Wednesday, February 23, 2011

The Cyclone is Gone and the Babies Keep Coming!

Well I am happy to report that the cyclone has come and gone without much excitement. There was loads of rain and wind but fortunately no real damage to the island. However, as I suspected it might, the low pressure and change in weather did bring lots of babies (pikinini's). I wanted to go into the hospital on Sunday but all my scrubs were being washed and due to the extremely wet weather had yet to dry, so instead I stayed close to my bungalow as I was advised to do. Thankfully I had rested up for the days to come.

On Monday I spent the majority of the morning and into the afternoon with a lovely primip (1st time mom) whom I will call 'Jane'. She was 21 years old and there being supported off and on by her mom. Usually we have the women walk around as much as they can if they are 4 or more centimeters dilated, checking in every so often on mom and baby. The policy at the hospital is every 4 hours however, I tend to see how the mom's are doing and listen to heart tones on the pikinini's more often. We usually do not bring the women into the delivery room until we have checked them and they are "fully" (meaning 10 centimeters or fully dilated) or until they have told us that they feel as though they need to "sit, sit" (literally shit shit or push). This morning was a bit slow and it was very hot (nothing new) so even though 'Jane' was only 7cm the Midwife in charge said that it was fine if I brought her into the delivery room - the only room in the labor ward with air conditioning. The next 4 or so hours would find me trading off between fanning 'Jane' with the large clip board (which is covered in small pieces of tape to be used to secure IV's) and holding her hand through contractions as she softly said "Ah wei" (Ouchy). After some time 'Jane' was understandably getting tired and worn out. I started a bag of IV fluids to give her a bit of hydration. I checked her again and she was still 7cm maybe a generous 8, with a large bulging bag of waters still present. Her baby's head was making it's way down nicely and I knew that we could get things moving (so-to-speak) if I were to break her water; but I wanted to be patient. Still, after more time and an even more tired laboring mom, she had only progressed to 8cm and was verbally in quite a bit of pain (this is not something that is common here...most women literally just push their babies out without the verbal outward signs of the inward pain that they are no doubt experiencing). I suggested to the Midwife that maybe I "break her bag", she agreed that this was a good next step.

I informed 'Jane' of what I would be doing and told her that it would hopefully speed things up. I was very happy to see clear fluid upon AROM (Artificial Rupture of Membranes) and literally within about 5 minutes she was in rocking labor and fully dilated. I coached her through pushing and she did a lovely job! Finally she had pushed out a crying (before his body was out!) 5.3 pound 'wee boy'. Her mom, who did not want to be in the room for the actual delivery came in after he was out. She told her daughter that she needed to thank me, which 'Jane' had already done. Then she said that they should name the little boy Kate. This was a very sweet gesture and I know that there are a few kids running around the island with names of the Midwives that have delivered them. Although an amazing thought I also felt that it could be a bit difficult for a male named Kate and hoped that maybe they would pick another name =) I checked on 'Jane' and her partner later that afternoon and the next day and have been constantly thanked by the family, to which I whole heartedly reply, my pleasure (which it always is, and a true honor). Finally, before the family was getting ready to leave I asked, "So what have you decided to call him?" I was happy when their response was Jimmy.

The next day proved to be one of the busiest I have had thus far and truly earned me a day off in the sun today. On Tuesday I managed 3 births and helped out with a 4th in a fairly short period of time and also sutured twice! Each time I carefully sutured the women it took about an hour and I had a couple nursing students observing me as I learned to perfect my sewing and they learned about tear repair. I feel very thankful for the experiences and to the MW's who oversaw my technique. I am happy to report that all of the babies delivered are doing well, although one did give me a bit of a scare.

I was supporting one woman who was almost "fully" when the Midwife brought another laboring mom into the room and drew the privacy curtain between the two women laboring side by side. She popped her head around the curtain and said "she is fully, do you want to come and help her?" Not wanting to leave the first woman but knowing she had lots of other support around her I happily agreed. When I re-checked this second mom I felt a large budging bag of waters and the MW suggested AROM. Upon breaking her bag out came moderately meconuim (newborn poop) stained water (this can sometimes mean a distressed baby so you have to be a bit more on your toes). Again the nursing students were there doing their maternity rounds, I turned to them and explained what the color meant and that it would be good to be thinking ahead about the possibility that suctioning (baby's mouth, throat and nose) may be necessary. A few minutes later out came a screaming (thankfully), covered in poo, little girl with a hand by her suction necessary. I barely had time to help baby latch on to the breast when I was called to the other side of the curtain.

