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Dulcie on childbirth in Tanzania

The CMS missionary training college is called St Andrew’s Hall and we went to their graduation today. There’s a wealth of missionary experience in the people there, including a number from Tanzania. What a wonderful opportunity for us to hear stories and learn! We got talking with Dulcie, an elderly woman who went to Tanzania single, married another missionary and had her children there. I took it as an opportunity to ask her questions about having children in Tanzania and her answers just about floored me!

To give a bit of background, I’ve been of two minds about the possibility of one day giving birth in Tanzania. Most of me thinks women have been doing it for years and it’s a natural thing with little need to make a fuss. If Tanzanian women can do it, why not me? But then, though Tanzania’s infant and maternal death rate is improving, it is still much higher than Australia’s. And even if 99% of births are smooth, what if you’re the 1%? On top of that, we’ve heard varying reports:

  • We’ve heard that Dodoma actually has a neonatal unit – but no doctor, so it lies dormant and empty! (The unit doesn’t feature in the government’s report on newborn health. It lists them in Mwanza, Dar es Salaam, Mbeya and Kilimanjaro.)
  • One missionary mum we spoke to in Dodoma was adamant that having a baby wasn’t something you mess with – we would need to go to somewhere like Nairobi, which has ‘proper, western healthcare’.
  • Most people just assume that we’ll come back to Australia to have our children, or at least time things to coincide with home assignments.
  • Another missionary played down any concerns about childbirth in Tanzania – but she’s a doctor herself.
  • A doctor who’s done short term work in Tanzania told me that the midwives in (significantly more developed than Dodoma) Arusha are world-class.

With all this conflicting information, personal testimony is important to me, so I asked Dulcie about childbirth. Her response: ‘Pfft, absolutely fine, no worries!’ She had her boys (now 43 and 46) at a little catholic hospital 11 miles down the road from where they lived on the far side of Lake Victoria and it all went smoothly. What a relief, I thought! She was clearly relaxed about it and confident that we’d been fine. Medical care has improved, 45 years down the track, she pointed out, and there are mobile phones and other ways to get in contact with health professionals if need be.

That all sounded fine until she dropped the bomb – “I did have one child that died.” You can imagine my surprise! How could she not have mentioned this earlier?! As it turns out, her oldest was actually a twin but one was much weaker than the other and didn’t survive. Dulcie says it’s survival of the fittest out there and this is the natural way of ensuring healthy babies. In Australia, they might save that child, but it may have a significant disability – in her words, it wouldn’t be perfect. I wasn’t quite sure what to do with that statement!

Categories: Tanzania Woman Written by Tamie

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Tamie Davis

Tamie Davis is an Aussie living in Tanzania, writing at meetjesusatuni.com.

4 replies

  1. Sounds like you’re in a tough situation Tamie, I’m not sure what i would do except keep praying and put it in Gods hands. If you choose to go ahead with having a baby in Tanzania, know that you will have lots of support from us here.

  2. I was so excited to find this post! This is a topic I think A LOT about – perhaps a little too much. I’m passionate about this issue so do forgive me if I’m a wee bit overbearing ;-)

    Most missionaries I’ve chatted to here have traveled out of Tz to have their babies. An Aussie family in Musoma had one child in Nairobi and the other 3 in OZ. Other American missionaries I know have also traveled back to the US to give birth.
    Nairobi: First of all, this option will be expensive. We have considered it but ultimately decided it’s much the same as going back to Adelaide. The reasons are this:

    Unless you know someone you can stay with in Nairobi, you will have to pay for accommodation for at least a month (before the birth) and possibly longer (after the birth). You are not able to fly over 36 weeks (and that is the absolute maximum!) For other airlines, the cut-off is between 28-35 weeks. I don’t think you would want to catch a 24-hour bus from Dodoma to Nairobi at more than 35 weeks either – it would be extremely uncomfortable. So, there is actually no way of getting quickly and easily to Nairobi from TZ unless you go when you are much less pregnant (e.g. under 35 weeks).

    If you are going to get Western services in Nairobi, expect Western prices. If Arthur cannot get time off from CMS – then you would potentially be on your own and heavily pregnant in Nairobi for weeks. Of course, if you could arrange to stay with some missionaries – then the accommodation problem is solved (but its still expensive and involves a long stay). I came to the conclusion I would rather be in OZ with friends and family than alone in a (relatively) dangerous city in a foreign country.

