Monday, September 7, 2009

Each Day I Am Learning...

at Vila Central Hospital. I have, lately, been delivering babies that are very healthy and normal but I am also involved in labors that are very different from what is within my comfort zone as well as my scope of practice in the States. At the end of last week I came into the hospital late in the evening to begin a shift. When I arrived there was only one young girl in early labor. She was 1cm, but was admitted to the hospital at an early stage because of a genetic heart defect. Her heart condition is known as Ventricular Septal Defect (VSD) and there was a concern that, even though this defect had been surgically corrected in 2006 (when she was fifteen years old), she might not be able to tolerate the stress of labor well and her baby may not either due to improper functioning of the maternal heart. The doctors who were monitoring this young girl’s case were worried about strong contractions and their impact upon both mother and baby so we were to give her 5mg of morphine if labor became too intense for her. Certainly labor is intense for any woman, but there are always women who seem to have a more difficult labor than others. This was one of those women. This poor thing, from 3cm onward, was wracked by the most intense contractions that, at most, gave her one minute of relaxation and peace in between. Ni-Vanuatu women are some of the strongest women I have ever met, this girl being no exception, but she was in such extreme pain, her cervix dilating so quickly, that she was just falling to pieces. I did something that is very rare in this hospital and I sat and held her hand for the duration of her labor. Usually the mothers are not particulary interested in being coddled, but this was a very different and intense case. The mother dilated from three to ten centimeters in a very short amount of time, under two hours, and her baby was delivered very quickly. The baby made no respiratory effort initially, though the heart rate was very good, and in just a couple minutes and with a little bit of oxygen, this baby boy to begin breathing on his own. He has remained quite stable and happy and although there was concern that he may also have some sort of genetic heart defect, this has been ruled out. He will need to have surgery at some point for bilateral syndactyly of his hands (both his second and third and his fourth and fifth digits are fused together, giving him a type of claw hand) and of one of his feet, but he is otherwise quite healthy and normal.

The next labor of the evening was fairly straightforward, although the mother ended up tearing rather significantly with the baby’s passage through the birth canal. I have learned to suture through my education quite a bit, but what I have not been able to always reinforce through practice in the States, I am reinforcing here since the Sister’s will watch over my shoulder and give me advice on my suturing. I have begun suturing quite regularly here and have even gone to sleep dreaming of various tears and how to fix them...great for learning but not the best for sleeping:) 

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