Tuesday, February 9, 2010

Warning: Graphic

My second day here, I got the low down on how to do all of the paperwork. In their chart you fill out the newborn information. There are two boxes on that page: live birth and stillborn, the stillborn box is then toggled in to two more boxes: fresh and macerated. The first time I read through this, I thought, “gnarly, I hope I never have to deliver a macerated baby”....

When I arrived at the delivery ward this afternoon it was slammed again. Most of the beds were full, a mom was about to come out of c-section, several moms were written in red meaning that they were antenatal and waiting to deliver. One of the student nurses came up to me and asked me, "how do you call it when the baby dies inside?" Fetal demise I told her, and helped her spell it out in her little notebook. That's how I found out there was a woman in the ward waiting to deliver a dead fetus. Part of me really wanted to participate in this experience and part of me was terrified of it. I went about my business running from here to there trying to make sure everything was getting done, when at around 8:45 one of the student nurses grabbed me and asked me to check a mom that he thought was getting close to delivery. It was the mamma with the dead baby. My heart sped up but I went in and checked her and she was 9 cm just a small lip on the right side. I had her lay on that side and checked with midwives about how to proceed. They recommended I go and break her water and then check her again in a few minutes. I grabbed a bedpan and amnihook and knowing that meconium was coming held my breath as I snagged her bag of water. Thick dark brown water came pouring out. I had never seen anything like it. After a little while I checked her again, the midwife asked if the baby was head down or breech. She was fully dilated and as I began to determine the position my fingers ran across the cord, at least I think that is what it was, it had no pulse so I couldn't confirm it. The presenting part was bumpy and not smooth like all the heads I have felt so I guessed that the baby was breech. I had one of the midwives come by and double check and she said she thought it was breech and felt a cord also. It would make sense a cord prolapse would be a definite reason this baby didn’t survive. It was about 9 pm when we determined that she was fully dilated. This was getting intense I was about to do my first breech delivery, and my first and hopefully only stillbirth. The midwives instructed me to just let her continue to have contractions until she could not resist the urge to push and not encourage any pushing until that point. So I sat in the delivery room with this mom and coached her through contractions and supported her the best I could, constantly wondering if she understood what was going to happen. As I sat there the two beds in the second delivery room filled up with two moms almost ready to push and then a fourth mom came in and started pushing in the bed next to us. It felt so chaotic. Not what I wanted for this mamma that was about to do something so difficult. Finally, a little after 11pm, pushing was irresistible and there were clear signs the baby was getting close. One of the midwives was standing with me coaching me on what to do when a student ran over to say that the mom in room two was about to deliver so she left to go catch the baby. Mind your room 1 and 2 are connected by a sink room where they was the sheets and instruments. As I gowned and gloved up, a round circle with hair appeared on the perineum. I was slightly confused because I was sure that baby was breech but I just let the events unfold. My heart was pounding and my throat was totally dry, I was very scared of what I was about to witness. The top of a tiny round head began to emerge, I went to support it and was shocked by the soft consistency of it. The head kept coming sort of oozing out of her body I wasn't sure if I just let come or support it or support her perineum. I was freaked and at a total loss for what to do. Finally the face appeared and with another little push the body slipped out after. As all of this was happening you could hear the mom in the next room pushing and newborn baby crying. A stark contrast to the deafening silence coming from the baby I had just delivered. I never imagined the joyful sound of a new baby’s cry would be so tormenting. I couldn’t believe these two things were happening at once it seemed so cruel to the mamma I was helping. After the baby, came placenta about the size of the palm of my hand. I kept looking up at this mamma that was staring at me blanking. I was wishing I could know what she was thinking and feeling, wanting to take whatever it was away. The midwife came back over to check on how things were going. She told me that I had to go and weigh the baby. I was mortified and then I was mortified that I was mortified. I didn’t want to touch it. Its head felt mushy with a few disconnected cranial bones and its skin was splitting and peeling. It turned my stomach when I lifted it up to carry it to the scale, I swallowed hard to hold it together. It broke my heart that I was reacting like this to this poor sweet baby. 1.5 kg and then I put him in a crib wrapped in a blanket and cleaned up the mamma. The shift was changing and sweet, sweet Lissie who had just come for the night shift came in and took the chart, put her hand on my shoulder and sent me off telling me to go home. I walked to the nurses tea room and just burst into tears. Everything felt so intense, I couldn’t imagine being the mom. Once I pulled it together I went back to the delivery room and held the mammas hand as she cried watching Lissie diaper and dress the baby and then wrap in blankets. The family gathered and the weeping began and I slipped out to head home. When I got back to the hotel around 1 I slipped into the pool, it is the first clear night since I arrived here usually there are a fair amount of clouds in the sky. And the stars were fierce. Glinting and glowing in slight shades of white, yellow and red. I have heard some legend somewhere that the stars are the souls of all the unborn babies.

4 comments:

jennifer said...

you are doing amazing work. much love hill.

Michael said...

I'm so happy that you'll deliver hundreds of babies there and the rest of them will be healthy. You'll never forget the whole experience.
love, mike

K&H Home Solutions said...

S P E A C H L E S S ! !

Nicholas Graham said...

Quite an amazing story.