Wednesday, November 3, 2010

Ups and Downs

Hi again, been so busy lately have not had much time to write...and no access to internet either. Today my friend Jeremi let me borrow his computer, cheers mate!

It has been a whorlwind of emotions for me, both in and out of the hospital. Last Saturday (30th of October), I helped deliver a VBAC (vaginal birth after cesearean, she had previously had a prolapsed cord). The woman was making noises like a hose whinnying (it made me smile, but not in a sadistic way). As she was pushing and I could start seeing the head, a steady trickle of blood started to escape. It was more than I wanted to see, and I could not see any tears. At first I thought, "Shit, maybe the placenta abrupted a bit." I listened to the fetal heart tones and they were fine. As the head crowned and came out, more blood came. The baby came out, and with it more blood. She was given an injection of Syntocin and the placenta quickly delivered. Still more blood. I rubbed her uterus which was very firm, so the blood was not uterine. I checked for tears, using gauze to try and wipe away the blood, but it could not be wiped away fast enough. So, I inserted a finger and felt for tears. On the left side of the vaginal floor my finger sunk DEEP into a tear, and I could feel the blood pulse out with her heart beat. Shit. I had the midwife in charge call the OB (who thankfully was in the hospital) and I packed the vagina with gauze to try and put pressure on the bleeding vessel. The blood was soaking through the gauze and pooling on the sheets,. It clotted and was an inch thick. I was worried, though I remained calm and spoke clearly to the woman and told her what was going on. She was a sweetie. The OB finally came in, had a look, and decided to wheel her off to the surgical theatre to deal with it. Over an hour later she was wheeled back in, with a third degree tear and a lot of blood loss. In just the time I was with her, I estimate at least 800ml blood loss, which is a lot for Vanuatu. I can't even imagine how much more she lost in the theatre. This was the first time I was VERY grateful to be delivering babies in a hospital setting.

I was a little shaken from this, but the next birth totally redeemed my love for midwifery. A G2P2 momma pushed for only a couple minutes, out came a lovely baby, no tears and no blood loss. Such a contrast to the previous birth.

The next day Susanne delivered a baby with gastroschistisis (spelling??), its insides were born on the outside. I wasn't there, but apparently everyone but her stood there in shock and didn't know what to do. The intestines were covered with saline covered gauze. The baby is still alive, and if it makes it until Sunday some doctors are coming from Figi to do surgery. But, it is looking very pale and vomiting meconium and probably will not make it.

Follow up: the baby who was brought in dead from the mum who killled it...the mum was taken to jail. THe sad thing is, what she really needs is some mental health help, which she will not get here. She probably came from an abusive family or was a rape victim, but she will not get the help she needs.

The baby who was born breech and needed resuscitation died. It was seizing and had brain damage. Sad.

Two days ago I delivered two babies. The first one was a lovely birth, and I sutured a first degree tear. The second baby was born with club feet. It will likely be given some sort of therapy, but perhaps not for over a year when a volunteer medical team comes from NZ. Maybe they will do boots or braces.

It has pretty much turned into the tropical rainy season here. Sunshine in the mornings (which we are avidly soaking up) followed by torrential rains in the afternoons. And, I freakin lost the umbrella, darn.

Only one and a half weeks left here in Vanuatu. I am up to 34 births now, and only need 4 more to reach 100 total.
Be well,


Hillary Roland said...

Sam!!! Finally got caught up on my blog reading. Sounds like you are having some amazing experience. Where are you staying? I am a little jealous I miss Vanuatu. Say hi to Lizzie for me. - Hill

Z said...

Sam! I just read your most recent blog post. Midwifery sounds really intense. I'm glad you really enjoy it! Vanatau sounds awesome. Congrats on your 100th delivery! - Z