Ames sensibles s'abstenir : c'est la lettre qu'une sage-femme traditionnelle
nord-américaine vient d'envoyer à la représentante de l'OMS en République
Dominicaine pour dénoncer des pratiques qu'elle a observées dans un hôpital
public...

Bernard Bel
Secrétaire de l'AFAR

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To: Dr. Ana Cristina Nogueira
PAHO/WHO Representative
Edificio Cruz Roja y OPS/OMS
Calle Pepillo Salcedo - Recta Final
Plaza de la Salud
Ensanche La Fé
Santo Domingo, República Dominicana

My name is Stacy; I am a traditional Midwife in North America. I returned from a
1 week trip to Santo Domingo's Altagracia Hospital de los Partos. My intention
of going there was to attend a few births which I could document for the purpose
of receiving certification in the US.

I am still in shock from the horror of the behaviors I witnessed in this
countries public hospital.
The standard of care for a laboring woman is this:

Laboring women, labor in one room with sixteen beds and sometimes three women to
a bed at a time. There are no clean sheets or chux on these beds, they are in
their street clothes, body fluids are expelled on the floor or on the bed, all
waste products are released in the bed or on the floor by the side while they
labor. The women are not given food or water to drink.

When the doctors find the woman is completely dilated (or not as I witnessed),
she is walked down the hall to the delivery room. If she refuses to walk she is
placed in a wheelchair soaked in blood and fluids of the women who sat in it
before her, no cover.

In the delivery room, less than three minutes from full dilation, the woman is
then instructed to climb up on the table with a plastic garbage bag on it and
put her legs in the stirrups. The intern then sticks her fingers inside the
woman's vagina and yells for her to push. She gets one push. Even though the
baby's heart tones are WNL, and the baby's head is either -3, -2, or +1, or +2
station, the interns and doctors reach for a large needle and inject her with
lidocaine and proceed to cut an enormous mediolateral "episiotomy" into the
ladies bottom. The scissors they use are dull and they cut and cut and cut. I
witnessed the doctor opening the scissors to find they had blood on them from
another woman. She called for a nurse and none came; she used them anyway to cut
this woman (What is the AIDS rate in this country neighboring Haiti?)

After the large incision is made, the doctor again puts her fingers in the
vagina and orders her to push, if the baby does not fly out (which is rare), a
nurse or another doctor pushes the baby out from the fundus.

One day I witnessed an intern cut a woman on both sides and a third time into
the rectum; the head was not even visible and no one took a heart tone. This
woman was left with a gaping hole in her pelvic floor which words cannot
describe.

After the baby is forced out of the woman's severely compromised vagina, the
doctors immediately clamp and cut the umbilical cord depriving the baby of its
blood. The baby is whisked away to another room and the doctor immediately pulls
on the cord of the still attached placenta until the woman hemorrhages and the
placenta is expelled. Three times in one hour I witnessed projectile expression
of copious amounts of blood at this pulling.

Not only did I witness this type of bleeding as they pulled on the cord of this
one woman's uterus, it was then found that she had two large medio-lateral tears
on her cervix and a mediolateral episiotomy which was (and averages) nearly
three inches in length. Needless to say the woman lost more blood than one could
imagine, I could not begin to estimate. After much suturing in in a non sterile
environment, the woman was instructed to sit up, get off of the table and walk
back to a post partum room (she could not and the wheelchair was used),where she
received little to no post partum care or any pain medication.

The private hospitals in the D.R. supposedly are much safer and saner than the
public hospitals. I witnessed the same behaviors on all of these women giving
birth in 2 separate public hospitals.

Instead of coming home and filling out my paperwork that I had attended births
in another country, I am writing to you as a plea to investigate the situation
in the public hospitals in the Dominican Republic. I am at a loss as to what I
could do alone. If you are unable to do anything perhaps you could advise me on
what could be done and who could possibly teach these doctors and interns how to
receive a baby safely. The practices in the DR. not only endanger the health of
the babies, but the mothers as well. The cross contamination of blood is
rampant, the infection rates must be through the roof, the integrity of the
mothers vaginal tissue is severely compromised. What happens in the public
hospitals of the Dominican Republic as I am witness is not birth but torture. We
as an educated global society should not in good conscience turn a blind eye to
these women and children of our world.

Thank you for your time and response.

With all my heart, -Stacy Sheer