Easing the trauma of childbirth for women in rural settings

Family medicine registrar Dr Andrew Wilkins is one of seven vocation-driven, married healthcare-worker couples uplifting and caring for deep rural communities served by two neighbouring coastal hospitals about 100 km from Mthatha.

All of them are in for the long haul at Madwaleni and Zithulele hospitals which are separated by a deep, wide valley that meanders to a coastal recreational eco-village nestled beside the picturesque Xhora River estuary. It's here that they kick back socially over many a weekend, sharing case histories, patient anecdotes and research, and relaxing outdoors.

Dr Wilkins is a second-year family medicine registrar attached to the Walter Sisulu University in Mthatha. "This is one of the most pleasurable, rewarding things I've done," he says. "Not a day goes by when I haven't enjoyed the challenges. Even in the hardships, we're a team and can see the tangible difference we make in these rural settings."

Building resilience amid a lack of resources

The challenges are significant at Madwaleni where he's stationed with Sarah, his speech therapist wife, and their twin daughters, Madeline and Josephine.

Like the powerlessness he feels at 02:00 in the morning when he's trying to help "a horrifically sick child and I can't do bloods or X-rays and have no access to proper investigations." Or battling with an Mthatha referral hospital when he doesn't have enough information for them, facing logistical hurdles with electricity cuts, oxygen running out, week-long water cuts, or helping his agile CEO handle a waste disposal strike.

"You can try and find creative solutions, but in many ways it's exhausting and demoralising, especially in the first year or two when you adjust to the lack of resources and are still building resilience," he says.

Making childbirth safer for rural women

His Discovery Foundation-funded research involves assessing maternal and foetal outcomes from vacuum-assisted vaginal deliveries by non-specialist medical doctors at Madwaleni Hospital - a practice encouraged by the World Health Organization.

Their 3-10% instrument-assisted deliveries help lower the risks associated with having a caesarean, such as infection of the wound. Dr Wilkins' research hopes to contribute to adaptation, improved instrument skills and better outcomes for complicated vertical deliveries.

"We mostly have healthy, normal, uncomplicated cases but then some women have difficult deliveries, and they can end up as complicated C-sections. So, if we can offer uncomplicated instrumental delivery and avoid this, that will help hugely," he says.

Creating a training programme for other rural hospitals

The triennial Saving Mothers report consistently shows that complicated C-section deliveries at district hospitals lead to many mothers and infants dying. Dr Wilkins explains that using instruments sometimes results in short-term trauma to the baby's head or the mother's genital area.

He estimates that they do between 25 to 50 C-sections a month, most of them elective and often because the mother had one before, and about three to 12 instrumental deliveries a month.

"Hopefully there'll be a benefit if we can avoid that first C-section, lessening the likelihood of the next one. If we can show that Madwaleni is doing well, we could create a training programme for other facilities when instrumental deliveries are indicated, and do more of these safely," he says.

"We love it here"

Born, raised and educated in Durban, Dr Wilkins was consistently in the top 10 pupils academically. His father, Mickey, headed up a local NPO that ran a large feeding programme, early childhood development centres, an abandoned babies' home, plus small business development. His mother Toni was a social worker and counsellor.

In 2013, Dr Wilkins graduated from the University of Cape Town, where he met his wife, did his internship at Ngwelezana Hospital in northern KwaZulu-Natal, and community service at Murchison Hospital in Port Shepstone. He moved back to Durban in 2017 where he married Sarah. Then both in private practice, they took three months off "to travel and do some dreaming about our future," something that has paid off handsomely.

With persistence from his colleagues, an unprecedented post was created for Sarah at Madwaleni. "We'd never set foot here before, but now she runs the rehabilitation department," he says. "We love it here. It's where we want to be for at least the next five years."

This article was created for the 2021 Discovery Foundation Awards and has been edited for the Discovery Magazine.