Thursday, March 27, 2008

Finding the rhythm. . .

We are settling in nicely. Yesterday was a gorgeous day off with brilliant blue skies and a hot, hot sun. Our Seattle-pale skin is browning nicely (Sunita obviously in the lead, Kat coming in second as my meager celtic melanocytes struggle to keep up. We visited the Mele-Maat cascades – an amazing set of waterfalls with a number of shallow pools for swimming. You are able to swim right under the waterfall, letting the cold, pounding water temporarily relieve the heat of the day. Quite amazing – we have a lot of waterfalls in our collective experience and all agreed that this one was one of the best. We are working 4 days on, 1 day off. Kat and I took the am shift today – starting at 4am and staying til around 3pm, Sunita is at work now on the 3-11 shift. We are kicking it into high birth gear – planning to work long hours for the next ten days and then maybe take a few days off to adventure around to the surrounding islands (there is a live volcano that is calling my name). Averaging about 3-4 births per shift, more on a busy day.

Today started out with the observation of a vacuum assisted delivery – a first time mom with a “prolonged” pushing stage. Most women, even first timers, push their babies out in short order here – the 3 plus hour sessions we host in the states are completely unheard of. This woman was making slow progress after 1 hour and the OB was called in. The vacuum was used and baby came out with quite a cone head. Kat and I agreed that with some creative positioning and patience, the baby would most likely have gotten out on it’s own. However, the heart rate was starting to show signs of stress and the culture here doesn’t really go for pushing in any other position besides on the bed on their backs. For an instrumental delivery, it was fairly uncomplicated and a good learning experience.

Next up was a first time mom who went from 5 cm to complete in less than 2 hours and then proceeded to push her baby out in 15 minutes. That is a pretty normal timeline for the women here. Delivery was quite smooth, but there was a relatively complex (at least for a novice like me) 2nd degree (into the vaginal muscle, but not extending into the anal sphincter) tear. I have to give myself a little bit of pat on the back for a job well done. With the guidance of Kat and a senior midwife, it looked pretty darn good. (We have been studying our Ann Frye suture book religiously and are feeling like our techniques are really starting to come together – no pun intended).

To end the day, a sixth time mom showed up and had her baby in the admissions room. Normally a woman shows up in labor, we get her chart from the antenatal care department, take her vital signs, get a history of her labor (when did contraction start, is the bag of water intact, any bloody show – all done in Bislama mind you), do a CTG (electronic tracing of fetal heartbeat and contraction pattern), followed by a vaginal exam to asses dilation. Five minutes into the CTG, we heard the telltale signs of second stage. Kat lifted the woman’s dress to do the cervical exam and saw a crowning head. I managed to run to the delivery room to grab our tray of instruments: surgical gown, sterile gloves, cord clamp, gauze, towel for baby, suture tools and kidney pan to catch the placenta. Kat slid on a pair of gloves and barely caught the baby.

My greatest lesson so far, and one of the best gifts of this experience, is the reminder that birth works. The cervix dilates, the mother pushes, the baby is born. These women don’t have childbirth education, don’t take prenatal vitamins, certainly haven’t written a birth plan, many have had little, if any, prenatal care. And yet their babies come out. Always without pain relief unless undergoing instrumental delivery, 99% breastfeeding easily within the first hour. Why does it seem so (relatively) easy here and become so much more complex at home? I can’t really say – maybe it is because these women know that their only option is to push their babies out – there isn’t an anaesthiologist waiting down the hall to make the pain go away; maybe it is because they have seen their mothers, aunties and sisters push out babies and breastfeed them – an experience most US women lack; maybe they posses some physiologic/genetic difference that makes these women bad-ass birthing machines. I’ll let you all know once I figure it out.



gi_relax said...

Hi Girls,

I am simply amazed and fascinated reading your experiences ..and I had the same question...why are so many doctors using c-section everywhere else, scaring the parents into it right before delivery and here these women JUST DO IT! Are there even cases of jestation diabetes where complications arise?

I am a little surprised that the women use only one position during birthing....I guess cultural influences are strong everywhere.

Question for you girls is would you use vacuum assisted delivery in US?

love you Sunita...will call you soon!

micaela said...

love you sisterface! you're amazing :)

ekdolphin said...

i want some waterfall swims and sun bathing with the ladies! work hard play hard...we've all become pros of that one over the last 5 years. you ladies are gaining tremendous experience and i love reading you stories!

april charmaine said...

i love you caitlin and am completely in awe. you are such a courageous genius, may your heart be filled and happy on this journey.
p.s. i'm doing the play!