Functional analysis of cephalopelvic relation
I think it would be good if I gave you the context of my practice (Table 1), so that as I talk about the functional assessment of cephalopelvic relationship it will be in that context. First of all our practice is in the Third World poverty, in the midst of a country that has first real wealth, but in the part of the country where I practice is a Third World setting, a kind of poverty that unless you have been in that poverty it is almost impossible to describe. I am appreciating your kindness to me and the comfort and the pleasure I have had in the few hours since I have been here. I have suffered not from jet-lag, having come a long distance, but from culture shock. In the hospital where I work, we do 28,000 deliveries a year. The people come from abject poverty. To describe the living conditions for many of them, it is in shanties, in corrugated iron makeshift homes. There is no sewage, no refuse disposal, no tap water, and severe undernutrition. Over a million people living in this existence, and to come and see this, it is so overwhelming. It is in that type of practice that I have lived and worked for 30 odd years not only in Durban, 7 years in Simbabwe, the last 11 years in Zululand in Newtown. We have limited hospitals and limited clinics for patients to deliver. Apart from every bed full. Many of them are unable to come to the hospital. When I first went to Durban 11 years ago, we used to be repairing about 3 fistulas a week and 3 ruptured uteri a week at least. The facilities are very limited, limited trained personnel. In the city in upperclass private practice, there is one doctor to 1,000 people. In the areas from which my patients come, there is one doctor to 90,000. I can take you to parts of the country from which my patients come where there are 200,000 people with one clinic, no hospital, and very limited transport facilities. High parity, pregnancies at a young age, a broken family life system with the inequities of migratory labor, with the men working in the goldmines, which supports the economy of our country. In the structure of our country it means that the men are in goldmines 1,000 km away and women and the children living in the homelands. So many of these young girls are without the father figure at home and family cohesion. 50% of our deliveries occur in primaps under the age of 18. 20% have their second child before they are 18. Poor transportation, no communications, no telephones, and very limited equipment. The equipment that we have and I will describe is used not so much for service work but so that we can learn and interpret from it so that it would be of help to those who work in the developing world with similar limited facilities.
KeywordsCesarean Section Fetal Distress Traditional Birth Attendant Normal Vaginal Delivery Ischial Spine
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