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Dr Eckhart Buchmann, obstetrician

- By Wits University

For the last 100 years, medical textbooks have advised doctors to perform a painful and useless procedure on pregnant women in labour.

“There’s this assumption that you can tell how far down the birth canal a baby’s head has come by feeling landmarks with your fingers,” explains Dr Eckhart Buchmann, an obstetrician in the Department of Obstetrics and Gynaecology within the School of Clinical Medicine at Wits, based at the Charlotte Maxeke Johannesburg Academic Hospital.

“We have found no evidence in support of using this technique, so we no longer use it.”

With 40 women giving birth in the labour ward every day, Buchmann says this kind of assessment, which particularly questions what he terms “recycled knowledge” from outdated textbooks, is key to ensuring the best care for each patient.

In a related investigation, he was able to validate the simple and time-honoured  way of measuring how much a mother’s cervix has dilated. “In this case, the method, which also uses fingers, proved more reliable than using an ultrasound or other technologies, so we will continue using it.”

When he is not helping establish best-practice guidelines for obstetrics, Buchmann teaches young doctors how to handle pregnancy-related emergencies safely and correctly. He does this through a new, hands-on programme known as ‘Essential Steps in Managing Obstetric Emergencies’, or ESMOE.

“We’ve been running these workshops, which make use of rubber model simulations, in Hillbrow and Soweto once a month for a year and half now,” he says.

Hundreds of doctors have received the training, and Buchmann’s research shows that the medical knowledge and skills of these clinicians have markedly improved. He is currently involved in researching whether the training makes a tangible difference in terms of saving the lives of mothers and children. “We expect that it does, but we must make sure that our interventions are working.”

In the case of HIV-positive mothers, interventions, particularly those related to anti-retroviral (ARV) treatment, do seem to be working.

“One in three women attending our antenatal clinics in Soweto is infected with HIV,” says Buchmann. “That number is not coming down, but we will soon release data showing that the number of maternal HIV-associated deaths is dropping.

“Young women don’t get pregnant expecting to die, so these findings will give people a lot of hope, and it shows that we’ve done well in a difficult situation,” he says. With regular testing and treatment, and proper antenatal care, HIV-infected mothers have a very good chance of survival until old-age.

Buchmann also assures mothers that taking ARVs will not harm their unborn babies. But there is something that can harm a growing fetus; something people don’t often consider: second-hand smoke.

“Have you seen any posters warning pregnant women that they shouldn’t be exposed to smoke in their households?” asks Buchmann rhetorically. “We have no idea of the exposure of women in this country, even though second-hand smoke increases the chance of a baby dying before birth.”

Buchmann and one of his registrars are currently designing a study to find out if, and how often, pregnant women in Soweto are exposed to second-hand smoke. This research project is just one of nine Buchmann is currently supervising.  In addition, he spends many a Saturday teaching research methods to other clinicians all over the country. The rest of his spare time is largely dedicated towards analysing data and writing up his research findings.

Despite all these contributions to the field of obstetrics, practiced under these unique, highly demanding South African conditions, Buchmann remains modest. “I’m really no great shakes. I’m just doing my job.”