Bing! Bing! Bing!

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First day on the L&D unit, and what a day! I saw three deliveries total, which was really awesome. Overall I had a good experience. Thai nursing students are all trained to be midwives, so the nursing students were the ones delivering the babies. I thought this was so neat. I was actually kind of jealous because I have to go back to school for at least 3 years to be a midwife in the States. The staff were all very friendly, including the nursing instructors from BCNC and Chiang Mai university. They were both willing to answer our questions and also asked us about ourselves. There was probably a total of 15 or 20 nursing students on the labor unit, which made it really hard for me to help out and get hands on experience. I spent most of my time observing and asking questions. However I was able to feel the uterine contractions on a mother’s abdomen and complete a baby assessment. I learned that in Thai “bing” means “push”, which really comes in handy when you’re on this unit. The unit is set up into different areas. One large room is for observation, another for active labor, and the back room is set up for deliveries. There were probably 9 women on the unit total when we were leaving. About two hours after delivery mom and baby are transferred across the hospital to the postpartum unit where they stay for 2 days. C-section moms stay for 5 days, which is pretty similar to America. During the first delivery i saw the mother didn’t want to push and so a skilled nurse pushed really hard on her upper abdomen/fundus to get the baby out. Our preceptor told us that this procedure is illegal in Thailand, and yet skilled nurses will use it. The second delivery was going as planned, but the skilled nurse still did the fundal push, which i didn’t understand. There was no reason for it because the baby was coming and was not showing signs of distress. The third delivery happened very fast. The mother pushed for two rounds and the baby was born. The baby was 34 weeks along, which caused some concern. The doctors had tried to stall the mothers labor, but it didn’t work. This mom delivered her baby right as we were leaving so we couldn’t stay to watch how everything played out. I did notice that the baby needed to be stimulated a lot and the mother was losing a lot of blood. I noticed a few similarities and differences between American and Thai nursing. First of all, no family members are allowed to be present in the labor ward. In America at least 2 people are allowed to be present for the laboring process, if not for the birth as well. I believe that having emotional support is key in decreasing anxiety and stress. The nurses also weren’t very attentive to the emotional needs of the patients. One women reached out for a nurses hand during contractions and the nurse pushed her hand away and placed it on the bed. This broke my heart because the mother needed support and she was not receiving it. Another difference is that every women gets an episiotomy during the delivery process. And this is no small incision! I was shocked to find this out because in America we know that episiotomy’s are not good for moms unless the situation is emergent. I couldn’t help but cringe every time the nurse cut into the mother, who only had a shot of lidocaine to dull the pain. Something else I noticed is that Thai women do not show much emotion when it comes to pain. I believe that it is their culture to hide pain, which made the labor ward fairly quiet. I was talking to a Thai nursing professor and she mentioned that the doctors at this hospital don’t offer any pain medicine to their laboring mothers. I half expected this, but I found it odd that the doctors made that decision and it wasn’t just due to a lack of medication. The final big difference I noticed was that as soon as the baby was delivered it was taken away from the mother to be assessed. The mom could only see the baby for about 30 seconds after the cord was clamped. There was no skin to skin time, which is ironic because right on the wall theres a poster about skin to skin time. The baby was not returned to the mother until about an hour after the delivery. Its very important that mom and baby stay together after delivery because it helps the baby maintain body temperature, regular blood sugar, and it stimulates breast feeding. A similarity I noticed was that the babies all received a hepatitis B and vitamin K shot. The nursing students preformed the same assessment on the baby as we do in the States. Fetal heart tones and contractions are monitored during labor, although its intermittent because moms are encouraged to move around during labor. Also mom’s deliver in the same position (on their back with their legs spread apart) in both countries. I was expecting the Thai community to take a more natural approach to the delivery process and have their moms deliver in a variety of positions. Although the lack of materials was noted, the Thai people tend to deliver their babies the same way Americans do. One cool thing that Thais have and we don’t is a device that measures the amount of postpartum bleeding, and a protocol with it. This device is a plastic funnel shaped bag with marks on it. Each mark is associated with a different amount of bleeding and a different nursing protocol. Although we have similar bags in the states, we don’t have protocols associated with specific amounts of bleedings. It just depends on the doctors orders.



After clinicals our buddies came and got us all ready for our traditional Thai dinner. It was so fun to have them come up to our apartments and help us get dressed, do our makeup, and fix our hair. They picked fresh flowers and put them in our hair! It was a great bonding experience for us all. I even had everyone try a fruit gusher, which was really funny because most of them said “oh delicious” but their faces said “ew this is nasty”. One of the girls did my makeup and made my eyebrows dark, which I thought looked really funny! But in the end everyone looked beautiful! The restaurant we went to was gorgeous and over the top. I enjoyed watching the show and interacting with everyone. I especially liked getting up and dancing with the Thai women. The food was good too, although it messed with my stomach a little bit afterwards. My favorite foods were the egg drop soup, fried banana, chicken, and of course the watermelon. I ended my evening with some homework and preparation for tomorrow’s class. I’m looking forward to what tomorrow brings. Goodnight

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