Wednesday, October 27, 2010

30 babies and counting...

Hi, sorry it has been a while since I have written. I have been super busy and have had no time for internet. And thanks for all the kind words from my last post.

So much has happened. I have know helped 30 babies come into the world. I only need 8 more births here to reach a total of 100 ever. So good. We still have two more weeks here, so this is totally possible.

Last week I saw my first breech. I was horrified at the management of it. The midwives called in the OB (who is a resident and simply sucks) and the main OB in charge. I was always told for breeches that hands off is the best way to deliver. The resident was ALL HANDS ON, and was fussing all over with the baby and vagina. It was a frank breech (butt came out first). The OB in charge told her to deliver the legs and bend the knees. She couldn't figure out which way to bend the knees, so she hyperextended them! I was grimacing the whole time. Then she delivered the arms, and let the baby hang from the vagina (which is fine). When the momma went to finally deliver the head, the head popped out and a HUGE gush of amniotic fluid came out and went all over. With the fluid, the placenta was delivered and the umbilical cord broke. We have no idea how long the placenta had been detached. Baby was immediately taken away for ventilation (with bag and mask), chest compressions and epinephrine was injected into the umbilical vein. Baby's apgar scores at 1 minute, 5 minutes and 10 minutes were all zero. So bad. Baby did eventually breathe a little, but has been in the nursery ("NICU" kinda). It was seizing the next couple days and had an oxygen saturation of only 60%! It will not make it.

A couple days ago, the first baby Samantha was born. The grandpa insisted the baby be named after me, he was so cute. He alse MADE ME wash the baby ("swim the baby") and dress it. Baby Samantha loved the bath, she was so cute. Glad my namesake wasn't an ungly one :) Allison has had like 15 little babies named after her, but just the one for me. They can't even say my name 100% correct, haha.

Today saw another kind of brutal birth. A first time momma, with a long pushing stage. After an hour of pushing (which is already forever long here!), I decided to put an IV in and give her some normal saline. I thought a little hydration would do her good and maybe perk her up a bit. It did help. She pushed for another 45 minutes. As baby was just about to crown, a Chinese doctor came in (the Chinese doctors here are not well liked by the Vanuatu people, and she speaks almost no English or Bislama). She stood on a step stool and put all of her weight on the woman's belly to push the baby out. It did work to help get the head out, but it was brutal. Then, the head was out and I checked for a cord, there was one, but it was loose so I left it. I was applying some downward pressure to get the anterior should out and the Chinese doctor said I needed to push harder. I was doing it fine. When I didn't do what she demanded, she pushed me out of the way and ripped down on the baby's head. Honestly, I am surprised the baby does not have a brachial plexus injury, ohhh so bad. She was manhandling the baby and the woman ended up with the biggest, messiest tear ever. It was only a second degree tear (goes into the muscle layer), but it extended from the top of her left labia minora, into the vagina (where the deep part of the tear was) and down the perineum. I have never sutured something that big, but honestly I did a good job. Love the subcuticular stitch!

Other than that, life is good. I finished my scuba certification and plan to do an advanced course. Been swimming almost daily in the ocean, so freaking great. In fact, I am going to go swim right now. Peace and love,

Sunday, October 24, 2010

Horrible and scary story, read at own discretion...

Hi again. So, lots has happened. Hmm, where to start.
Yesterday at the hospital was a crazy night. First, we had a woman who was 5cm dilated and was having huge late decels (the baby's heart rate decelerated after the peak of contractions=bad). It got as low as 50 beats per minute and was lasting over a minute, regularly. She was dilating quickly, and ended up having a vaginal birth and baby was fine (though small at 1.9 kg). The baby's eyes did do a weird shaking thing, which I have never seen.

Second mum I helped deliver, G3P3 (3 pregnancies, 3 births), no tears, no problem.

Then, a mom and her family came into the hospital. The baby had been born "in the bush"and was wrapped up in a blanket and was handed to the midwife. I was busy making cotton balls, but I wanted to know what was going on, so I went into the labor ward. The mum needed suturing, so I helped Susanne draw up Lignocaine (like Lidocaine) and she sutured the second degree tear. Susanne said this may be a police case, the baby was dead. After helping suture, I watched the OB (who was specially called in) examine the baby. The baby's face was covered in blood, and the body was covered in dirt and leaves. Blood was coming out of its mouth. There were small bruises and lacerations on the baby's nostrils and on the neck (where the carotid arteries are). This is what the mum told the midwife: she said her baby was only 6 months along (which it was not, it was definitely full term and a good sized baby) and she was out in the bush collecting oranges. She said she jumped up with a stick to get an orange, and when she landed back on the ground her baby "fell out" and hit its head on a rock. She said it died there (there were no marks on the skull and no broken bones, though the x-ray report has not come back yet). She delivered the placenta, left it and the baby there, took a bath in the ocean, and then went home to take a nap (leaving the baby alone, dead, in the bush). Later, her mum asked her what happened and she said her baby fell out and she left it in the bush. Her mum made her come into the hospital. So, a police report was filed. I could not get the picture of the dead baby out of my mind for the rest of the night. It was sad. The mum was kept at the maternity ward over night, and lots of security guards were around. I don't know what is happening now, but I will keep you posted when I find out.

