but the discussions were fun....

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