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.


kat said...

Well done, Kate.

I'm really excited for you. It seems as though you have had quite a welcoming introduction to the life at the Vila Central Maternity Ward.
Keep up the good work, remember to take some time for your self, and tell the midwives that Kat, the longfalla midwife, sends her love.


Anonymous said...

Great work Kate! Some awesome experiences so far to say the least. You rock, wish I could be there with you. Say hi for me too! (especially to Christine, Annie and Timanu).
Best wishes!

Anonymous said...

It is so wonderful to hear your stories as you continue to blossom into the amazing midwife you are! You are incredible! Wish I could be there with you as well.