    Tanzania (excluding Dar):
    There are NO epidural services in the whole of TZ bar Dar. I’ve searched high and low for these since I arrived ;-). They don’t exist anywhere, not Mwanza, nor Dodoma, Arusha etc.

    The problem with this is that many, many women require epidurals. This is only anecdotal but almost everyone I know in Australia who was determined to have a natural birth with minimal pain relief opted for an epidural in the end. In some cases – it was the only thing that saved these women from having to have an emergency c-section. Personally, I am point-blank completely and utterly refusing to even consider child birth without the option of an epidural.

    Another Kenyan girl we know recently gave birth in Mwanza. She chose the private hospital here which is supposed to provide the highest quality obstetric services in town. She had an agonizing labor and a vaginal delivery but she was so traumatized by the experience that she doesn’t want to have any other kids. Ever. An epidural for her could have made all the difference. That story sticks with me cause I tend to think African women are stronger than us! They put up with so much more and seem to have amazingly high pain-thresholds. For this girl to have found it so excruciating leads me to think that it’s extremely tough – even for these resilient, strong women.
    Tanzania has a very high maternal mortality rate but what is perhaps less well known is the morbidity rate. Most women give birth in rural areas without a trained birth attendant or in a clinic (most clinics are drastically under-staffed and under-equipped anyway). Our wards at the hospital here are full of women with fistulas that developed as a result of obstructed labor because these women had no/little trained assistance. Millions of women are NOT able to give birth ‘under a tree’ like some Westerners think.

    I used to think along the lines of ‘most of the world’s women have done this in far worse/under-resourced environments than me…so what’s the big deal?’ But there are millions of women in Africa whose children HAVE died during childbirth or shortly after for the simple reason that they were not able to access health facilities/health workers and/or could not get emergency c-sections when needed and were subsequently severely damaged by prolonged, obstructed labor.

    I think the key thing to remember is that childbirth is not a simple, straight-forward thing. It might be for a lucky minority of women but even in Adelaide I know of women (about our age) who had horrific, 2-3 day labors and extremely painful, traumatic deliveries – with extensive tearing. My personal opinion is that most women are completely uninformed about the inherent risks of childbirth. It’s not a totally natural thing at all – if it were, then no-one would need to go to a hospital to deliver.

    Dar es Salaam:
    There are two hospitals here which *might* be able to offer epidurals:
    IST Clinic: These guys are good (and I think they recently started offering epidurals) BUT they only deliver for women who’ve already had one normal delivery as they don’t have a surgical theatre.

    The other one is the Women’s Health and Trauma Centre: I’m unsure whether there are epidurals here (I thought that only one clinic in Dar offered them, either this one or IST but they were a new development). Epidurals involve a risk of paralysis so I’m not comfortable having one at a place which has very little experience in administering them.

    Various doctors in my family (there are a lot of them!) have informed me that there is a 1 in 5 chance of having a c-section anyway. 20% seems quite high to me and I also think this statistic reflects how UN-simple childbirth can potentially be. I just googled the rate of c-sections and I found:
    – about 30% of women who gave birth in the US had c-sections in 2005.
    – There is also a comparable rate in OZ http://forums.naturalparenting.com.au/birth-information-questions/10725-one-third-australian-births-caesars.html
    – I’ve also heard the number of c-sections is higher here as it is the main (perhaps only) way of dealing with a complicated delivery.
    I assume that elective ceasers also contribute to these numbers.

    Ok I think that’s about all I’ve got! We’ve recently decided on one “solution” to the childbirth conundrum (at least for now) which I can PM you about later if you like. Hope this has been a teensy bit helpful.

  3. Katie, I was counting on you having opinions and research on this topic! Thanks for weighing in! :)

    I’d heard the expense thing about Nairobi before – good to have that confirmed. Hadn’t heard about the epidural thing though but I have an anesthetist friend who’s offered to come over should it ever be necessary.

    I’d love to hear your solution too – email me!

  4. If you ever needed any encouragement, I’m living proof of the benefits of being born 9 months after your parents’ final Bible College exams… :P

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