Wednesday, September 23, 2009

First Day and First Catch

Just back from my first day in the hospital. A nice mellow morning of monitoring a women that was being induced since her dates showed she was over 42 weeks, cutting and folding gauze, giving BCG vaccinations (for tuberculosis) to the babes before discharge, and getting to know the midwives, nurses aids, and the general feel of things around here.

The woman whose labor I monitored today was very sweet. She speaks perfect English, which was a nice way of easing me into my first birth here since I could actually communicate with her. This was her fourth birth. She received her first dose of misoprostol intravaginally at 8:25 this morning and started having mild contractions around 11. I left for lunch and a swim around 12:15 since it seemed that things were still in the early phase, returning just before 2 to hear that she was 5cm. Her mother excitedly waved me in to the room and the laboring mother, clearly in a active labor, looked at me and said, "I'm at another level." That was clear and we moved her into the "theatre" or one of the delivery rooms. The nice thing about this room is that it is air conditioned so on a hot day such as today, it was refreshing for all involved. She climbed up onto the table, Sister Leilangi (the head midwife) checked her while I gowned and gloved up. A small anterior lip of the cervix was all that remained and then I was instructed to break her bag, by snagging it with a pair of forceps. That was a new use of this insturment for me, but here, where resources are precious, anything reusable is of great value (versus the disposable amni hooks we use to rupture membranes on other occasions). Within seconds her sweet babe's head was on its way out with her little hand up by her ear and her cord around her neck. With the next push, out she came, covered with vernix (the white creamy waterproofing agent that babies who are generally 40 weeks or less still are covered in- so clearly her dates were off, this was NOT a 42 week babe).

This woman has 2 other girls and 1 boy, and when she was in early labor, I checked her pulses since she didn't know if it was a boy or girl. Her sense was a girl, her mother thought it looked like she was carrying a boy. I thought her belly looked like a girl, but my reading of her pulses said boy. Clearly this is reading of pulses is not one of my strengths (yet). I'll keep working on it :)

One thing I'll really need to get used to here is all the needle pokes for mom and baby. All mom's here receive syntocin (synthetic oxytocin) immediately after giving birth, followed by ergometrine if her blood pressure is normal- both to control bleeding. There is very good logic to this here since prevention of hemorrhaging is of utmost importance- blood transfusions are hard to come by from what I hear and the blood is not super-purified like we have in the states. So the benefits definitely outweigh the risks of giving the meds.

For the babes, within the first 10-15 minutes they receive injections of vitamin K, hepatitis B vaccine, and BCG vaccine (or alternatively they may receive this before departure the following day- depending on whether the vial of vaccine is open at the time of birth and therefore needs to be used, otherwise they will open one vial and do all the babies at the same time the following morning). So yes, lots of pokes within a short period of time for both mom and babe.

I'm amazed by the efficiency here! It has to be this way since they are averaging 200 births PER MONTH on this island! I can't believe that 2400 babies each year are born here! This is not a huge island. Last April was their biggest month this year so far and they had nearly 300 babies that month!!! That's average 10 births per day! So today was my first catch and there is no question that second, third, fourth and beyond will likely be tomorrow or the following day. This is exactly how I like it- jumping right in.

Now, a shower and off to my first experience of a nakamel, or kava bar, to drink and be merry.... or perhaps very relaxed. Will let you know how it goes....

1 comment:

Em said...

Hi Molly. I found you here via Facebook and I'm so excited to read about your adventures. I had no idea you were a midwife, but I am so happy that you are. My daughter was caught by a midwife 15 months ago and I was so sad when we moved because I wouldn't be able to have her at the birth of our next babe. Luckily, I managed to get an appointment with the ONLY midwife who does hospital births in Charlottesville. Can you believe that? How is there only one?!

Take care, Em