Skin-to-skin in Gulu, Uganda

When the electricity goes out in a small, rural hospital in Gulu, Uganda, hospital staff sometimes use the light emitted by their phones to repair tears from childbirth, to check for complete placentas, and for various other procedures.

“Sometimes there is no electricity for long periods of time,” Healthy Children Project’s Kajsa Brimdyr, PhD, CLC reports.  “There’s so much that happens by just trying to see by the moonlight.”

Brimdyr and colleague in Gulu. 

Gulu averages 60 inches of rain per year, in torrential downfalls, thunder and lightning, Brimdyr continues. The storms cast darkness during the day and wipe out the electricity.

In general, the lighting is limited in the hospital’s maternity ward.

“If you want to close a curtain around a mother’s bed to give her privacy, there is no light in that ‘cubby’ anymore,” Brimdyr explains.  “So there is a constant trade-off between privacy for the mother, and light for the staff to see by.”

Healthy Children Project’s famous Milk Duck Race raised $1,122 at this year’s International Breastfeeding and MAINN Conference which will be used to purchase about 40 headlamps for labor and delivery staff in Uganda.

The Milk Duck Races.

In addition to unreliable electricity, Ugandans battle a lack of other resources. When a mother finds herself pregnant, she starts to assemble her ‘mama kit.’ Mothers are responsible for collecting items like gloves, a bucket for the placenta and fluids, and plastic to lay upon.

Uganda suffers from high mortality due to malaria and other diseases and an upsettingly high neonatal mortality rate at 21.4 deaths per 1,000 live births.

Many of these infant deaths can be avoided by placing babies skin-to-skin with their mothers immediately after birth. In fact, when compared with newborns put to the breast within an hour of birth, the risk of dying in the first 28 days of life is 41 per cent higher for those who initiated 2 to 23 hours after birth, and 79 percent higher for those who initiated one day or longer after birth. [, page 30]

In 2014, researchers at Karolinska Institutet’s Division of Reproductive Health with colleagues at Makerere University and the University of Gulu, developed a plan to increase the number of mothers and newborns who have early skin-to-skin contact in the first hour after birth in Uganda.

The team held inservices at the aforementioned hospital in Gulu where they screened Brimdyr’s skin-to-skin in the First Hour After Birth; Practical Advice for Staff after Vaginal and Cesarean Birth. Nine months later, they returned to see if hospital staff could change practice by simply watching the video.

“[The researchers] found that people really overcame [the perceived] challenges once they watched the video,” Brimdyr confirms. “They saw the importance; they could see [skin-to-skin] had made a difference.”

Still, staff commented that the babies in the practical advice DVD are clearly Swedish and American babies; they don’t look like Black Ugandan babies.

So in November 2017 Brimdyr, Healthy Children Project’s Executive Director Karin Cadwell, PhD, RN, FAAN, ANLC, CLC, IBCLC, and a team from Karolinska traveled to Gulu to produce a video of Ugandan babies going through the nine instinctive stages.

The video is also available in Luo, a native dialect.

“Something that I really love about video ethnography is that I’m only showing what’s actually happening,” Brimdyr reflects. “There are no baby actors. There are no mother actors.”

Skin-to-skin is entirely sustainable because it involves resources Uganda (all countries!) already has: mothers and babies. Helping implement skin-to-skin eludes White Savior Mentality.

Brimdyr reflects on her experience in the maternity ward: “It’s the most important thing anyone can do, is be with women during birth and the first hour. I felt so honored to be with them. It’s amazingly profound.

“The care, the compassion from hospital staff was really unique. The relationship between moms and grandmothers as they came in and interacted… there was such a feeling of family and collaboration. They embraced us immediately and welcomed us into their group. It was really amazing.”  

Brimdyr and colleagues have discussed follow-up projects in Gulu. She says the hope is that the implementation of skin-to-skin in the first hour after birth will spread through Uganda and Sub Saharan Africa.

More here and here.

Please consider sharing HCP’s short video about this project.

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