Thursday, March 3, 2011

2 Sets of Twins!

I awoke at 6am at the hospital to get a report that the mom of twins was 5-6cm. I went to check on her as she was being monitored on the CTG (Electronic fetal monitor- for heart rate and contractions). I rubbed her back and gave her smiles, during a contraction she would quietly say, "ohh Mrs." At about 10am we moved her into the labor ward to get checked by the doctors who had also been over seeing her case. They decided to break the bag of twin I (the one who was head down) and advised to begin induction at 12pm if she was not in more progressive labor. I stepped out of the room for a minute to find we had a new admit. A woman who was having a planned c-section in 2 days, she had 2 previous sections, and also twins!

The NZ midwife asked if I wanted to help and we brought her into the other side of the labor ward to be assessed. We could tell by her breathing that she was having a urge to push. The midwife did a quick vaginal exam and found that not only was the woman fully dilated but there were 2 feet there!! She asked the woman to try not to push, said, "Kate can you put an IV in?" and with that, quickly left the room to get the doctors who were meant to perform the section. Soon after about 4 people came into the room and one doctor said, "On the ultrasound they were head down" - Not anymore. Moving swiftly we got another bed in the room and had her transferred to the operating theatre. I didn't think there would be time to get the epidural in before this set of twins arrived; however they managed to get her numbed up in time to get both babies, who were BOTH breech, out safely. We sent one of the students in to observe and she was over the moon when she came out of the operating room. Everything went great! The twin girls were brought back into the labor ward and placed on the warmer to await their injections, swim (bath), and scale (weight). As they laid arm in arm, our mom in the next room was surprised that they were out already and she told me she was feeling as though it was time to have hers. It seemed as though something might be holding her back though.

It is not uncommon here to have a Vanuatu Midwife say to the women with a stern but effective voice, "You no cry!" I went in to support the mom and she told me that she wanted to cry but the midwife said she couldn't. She had also shared this with one of the student nurses that was around. When the midwife was not in the room, I did a vaginal exam finding she was at 7cm at about 11:30 and I told her that it was okay to cry. Again, I rubbed her back and she repeated, "Ohh Mrs." Enter the midwife (who, don't get me wrong, I very much like). She started the induction and within 10 minutes the mom of twins was fully dilated. I got into place to catch twin I. She came out head down, screaming away, big and beautiful. Then the doctors and another midwife were in the room to assist with the breech twin if necessary. I smiled up at the mom in between births and reinforced what a good job she had done. Again I got ready to catch, I did a quick VE (Vaginal Exam) to confirm the position- it was a leg! We waited a few minutes for twin II to present. Next thing I knew, not only did a little foot come out, but so did a hand! Seriously! Imagine that, and straight away came his bum and the rest of him, except his head. Both myself and another midwife were hands on, within seconds and with a bit of assistance the smaller sweet little boy was born. I again gave mom (who had been silent through out pushing) a big smile. Many hands were around to help as I delivered the 2 separate placentas at the same time.

Right away another midwife brought both the girl and boy over to the mom for some skin-to-skin time. I have never seen a bigger smile in my life- it was so so beautiful to see this mom with her two little ones in her arms and her ability to express her feelings, that this time I couldn't hold back my tears. Slowly multiple family members entered the room to meet the two new additions. All three are doing well and I have checked up on them everyday since. It made my week!

Delivered a baby with very "sticky shoulders" yesterday, to a young 23 year old who was post dates. This would be her second pikinini, she was just shy of 8 pounds (large for here). And today, everything began very slow and quiet. I had time to make a whole box full of cotton balls, yes, by hand! They have a large roll of cotton wool that you pull apart and roll in your palm to make the balls. They also make their own gauze squares here (of which I have also made a load). Anyhow, in the afternoon a woman came in pregnant with her first baby. I stayed outside of the assessment room as the nursing students practiced their skills of blood pressure, pulse, palpation, and attempting to listen to the little one. The woman sounded as though she was in very active labour- close to pushing I would have guessed by listening from 5 feet away. After about 15 minutes I went in to check how things were going. The woman's water had broke in the car on the way to the hospital and I asked how far dilated she was, they told me 5cm (half way there). She didn't want to sit still and was trying to take the monitors off of her belly. I asked her if she wanted to get up and she said yes. I told the students that she was welcome to get off her back and stand up as long as they could continue to monitor the baby. I watched as the woman began to silently push - I felt as though she may just be trying to push prematurely and feeling baby's head (as can sometimes happen)- the vaginal exam of 5cm from 5 minutes earlier had also been confirmed by the doctor.

Next thing I knew the woman who had started to get off the bed, quickly got back up and I saw a head and shoulders emerging! No time for gloves, I grabbed the sheet that was at the foot of the bed and caught the little man as the rest of his body was very quickly born! I rubbed his back and blew a little in his face to get him to come around and within about 30 seconds he was singing away with his cries. Poor mom had gone into labor just under 2 hours earlier! When she said she needed to push, she meant it! I was so thankful that she managed to get back onto the bed in time. I helped to get baby onto the breast after the midwife repaired the 2nd degree tear and made sure he had a new warm blanket on. I have heard that babies "fly out" here and this birth was truly one of those cases! After going over a few things with the student who had helped out, and cleaning the assessment (turned labor) room I headed back to my bungalow for a shower and dinner. I am sure tomorrow will bring more excitement, but hopefully we will be able to get all the mom's into the labor ward this time, before they push their babies out! All is well =)

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