Susanne (who says HI!), caught the next baby, a G2P2, no problem. The next woman, I helped deliver (G2P2). I got to suture her two second degree tears (they were deep, between the vaginal floor and labia minora, a tricky spot to suture, but good experience).

Other than that, not much else new. Oh, we have been swimming out in the harbor (Molly, we go past the helicopter pads to the rock in the ocean). It is super sweet, and a good swim. Sorry if this blog is choppy, I am a little intoxicated :)
Peace and love (and Southern Comfort with Coca Cola),

Wednesday, October 20, 2010

20 babies and counting...

Hi again. Still love it here.
Last night was kind of a blood bath at the hospital. Both Susanne and I left covered in blood, amniotic fluid and sweat. But it was a good night, between the two of us we helped 4 babies be born. The first baby was the woman's fourth, easy easy.

The second and third (Susanne and I each had one) had similar labors. Both had an induction of labor with a 1/4 tablet of cytotec inserted into the cervix. Hours later both had labor augmentation with a drip of syntocin (same at pitocin or oxytocin). Then both took forever to fully dilate and ended up delivering the babies the same minute (8:10pm). During the whole labor we thought my woman's baby was OP (occiput posterior) due to the funny shape of her belly. There was a lump high up near her fundus and then a dip and another lump low down. The midwife in charge said that was classic for OP, but I had never seen a belly like that before. Eventually, I put in a urinary catheter hoping to speed things up a bit, nearly 400ml of urine came out (a lot!!) and the lump at the bottom was noticably smaller. So I wonder if it was just a distended bladder we were seeing for a long time. Poor momma. Baby was born with a nuchal hand and a nuchal cord, but she only had a very minor perineal tear. I sutured it up, perhaps my best work yet. I really and getting better at suturing. It is amazing what a little practice can do! Ha.

Susanne's momma had a retained placenta. 35 minutes postpartum the placenta was still inside, and this was with active management (giving 10 units syntocin with delivery of the baby). The midwife in charge called the OB to come and he did a manual removal. I don't know the whole story, as I was busy with my woman, but I saw him deliver it in chunks. She lost a lot of blood, and that was a mess to clean up. Blood everywhere.

The fourth baby was the quickest ever. I admitted the woman, checked her cervix (6 cm, BBOW, -1 station, 80% effaced) and listened to baby. Took some vitals and AROMed her (artificial rupture of membranes). She was told to go on a "walkabout" and when I saw her next she was lying on the bed with the baby crowning. I barely had time to put gloves on to support hte perineum and the head was out. Head and shoulder came out no prob, but when I had to PULL the baby out once it got to the umbilicus. That baby was huge! 4.3 kg (umm...over 9 pounds). A fat, happy baby. And a small small tear which I let Susanne suture.

Hmm...what else is new. Soaked up the sun some more yesterday on Erakor island. Ohh! Today we leave for an overnight trip to the island of Tanna where there is a live volcano. I am so excited! My whole life seeing a live volcano has been on my to-do list. Yay. I hope it doesn't rain, which could affect visibility. I even had a slight nightmare last night that we couldn't make it there (they wanted to see our birth certificates and we didn't have one and then my mum's car broke down and we never saw it). But, hopefully that will not be an issue.

So that is all for now. Elias, yes please post the comments I don't know how. Hope all is well!!
Peace and love (and delicious sweet potato hashbrowns...)

Tuesday, October 19, 2010

Anterior lips..

still loving life in Vanuatu. Two of the last three babies I have helped deliver, the mommas had huge anterior lips (a bit of swollen cervix in the front under the pubic bone), like nothing I have felt before in the states. I just had to keep rubbing it down and holding pressure on it. I'm sure it hurts like hell, to have me in there messing and pressing, but I need to when it gets swollen. Each of these mommas were trying to push before they were fully dilated. So with a lot of pressure, I shoved the last of the cervix up under the pubic bone and the babies descended instantly and came out with 3 minutes. They are amazing pushers here.

The second baby I helped with last night was born with a nuchal arm (her arm was up by her face) and a nuchal cord (cord wrapped around the neck). Both proved to be no problem at all, and she did not even tear! Quite a feat.

