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,

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