Wednesday, April 9, 2008

Six sweet babies. . .

So I worked a double shift the other night and was lucky enough to catch six sweet babies in a row – my personal Vanuatu record. All were fairly straightforward except for one, which I can truly say was the scariest moment of my midwifery career (and possibly my life). My very first shoulder dystocia! Shoulder dystocia occurs when the head of the baby delivers and the shoulder get stuck on the bones of the pelvis. The tricky thing is that once the head is out, the baby only has so much time before the oxygen supply to their brain diminishes. The other tricky thing is that it is quite hard to predict (sometimes it is correlated with big babies, but more often they are normal size babies in normal sized women) and you often don’t know it is going to happen until it is happening, making it somewhat hard to prepare for.

This baby displayed the classic signs – the head came quite slowly and once the chin was out squeezed tightly back along the mother’s perineum (called the turtle sign since it resembles a turtle sticking it’s head out of the shell, only to retract back into it), then the baby failed to restitute (normally the baby is born facing the tailbone of the mother and then turns to the left or right as the shoulders come down through the pelvis). Finally, and most alarmingly, the baby began to turn deep blue. Ohhhkay. . . so I tried unsuccessfully for what seemed like hours, but was actually a minute, to get this baby out, pulling harder then I thought possible, attempting to rotate the shoulders into different position. It didn’t work. The midwife that was working with me gave it a try and I was thankful to have someone else there, surely she could get this baby out. As she tried to manuver the baby I put the woman into McRobert’s position (hyperflexed thighs) and did suprapubic pressure. Still nothing. I ached to have the space and the vocabulary to flip the woman onto hands and knees, the Gaskin Manuver, which we use quite successfully in the States. Now two minutes had passed and the midwife stopped trying to deliver the baby and told me she was going to call the doctor. The doctor who is at home, at least 10 minutes away and with a reputation of not answering the phone on the first ring. Shit, that didn’t seem like the most promising solution to our problem – meanwhile the blue baby was beginning to resemble an eggplant.

Now it’s me and this purple baby and this kid needs to come out. Right now. For real. I took a deep breath and did a quick mental review of what procedures could be done. Oh yeah, delivery of the posterior arm – let’s give it a go. And so I did and so it went, the arm slowly brought up and out across the babies chest followed by one shoulder then the other and then the whole big baby. I called out to the midwife “Hemi come, Hemi come!” Joyous relief – I looked down and knew that this baby was here. Not breathing yet, but life still in his eyes. He needed a brief resuscitation but came around fine and was crying mightily by five minutes.

Now here is where things get a little weird. I was taking a brief nap that afternoon before going into shift and was unable to sleep. I felt anxious and my stomach was in knots. Strangely nervous about my upcoming shift, wishing I wasn’t going in alone. I kept thinking about shoulder dystocias. Worried that without the language to communicate with the mother, without the space I am used to, that I wouldn’t know what to do. I kept thinking about delivering the posterior arm. All night I was waiting for it, the first four babies came and went without a hitch, despite my worry – did this baby feel big, was that a turtle sign – nope all fine. And then number five showed up and it was just like I had imagined and I panicked and then I remembered the posterior arm. Coincidence, intuition, divine intervention, manifestation - who knows, who can say for sure? I am interpreting it as a small reminder that if you listen carefully often all you need to know is right there.

Baby was 4.5 kg – about 9lb 7 oz, pretty big for a ni-van baby. Oh yeah, her first baby was 3.8 kg and had to be delivered by vacuum extraction. This baby had Erb’s palsy after the birth – a slight paralysis of the left arm due to nerve injury secondary to being pulled on (sorry tumas small boy)– usually it is self-limiting and resolves completely. This baby is getting much better by the day and everyone expects a rapid and full recovery.
Tata, Lukim Yu, Caitlin


kevin-dad said...

yeah for Caitlin,

Beth said...

wow- i am so impressed with you ladies! michelle and i just read your blog together and we're excited to see you all - radiographics class awaits you! please enjoy the rest of your time there to the fullest :-)
with love and admiration,

gi_relax said...

Gosh! I am in total admiration, Caitlin! It is so awesome to have this experience.
I think if we allow ourselves to let the divine intervention flow through us, listen to the intuition, put the ego aside, most complexities get resolved.
Hope you girls are having final days of fun!!
much love,
G-momma (Sunita's mom)

april charmaine said...

you shall be changed women for sure for all that you have seen and experienced~ may the lessons be everlasting ****
you betta call somebody the moment you've reached our lovely soils again.

Anonymous said...

I can't add to what others have already said and you guys are pretty bored hearing over and over. You are awesome. The experience you are privileged to have is so amazing. That you can witness life and death (mostly life) beats anything we guys do here.

Sunita, I love you.

Sunita's dad (Mr Cool)