Thursday, March 20, 2008

One dozen babies blong Vanuatu...

It’s nearly a full moon, which may explain why the maternity ward was in full swing today. 12 babies from midnight til six pm – a tie between six c-sections and six vaginal births. Four of the sections were planned (one previous c-section with an L-shaped scar on her uterus due to a complicated delivery of twins, one with 2 prior c-sections and a mitral valve replacement, two others for reasons unknown), one emergent section happened during the night (not sure of the indication) and one during our shift for a G8/P7 (G= number of pregnancies, P = number of births) mama who dilated to 7 cm, at contractions stopped, then there was meconium (baby poop in the amniotic fluid), and there were decelerations in the baby’s heartbeat. All babies and mamas were looking good, but it made for a lot of post-operative follow-up and many, many baby baths. The policy at the hospital is for every baby to receive Vitamin K and Hepatitis B injections, as well as a bath before being given back to mama. For Sunita’s first baby bath, she had 12 people watching her and laughing…and making commentary about her not having any pikininis (babies) of her own.

On the more normal side of things, three babies were born in the early morning, two just as we arrived around 7 am. Then after a relatively mellow morning and a successful trip to the market (we bought a 12-pound stalk of plantains for approximately one dollar), things got pretty wild. Our first mama was a G4/P3 woman who had a nice, uneventful birth – notable mostly for the fact that it was the first papa who joined us in the delivery room. Next, we had a first time mom with an entire labor in less than 4 hours; she surprised us by starting to push while we were busy cleaning up after the last birth! This baby needed a little encouragement to breathe, but was doing fine by five minutes.

Our last delivery was a little more complex. The baby was in a posterior position and was descending slowly – the midwife used her “special technique” to turn the baby into a better position. All I can say about this technique is that it involves inserting an entire hand into the vagina and manually repositioning the baby’s head, not something I have ever seen in the States, but it seemed to work and the baby began to progress. Once the head was out, Kat felt a tight cord around the baby’s neck. Under the midwife’s advice, Caitlin clamped and cut the cord on the perineum, and the baby delivered. Oh my, was that a pale, floppy baby! Another one of the midwife’s techniques involves holding babies upside down by the ankles – again, not something I am familiar with, but once again, seemed to work. It was quite a sight- a very, very pale baby hanging and gently swinging by its ankles. Baby began to breathe by about 1 minute, but remained pale and with poor tone for at least ten. Finally, he started to cry and pink up and, like 99.9% of the babies here, was on the breast and feeding vigorously within the hour.

It must be noted that this would be a busy day by most maternity ward standards, but now imagine a ward staffed with one midwife, two nurses and one nursing aide. They do all the deliveries, do pre and post op for the c-sections, take care of the 6 babies in incubators as well as the 5 other neonates undergoing continued treatment for other medical conditions, and the twenty-some post-partum beds. All this and they seem to end everyday laughing. Lukum yu! (See you)

We ended our day with a bus ride home, a quick dip in the pool, takeout pizza (yep, they have pizza here – hooray!) and a cold Tusker (Vanuatu’s local brew). After our 12 hour day, we are ready to climb into bed and dream about more babies to come.


ekdolphin said...

ladies i am smiling reading about your crazy days in the hospital. don't you wish we could all end our days laughing...puts things into perspective. well i can't wait to hear you blow my mind with this new language when you get home and of course see all your pictures. we are wet over here in these parts missing our ladies that are on the other half of the world (wet as well)helping to bring many babies into the world. visit the ocean for me please. (kat can show you my favorite running game i play with myself and the waves!) love you. elan

Linda said...

As a nurse who did OB a long long time ago, I am really enjoying your stories! I did my OB experience at Boston City Hospital - in the 60's, very regimented. I wonder if Vanuatu is where one of the TV show "Survivor" series took place? Thanks for letting me join you vicariously! Linda (AKA Cindy's mom - Cindy born on same day as Darth by C-section - how we all met)