MOST births in our parts of Africa are uneventful in medical terms but that misses the point – which is that they are small oases of joy and hope amid poverty, venal dictators, psychotic warlords, Aids, Ebola and Covid. The mother-to-be is a special person with family, friends and workmates rallying round, pleased to do favours here and relieve domestic burdens there. As a result, whether her first or tenth pregnancy and no matter the chaotic state of her community, she walks with serenity, confidence and grace.

As medical students, the first glimpse of this gravid world was at the Royal Maternity Hospital in Glasgow’s east end, pictured right. It was known as Rottenrow, appropriate on hot summer afternoons when the pungent agricultural je ne sais quoi from the surrounding tenements could make your eyes water. Entering its reception area was a culture shock. No orderly queues but whirls of shouting, gesticulating citizens, here to give moral and, if necessary, physical support to their wife, daughter or neighbour.

Daphne had been caught short on the number 42A bus. “Ah’m no’ due tae hiv this bairn fir a month yet, hen, so whit’s a this then?”

She was addressing one of Rottenrow’s reception clerks in the present aggressive, a tense commonly used in the city, not in an angry personal manner but as an appeal to anyone within hearing distance – about a mile, in Daphne’s case – who could help.

Midwives usually make it clear to any hovering doctor that this is women’s work which they’ve been doing for years, thank you, so we’ll give you a shout if we need you?

Out in the bush it can be a very different story. Priska Sithole delivered her sixth baby at her hut high up on Msinga Top in Zululand after a very rapid labour. The afterbirth did not come out and she began to bleed. A neighbour pulled at the umbilical cord which broke. Her brother could not get his old truck started for an hour.

I found her lying on a trolley in our maternity unit, a big boned woman in her thirties, her cowhide skirt sticky with blood clot, as were her legs and bare leathery feet. As we battled to put up double drips, she sighed and died.

For mothers and countries who can afford the expense, modern obstetrics will have few Priska Sitholes to haunt it. This is an expensive and ordered world where normal deliveries happen in daylight or by Caesarian section at a specific time on a specific day, where forceps and other types of assisted delivery are almost unheard of, and where the threat of multi-million-pound lawsuits for negligence causing the baby’s brain to be damaged is the elephant in every maternity unit.

For the majority of mothers worldwide, however, their delivery will be at home, in simple clinics or overcrowded hospitals. Which is why teaching midwives, be they students or long qualified, is such a pleasure. Their influence in communities is substantial and covers many areas outside actually delivering babies.

One afternoon in Kampala I was showing our midwives how to deal with a delivery where the baby’s shoulders have arrested progress, using a rubber pelvis and a battered doll to show the mechanics.

“Here we are, ladies. Baby’s head is out but you can’t deliver the rest of it. Baby’s not breathing and going blue. What to do?”

Sister Venantius, a bright nun from Kenya, first rate when the going was rough but not enamoured with the academic side of midwifery, frowned. Then – inspiration!

“Doctor, I’d – I’d ...”

“Yes! Yes?”

“I’d put holy water on its head...”

Collapse of lecturer and students ensued.

Dr David Vost studied medicine at Glasgow University and is currently working at a hospital in Swaziland. He and his family live on a small farm in Northern Uganda near the Albert Nile. davidvostsz@gmail.com