I checked in on baby by listening to heart tones and helped coach mom through pushing. After a few minutes I had an intuition to listen to baby again (something they do less frequently here than I have been trained at home). When the woman who was supporting mom turned the monitor on for me I watched as baby's heart rate went from 120 to 110 to 100 then to 60 bpm! The normal range is 110-160 (with a few exceptions during pushing), I quickly got mom off her back and had her continue to push in a side lying position (also something not frequently done here). I kept my hand on the heart rate monitor and my eyes on the numbers as they came back up into a normal range. I tried to stay calm but on the inside I knew the urgency of getting that baby out quickly as to not see any more decelerations in the heart beat. For more pushes the 17 year old first time mom, stayed on her side. As baby was crowning (head appearing) the MW had her return to her back but we kept the monitor on and baby seemed okay and the birth was imminent. After what felt like an eternity to me, but was probably only 5 minutes, this young mom pushed out a baby boy who was not breathing. I quickly checked the pulse on the umbilical cord to get baby's heart rate, which was above 100. I rubbed his back, drying him off and trying to stimulate him and blew air on his face, all the while talking to him and asking him to come into his body. I called out for suction and this is what he needed to give him a bit of an extra push to come around. I kept talking to him and warming him up and felt that he was entering his body. A few seconds later (which feels like hours) he was coughing and started to cry. I almost couldn't hold back the tears of relief myself. I picked him up, thanking him for coming to join us and placed him on his teenage mom's belly. After a few deep, calming breaths, I checked her and saw that she would need stitches. The students gathered 'round as I dripped with sweat and was assisted through my first "real" suturing job. One of the students even took a piece of gauze and wiped my brow at one point; I gave a small sigh of relief after the hour was up and a large smile to them when I was done and thanked the mom (who had baby with her the whole time) for her patience.

Fourth baby of the day....I came into the delivery room and the MW asked if I was tired or if I wanted to do another birth? Of course I wanted to catch another baby and I had only been there about 6 hours (although a lot had already gone on). With some help, out came a large (by their standards) 7.7# boy and mom had some unique tears that also needed stitching. After another hour long suturing job, and no break for lunch in between births....Now, I was tired. I sat down in the tea room and had a little reflection time. Then I weighed this little sweet one and explained to the students the injections that I was giving him. Vitamin K in the right leg (which helps to clot the blood) and Hepatitis B in the left (the vaccine). I gave him a quick snuggle and then found a family member to give him a swim (bath). I was going to check on mom again when the MW's said, "go home, go home, have a swim and get some have done a lot today!" Another Midwife said that I really should enjoy the weather if it is nice (today) and take the day off.

I went home feeling happy with a successful and hard worked day. Had homemade dinner with 3 lovely midwives (also working at the hospital) who are all living in New Zealand now, but come from England, Italy, and Brazil. We talked about the state of health care in each of our countries and compared our different training and schools of thought with regard to midwifery. It was very nice. I told them that if I decided to take the day off today I would call them to do something. When I awoke to the sunshine I decided I deserved to enjoy spending the day seeing a bit more of the island.

We spent the day snorkeling, enjoying the sun and then laughing as we got absolutely drenched by rain on the trip back to the main land on the boat. The beach at Hideaway Island is covered in coral and beautiful shells and the sea life was unbelievably colorful! I saw small schools of neon blue fish, huge parrot fish, fluorescent purple coral, large blue starfish, and so much more. Had a nice walk to the large supermarket this evening after the heavens stopped talking to us (the thunder and lighting are unreal here!) of the cleaning girls stopped to say hi when I was standing in awe on my porch and said, "the sky is tripping" - funny expression. I am ready for another happy and eventful day at Vila Central Hospital tomorrow. Thanks for reading!

Saturday, February 19, 2011

My bungalow won't blow away, will it?

