Port-au-Prince Maternity Clinics Pushed to Limit

BY Talea Miller  July 15, 2010 at 5:58 PM EST

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It’s nearly dusk in Port-au-Prince on a recent sweltering summer evening, and four women at the Health Center of Croix des Bouquets are in the early stages of labor.

They are all expected to give birth by morning and will each be attended by the one nurse-midwife staffed for the night shift.

Already today, one of the public clinic’s doctors had to keep a woman suffering from postpartum hemorrhage, or severe bleeding at birth, from dying. Another patient who is almost full term is losing the amniotic fluid that protects her fetus. If it continues, her unborn baby could die.

None of this is unusual for the clinic, which has been forced to take on a flood of new patients, like all the health facilities across Port-au-Prince that remained standing after the Jan. 12 earthquake. Health Center of Croix des Bouquets, which provides services for free to the public, saw between 60 and 70 births a month before the quake, but now attends to about 150 a month.

In Haiti, maternal mortality rates are especially high, and now doctors and nurses across the capital are also reporting a rise in new pregnancies since the earthquake, according to the World Health Organization’s Haiti health cluster lead, Dana Van Alphen. The combination of fewer facilities and more mothers-to-be is stretching prenatal and birthing services to the limit.

“We’ve seen a great increase in the pregnancy rate since the earthquake, a lot of women come because of how promiscuous life has become since the earthquake,” said Francenette Defonce, a nurse-midwife at Croix des Bouquets.

Dr. Laure Adrien, an obstetrician and gynecologist who oversees the public clinic and is executive director of the Haitian Society of Obstetrics and Gynecology agreed and said there are more difficult pregnancies as well.

“We have more complicated pregnancies; we have a higher percentage of hypertension, preeclampsia; we do have a lot of postpartum hemorrhage,” he said.

The sanitation situation in the tent camps is also causing more postpartum infections. Many women from the settlements are coming to the clinic with unwanted pregnancies, sometimes with post-abortion complications, which Adrien said was not common before January.

“They will use [abortion] medicines, it’s not complete and so then they come here seeking care for post abortion-infections,” often bleeding heavily, he said.

Van Alphen of the WHO said 7,000 women affected by the earthquake are estimated to be giving birth each month in Haiti now, and 63,000 women affected by the quake are estimated to be pregnant. For clinics like Croix des Bouquets, close to large tent settlements, this means that every staff member is vital. Haiti has had a chronic shortage of both doctors and nurses for many years, but Adrien said the earthquake has brought another layer of competition for health workers, beyond the lure of moving abroad for better salaries.

“Our biggest problem here is to be able to retain our staff because a lot of the NGOs and organizations that came in this year have a big budget to pay staff, they are paying much more than we are capable of paying right now,” he said.

“These employees are tempted to work for the NGOs and organizations where they could make much more money.”

Nurse Defonce said she has not been tempted to leave her job here in Haiti, yet, because she loves the women she works with.

“It’s beautiful when you help someone to give life,” she said. “It’s really rewarding, I love it.”

For the women at the clinic, especially those about to give birth for the first time, the tie Defonce describes is clearly mutual.