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!

1 comment:

Anonymous said...

Kate, thanks for taking the time to share so much about your very eventful day!! We love sharing your day from Colorado. Jim Short :)