Tropical Cyclone Atu has formed just North of Efate (the island I am on) and it is intensifying, as the news reports claim. It was a loud one last night! Lots of intense wind and rain, and there is just more of the same today. All guests where I am staying were given a notice about the cyclone this morning; We have been advised to stay close, bring outside tables and chairs in, and close our wooden shutters if necessary. Most of the coconuts and large palm branches have been removed from the front of my bungalow- in the event that they should want to come through my windows =)

I have asked a few workers the above question, "My bungalow won't blow away, will it?" Somewhat seriously and somewhat joking.... To which I am greeted with large smiles and "of course not, you are safe here". This type of weather and high force winds (possibly gusting upward of 100Km/Hr tonight) is apparently the norm here, around this time of year. The owners say that it is just a "wee bit of wind". Okay, we'll see as this develops further. Atu certainly has made things cooler, which is a welcome change.

Friday, February 18, 2011

What a week!

I don't even know where to start, it has been an incredible week to say the least! Every day my heart is filled with countless experiences and I always intend to come back to my bungalow and journal or write a quick note on this blog.....and then after an 8-10 hour day (or 11 1/2 as today was) I come back, shower and pass out. Life here is amazing, wonderful and exhausting! The people here are beautiful and the women are so strong. Everyone is very friendly and I am always greeted with multiple smiles and "Gud Morning" on my brief walk to the maternity ward. Every birth has been memorable however I will only comment on a few, as discussing all 15 that I have already been blessed to be a part of would just be too much.

The first little girl that I caught for a lovely first time mama had BOTH of her hands up by her face when she came into the world-and no tear for mom! Everyday when I come in, I go into the nursery to check on the 26 weeker who was born on Monday night weighing just under 2 pounds (he is still doing well) and now I also check on the 30 week old little girl that I caught yesterday (born to a very sweet 17 year old mama) who was only 2.8 pounds! I feel a special connection with this mama and papa and give them big smiles every time I see her heading into the nursery to syringe feed her hand expressed milk to her little one. Rarely are the partners in the actual delivery room here, it is usually a female relative or friend supporting and fanning the woman down (if anyone). When the young woman previously mentioned was in labor I asked her if she wanted her boyfriend in the room with her, she said yes and I went out to get him but he had gone to the store....he returned fairly quickly post-partum and found his "wee baby girl" was born =) That same morning I did an initial assessment on a woman whose water had broke the night before but she wasn't contracting yet, when I checked her she was 2-3cm and at this time (especially with the water broke) they are supposed to stay in the ward.....she told me that she didn't have anything for the baby and asked if it would be okay to go home and get some stuff, I checked with the sister midwife and she said it was fine. Hmmm, later in the afternoon she was still not back in the bed I had made up for her and the next morning she wasn't in the bed either, I was starting to feel terrible that I had let her go, who knows how far away her village was. In the discharge book one of the options for reasons a person is discharged is 'absconded' (along with alive or dead), I now understand that a bit more. Sometimes people just don't come back. Then in the afternoon there was a woman who sadly was vomiting all over the floor in the hallway, I went to help her and realized this was my lady from the morning before! I was so so happy to see her and I think she was happy to see me as she had told me the morning before that she hoped I was there when she had her baby. Her little boy also decided to come out with a hand by his head (just as I had suspected he may when I palpated her belly earlier), and again no repair necessary! I check on her a few times a day just to see how she is doing.

Two sets of twins have come into the world this week and I was fortunate enough to be a part of both (or all four) experiences! I did the first assessment of a 30 y/o mom at 39 weeks who came in to the ward in labor. With help I made sure that twin 1 was head down and confirmed that twin 2 would be breech (if after the delivery of #1 we could keep #2 from turning transverse). I started an IV on the mom "just in case we needed it" and we went back into the delivery area. Twin 1 came out head first, weeing all over the place and crying, it was beautiful. Then came twin 2, not bum first as we had anticipated but all of a sudden a foot came out!! There was a pediatrician on hand and 2 other midwives in the room and they coached me through the delivery of the footling breech who pooped all over the place - before his head was even out! That was a sight! And he too was crying upon arrival into the outside world! Both boys weighing 6.8 and 5.9 pounds respectively received apgars of 9 and 10. They are identical and you could tell literally from the minute they came out, and the proof was in the placenta (mono-di as they call it). And this morning I went into a c-section for twins. I was asked by the pediatrician if I wanted to "receive" the second twin, to which of course I replied yes! All in the room waited with bated breath for these two to come out, because the reason for the c-section was that this young mom (21 y/o) had 2 previous still births and the doctors planned this section to give her the best chance possible to have healthy babies (she was 36-37 weeks). I almost couldn't contain my tears of joy as one after the other both girls came out with a large wail! They weighed 5.1 and 6.2 pounds, I was so pleased to be able to bring dad into the room where they were resting waiting for mom to get out of surgery. They are both doing well and are with mom in her room, along with 3 other women-which is a luxury because the other moms share their space with potentially 7 other mom's. It is quite a site to see all of these beautiful women breastfeeding their new little ones in one big space, all with their colorful wraps and helpful families, brings a smile to my face every time I walk past that area or through there to pick up a baby to get examined.
With all the joy there has been sadness as well for some families. It is a challenge to see something difficult and have to go right on to the next birth and contain my emotions. My second day here I witnessed a still birth (we all knew baby had died in utereo) and then went straight away to the birth of a woman (the same age), occurring across the room-it was terrible. Everyone was treated with complete dignity and mom and dad cuddled with baby after she came out and was placed in a blanket. She was 34 weeks and baby had some severe congenital abnormalities that I will not describe here. It was terribly sad to hear the crys 15 feet away as I coached the 18 y/o first time mom that I was with (with an anterior lip for a while-bless her heart) through the birth of her son. I had just about collected myself on my walk home and then I saw one of the workers from the place I am staying and he asked how my day had gone and I couldn't hold it back anymore. I think about that family often.

Due to the amazing efforts and hard work of a very dedicated New Zealand midwife, trying to get Vila Central Hospital established as baby friendly, all babies (unless they need extra attention) go skin to skin straight away on mom after delivery. A few multips (moms who have had one or more babies) that I have helped seemed a bit shocked by the gooey baby that I have landed on their tummy but after I explain (as best I can in English and broken Bislama) the benefits of this, they all seem fine. We try to keep baby with mom for atleast an hour, cuddling and breast feeding. That is of course unless we need the delivery bed for another birth, as happened tonight when almost 5 births were occurring within minutes of each other! I barely had time to put gloves on when a 32 y/o mom pushed her fourth boy out in 1 push tonight! The midwife who was going to assist me left the room literally for 1 minute to get something and returned to hear and see the 7.1# little man crying away on his mama's tummy when she returned- all was well. Mom and baby share the same birthday =)

After 11 1/2 hours at the hospital today with much excitement, I felt I had put in enough time and things were calm enough for the moment that I decided to come back to my cozy bungalow. I got a security guard to walk me home and as exhausted as I am wanted to finally write about some of my experiences here. I think I may take tomorrow (Saturday) off, sleep in, and see a bit more of the village. Although I greatly look forward to helping more mama's, bathing more beautiful babies (who I swear give a little grin when I wash their hair for the first time), and sharing smiles and experiences with the Vila people in the days to come.

Saturday, February 12, 2011

And the journey begins.....

Well, after days of travel I have arrived safely in the beautiful capital city of Port Vila, Vanuatu. For those of you that are new to this blog and this adventure, here is the brief....Every year a few senior Midwifery students venture to the South Pacific to learn, help, teach (other Nursing students), and complete their "baby catching" numbers (100 are needed total, to sit for the Washington liscense exam). We have a lovely relationship with the sister Midwives here at Vila Central Hospital. The population of Port Vila is 38,000 and I am on one of the 83 islands that make up the Y-shaped chain of Vanuatu. In this blog stories are shared about daily life and hospital adventures. I feel so very blessed to be apart of this and exchange with these women. I am also thankful to my mentors and those that have come before me in this journey.
Usually when I travel abroad I like to disconnect from phones, computers, etc. so "blogging" will be a very new experience for me. I hope if you are reading this you are well, and I hope to have many stories to post along the way. Kate