Saturday, August 22, 2009

Seven Babies!

I went into the hospital at 12am with Kelly (the New Zealand student midwife), hoping to attend the birth of the girl who had taken a long time to dilate from four to five centimeters. I am so fortunate to have met Kelly, not just because she is lovely and fun, but also because it is dangerous for either one of us to go alone to the hospital in the dark. I have heard (though I have trouble believing) that Vanuatu has the highest rate of assault on aid/volunteer workers than anywhere in the world. Granted, I am on only one island out of almost eighty that make up Vanuatu, and it is a very touristy island, but it is always better to be more rather than less cautious.  So Kelly and I walked the two minute walk hospital in the blackest pitch of night (I’m not even kidding…you cannot see people until they are one inch from your face), and arrived to see that the girl we were waiting on had only had her baby half an hour before we arrived (damn it!) and they had cut an episiotomy (DAMN IT!) because she had had a “long” second (pushing) stage. That being said, she was very happy and lying peacefully with her new baby boy.

 Although Kelly and I were disappointed to have missed that birth, we could not be too upset since we actually ended up being involved in seven births over our nine hours at the hospital! Kelly delivered the first baby of the evening while I assisted (albeit not for very long because I was called to deliver another baby). This woman was desperately wanting to push but we had to stop her because she was not fully dilated (although close at 8cm). The birth, itself, was a little concerning also because there was thick meconium in the amniotic fluid (babies with meconium in the fluid are usually under some stress in utero or post-dates and it can often lead to respiratory distress if the meconium is aspirated during delivery). Fortunately this baby was born and suctioned right away and had no respiratory problems whatsoever.

 The next birth that I was called into was the labor of a thirty-nine year old woman who had undergone no prenatal care for this, her fifth child. With that being the case, I had no idea what to expect (you expect that the baby will be completely fine, but there is no confirmation of this and so I needed to expect the unexpected). I performed the vaginal exam on her, assessing that the baby was, in fact, head down and that the mother was fully dilated. She began to push. And push. And push. She pushed much longer than most moms who are having their fifth baby should have to do! As I was waiting for the head to descend to the perineum, I noticed (oh, crap!) that the baby’s umbilical cord was pinned between the baby’s head and the mother’s pubic bone. This is a very dangerous situation in that the baby’s oxygen supply, until it is born, is through the umbilical cord. Because there is no continuous monitoring of fetal heart rate done here, it is difficult to say how long the cord had been pinned and if the baby was okay; the cord was not pulsing, which is not a good sign in terms of blood moving through it. One of the midwives, Sister Lydia (who is initially gruff and them so incredibly lovable!) was standing elsewhere in the labor ward and I told her the situation and asked her what I should do about this cord situation. She said, “Push it back!” (“Right,” I thought. “Duh. Push it back!”) So I did. And the mama had her baby a minute or two later. And that crazy little baby came out direct occiput posterior (with the face pointed up, or as I like to say “sunny side up”), which is not the ideal way for a baby to come out! This, combined with the umbilical cord situation, was why the pushing stage took so long. Much to my relief, the new baby boy vigorously cried right away. He was just fine. This reaffirmed to me what one of my favorite midwives back in the States always says: “Babies come out.” They do…and most of the time they are just fine.

 Baby number three of the evening was a baby that neither Kelly nor myself delivered. After our first two births of the evening, the maternity ward received a phone call. “Can you please come outside?” the caller said, “There’s a baby on the bus.” WHAT?! Kelly, myself, and Sister Lydia all went to the door to find a mother, who had just had her baby a short time ago, with some members of her family. We quickly ushered the mother into the labor ward and Kelly managed the mother and I managed the baby. The mother had not yet delivered her placenta, although she said she had given birth to the baby at least an hour ago, but she was luckily not bleeding and birthed the placenta quite easily and quickly. The baby, who I think must have been delivered outside on the ground (she had dirt and twigs on her), was wrapped in very wet and light sheets. When I unwrapped her under the warmer, her umbilical cord had been cut but not clamped. This is not a good situation since babies don’t have a significant blood volume and can bleed out through their cords if they are not clamped. Luckily this baby had bled only a little and seemed quite alert. She was actually one of the most beautiful babies I have ever seen with the plumpest little lips and the most exquisitely long lashes; she did not make a sound, just watching me as I inspected her from head to toe. I actually would have preferred her to be crying. Neither she nor her mother made much noise; I think that they were both in shock. This was confirmed when the temperature of the baby was taken and confirmed to be approximately 94 degrees F. No way. Since I was called to deliver another baby, Kelly kept taking this baby’s temperature and in the next few hours it only got as high as 96.7 or so; this was with skin to skin contact and being under a warmer. When Kelly and I left the next morning this baby was still under the warmer and her temperature and other vitals were being monitored every hour. When I go back to the hospital on Monday I hope to see that she and her mama are just fine.