Yesterday Susanne and I did two scuba dives. We saw the remains of a crashed plane, which was cool, though I asked the scuba pro and he said it had been placed there for divers to look at. There was even a fake skeleton in a baseball hat in the pilots seat with a beer can in his hand. Monday we will do our last dive for our certification, I'm excited. I am such a water baby, and diving is awesome. Looks like I will be doing the advanced course by myself though.

Today we are off again to sun and swim on Erakor island, yay. Hopefully we will stop at a little local bakery on the way and pick up something sweet :) By the way, we have mastered sweet potato hashbrowns. So good!

Ok one more random thing. Yesterday I cut a few really hot chili peppers, and washed my fingers so many times, but my finger tips were still burning. It just so happened to by my right hand which I use for checking the cervix. So, last night when I was feeling dilation and my hand was inside the womans cervix it burned like hell. No fun at all.
Talk later.

Sunday, October 17, 2010

15 babies and counting...

Hiya! Last night we delivered two babies, and one again today. I am up to 15 now in less than two weeks of work. Getting some great experience and hands-on skills. I love it! They love having us here to help, too. In Vanuatu the nursing students must do 20 deliveries before they are on their own out in the rural communities. So, we have been helping them learn skills like vaginal exams, Leopold's maneuvers, perineal support and suturing. They appreciate it so much.

On Friday night, Susanne and I went out dancing with some ex-patriot friends we met here. We met a group of plastic surgeons from NZ/Australia who are here doing a kind of mission trip. They invited us to watch some surgeries, so today we donned surgical garb and watched them repair a cleft lip. It was so interesting and they did beautiful work! The two surgeons are so kind and explained everything and we had a good chat about midwifery/maternity care. Then they gave us a curry lunch and chocolate biscuits. Yum.

Tonight we are getting a ferry to Iririki island for the Monday night tourist special (free snacks, sangria and prizes). I'm hoping to win a sunset cruise :) Yesterday Susanne and I took a free ferry to Erakor island where we lounged in the sun on the beach all morning. It was paradise. The one thing they don't do well here is lemonade (just a flavourless sugary soda). I was a little disappointed.

Not much else new. Tomorrow we are doing two scuba dives, I can't wait. I love it! I am hoping to get my advanced certification after I finish the open water certification. Whoop whoop.
Hope all is well with you!
Peace and love,

Friday, October 15, 2010

The babies keep coming...

again I must say Vanuatu is GREAT! I love it here. Not only am I getting a super tan (yes!), the island life is awesome and the birthing experience is great. I worked the night shift Thursday night/Friday morning from 11pm-7am. I caught 3 babies and had some crazy experiences. The first baby came out fine, no issues whatsoever, no tears.

The second baby had some meconium staining in the water, and a tight nuchal cord. I didn't want to cut the cord on the perineum knowing it may already have a hard time breathing. The head came out, and no tear. THen I went to summersault the body out to keep the cord intact. I was supporting the perineum also, but somehow she ended up with a 3rd degree tear. I could see the shiny white rectal capsule and did not feel comfortable suturing that myself. I asked the midwife to help, and she had never seen that before either. She ended up suturing it, but I feel if I had to I would have done it the same way. The woman was so calm and patient and did not bleed much.

The third baby came out fine, no tears. The umbilical cord was super thin and weak. After I saw a little separation bleeding (meaning the placenta is ready to come out), I was tractioning the cord (not even very hard, I have done it way harder on other women before with no issue). All the sudden, the cord broke off, there was not ever a snapping feeling. It broke off right at the base of the placenta. I was like "Shit!" but didn't say it outloud. Some of the amniotic membranes were dangling out, so they were able to be grabbed gently with forceps and the placenta gently worked out. It was scary for a few minutes there though. After that, all was well.

Yesterday I did a half day horseback ride. It was the best ever! I went with a woman from my resort, and we rode in the jungle, over some plantation areas and in the ocean. We took the saddles off the horses and just wore our bikinis and literally rode in the ocean. Not just the horses feet, they were practically swimming. The water was over the horses back, so I had to hold onto the mane to stay on. It was the best ever, and the horses didn't seem to mind at all! Today my adductors are a bit sore, but well worth it! And the horses don't know how to nicely canter, they full out gallop. I haven't run that fast on a horse since I was 15. Awesome.

Today Susanne and I are working at the hospital from 3pm-11pm. This is our first afternoon shift. Hopefully there will be some action. Hope all is well out there.
Peace and love,

Wednesday, October 13, 2010

more babies...

so Susanne and I "worked" the night shift last night from 11pm-7am. We got there at 11pm and there were two first time mommas who were in early labor. We made about a million cotton balls (all the cotton balls and gauze are hand made here) and then the midwife in charge told us to go home and sleep and she would call our mobile if the mommas were ready to push.

At 3:30am we got a call and ran over to the hospital (a 4 minute walk from our hotel). As soon as we walked into the labor ward a baby was crowning. This was the first baby I have seen born in the cul (the membrane sack has not broken and is covering the face and head). It took a moment with an amniohook to get it off the little baby's face, but he came out happy and no tears.

Moments later another momma (a new one who came into the hospital ready to push) was on the bed and pushing. She came out occiput transverse, but fit just fine. There was a minor perineal tear which I sutured. Yay. Then we got to leave the hospital again (1.5 hours later) and go back to sleep. I felt like a surgeon being called in to do a procedure and then leaving.

Our buggy ride on the island was wicked fun! It was a total mud mess and it rained the whole time, but it was so fun. I drove most of the way, through jungle and on a black sand beach.

Today Susanne and I did our first scuba dives. We did a practice dive in a pool to learn the tricks, then a reef dive. Amazing!! We saw all sorts of lovely coral and millions of fish. We have two more dives lined up for next week. Tonight we will work the late night shift again, so hopefully there will be more babies.

All is well here. Lots of fun stuff coming up, but will post more about that later.
Peace and Love,

Monday, October 11, 2010

7 babies and counting...

Hello! While this is a slow time at the hospital, we still have been catching babies. I have helped 7 come into the world, all without any real difficulties. It is amazing how quickly women labor and push here. I have only sutured once so far, which was good practice, but I have been supervising some nursing students in training as they suture. So I help them decide where to place the needle, what needs to be reconnected to what, ect. They don't really learn the subcuticular stitch, so any tear of the perineum gets a continuous stitch with a big knot. It doesn't look the best, and it is probably uncomfortable as hell, but it gets the job done. They pretty much suture all tears (even small first degrees) as the risk of infection here is high.

I have been helping do a lot of newborn exams (which ONLY includes head and chest circumference, length and weight). Also, all babies at birth get a vitamin K shot, hepatitis B vaccination and BCG subdermal (for TB). I feel bad poking the little cuties so much. I have seen a couple infected cord bases, which smell terrible and the babies are put on antibiotics.

Oh holy goddess, yesterday a woman in labor vomitted up a 6 inch long round worm! It was so gross. Of course I got a picture of me holding it (with gloves)! It was still alive and squirming around. The midwife in charge said that is not too common, and she has only ever seen one other worm (a tapeworm which was pooped out).

We were supposed to do our first scuba dive today, but it has been monsoon raining and we decided to postpone. Tonight we will go to a Kava bar with some ex-pats and then have a BBQ at the resort we are staying at. Sounds good to me. Hope all is well with everyone who reads this, if anyone does :)
Peace and love,

Saturday, October 9, 2010

I love Vanuatu!

Hello! Wow, this is my first blog ever. Kind of exciting. Susanne and I made it safely to Port Vila, Vanuatu on the 6th of October. We had a night layover in Auckland, with a free hostel booking. We walked all over Auckland and had a good time.

Vanuatu is amazing. The people are SO friendly, everyone says hello and waves at us. There are more white people here than I expected, a lot of ex pats and tourists.

Our first night here we went out to an outdoor bar with a kiwi guy we met on the plane. We tasted the only local beer, Tusker, a lager. Not to be confused with Tusker from Kenya. After a few beers we were all feeling great and decided to go to a nightclub, haha. It was kind of ridiculous. They played music like U2 and John Mayer, who are good, but kind of hard to dance to and definitely not nightclub music.

We have been going to the local farmers market, which is open 24 hours. There are so many beautiful fruits/veg/eggs/chickens there. We have tried several new and interesting vegetables that I have never seen before. Yum.

We have worked the past 3 days at Vila Central Hospital in the maternity ward. All of the sisters (midwives), nurses and staff are so nice. It has been pretty slow in terms of births, and I have only helped 3 babies come into the world so far. I did get some suturing practice, which was great. The women here are naturals at birthing. Their labors are short, and their 2nd stage (pushing) is super short. They make very little noise and pretty much only give birth on their backs.

The first baby I helped with was OP (occiput posterior) so it came out face up. Babies don't fit as well through the pelvis this way, so the mama had a lot of back pain. They call this presentation FTP (face to pubes) here, which is cute.

I am learning the local language, Bislama. It is a lot like English, and pretty easy to understand. My favorite little saying: pullem good wind (take deep breaths), sit sit (literally shit shit, which is synonymous with pushing).

Ok I could go on forever, but this is long enough for tonight. Now I am going to enjoy my dinner of lentils and sauteed vegetables. Yum.
Peace and love,