 Baby number four came to a nineteen year old primip (a mother who was having her first child).  She was fully dilated and ready to push, so I gowned up and got ready. Although she was ready to push, this young girl really didn’t want to. I was telling her (and Sister Olina was REALLY telling her) that she needed to push only with contractions and when she did, they needed to be long and strong pushes. Here, it seems that most mothers just push their babies out, whether or nor they have pushed out a baby before. Because of this, I believe, the midwives here are not as patient as midwives are in some other places. It is not unheard of, and I have seen more than once, that mothers in the States can spend greater than two hours pushing when they are having their first child. Two hours for one’s first child is, in fact, average. I am saying this because this young mother was pushing (though pretty lightly and ineffectively) for about half an hour when Sister Olina, who was watching me over my shoulder, began asking me if I wanted to cut an episiotomy. Please understand that I respect and admire the midwives here as well as their expertise so very much. I am learning here so quickly that it cannot even be put in to words. That being said, was I going to cut into this nineteen-year old girl and this nineteen-year old perineum after half an hour of pushing? HELL NO! Of course, I didn’t say this. Instead I said something like, “Weeeeell…let’s just give it a little more time.” Sister Olina shrugged as though to say, “Okay, have it your way” and since the baby wasn’t in any distress (we checked on the CTG machine), we let the mama keep pushing. And pushing. And the mama was ignoring my coaching and rolling her eyes (maybe at my crappy Bislama, which IS getting better everyday. It really is!) So Sister Olina asked me, every five minutes or so, if I was ready to cut an episiotomy yet. No! I wasn’t! It hadn’t even been an hour of pushing yet! Finally, I looked at this mother and started getting angry. Not at her, but at the fact that I was trying to help her and she was only giving me these itty bitty pushes. So I started getting louder and more forceful and in ten more minutes she had her little baby girl. So she had her beautiful baby, which she had worked so hard for, and I had my small victory: that she did not tear. Not one little bit. Later I came in to check on how breastfeeding was going and the new mama’s mother handed me her new granddaughter. I cooed over her for a couple of minutes and went to hand her back when the grandmother asked my name. When I told her she said, pointing to the new baby, “This is Carrie, too.” The new mother nodded in agreement. They decided to name this new baby after me and I am beyond honored.

 Babies five and six came almost at the same time and so Kelly delivered one and I delivered one. Kelly attended a beautiful birth and luckily she was done attending to that mother and came into the other labor at the tail end. I say this because this baby had a shoulder dystocia (which occurs when the baby’s shoulders become stuck behind the mother’s pubic bone. This is very serious and though there are handful of maneuvers to try and remedy the situation, the clock is ticking so that the baby doesn’t run out of oxygen). Luckily the dystocia was fairly minor and as Kelly tried to shove the scapula of the anterior shoulder externally on the mother’s belly, I kept sweeping for it internally. Finally I was able the grasp the baby’s anterior shoulder and pull him out. There was only about two minute’s worth of sweat pooled on my back, which is not to bad for a dystocia!

 Baby number seven, though happening at the hospital that evening, was actually an event that happened at home that morning. A seventeen-year old mother who had undergone no prenatal care (I’m not sure that she knew she was pregnant) woke up and told her mother that she was feeling very ill. She said that she had cramping and generalized stomach pains. She asked her mother to take her to the hospital. Her mother, evidently, said that she did not like going to the hospital and decided instead to go to work. Shortly after the mother went to work, the daughter felt the urge to use the toilet and before being able to sit down on it, squatted and delivered a rather small baby. From what I gather, the placenta was born almost at the same time. This baby, only 1.2kg, cried for a little while (though I’m not sure for how long). She was never detached from the placenta and she died later on in the day. When the mother got home from work, they all came to the hospital. 

Life is different here and I’m not in a position to judge the people around me or comment upon the decisions that are being made. I have been fortunate to have this experience at the hospital, to be provided with a glimpse into a culture that is not my own, but I am not part of this culture and never will be. Over time I will understand it better but I will never really be a part of it. That being said, I am also not quite a tourist. Though I am fortunate to enjoy fun things and the beautiful weather while on this island, I cannot pretend that I only see the ease in living here.

No comments: