Wednesday, March 2, 2011

Another Lovely and Busy Week

Since last week, the weather has affected the phones (which are still not working) and the internet where I am staying so it has been challenging to add to the blog- but every so often I find an internet connection so here we go! This week has proved to be just as eventful as the last 2! I am continually amazed by the strength of these women and the community that surrounds them. Often I ask the support person if they are the mum (of the laboring woman) or a friend and sometimes this is the case but also I observe cousins, aunts, and neighbors stepping in to help. It is really quite beautiful how everyone looks out for each other and how extended families live together under the same roof. During the week one of the mom's who I helped last week returned to the ward to have her baby weighed. Her older sister has taken the family in as the new dad is not able to be around (due to school commitments) for the first 6 months. This is the mom (that I wrote about previously) who left the hospital after I had done an initial assessment on her and didn't return until the next day when I found her vomiting in the hallway. She and her sister are both lovely, I was able to visit with them for about an hour as we had an unusually slow period and they waited for the pediatrician. At their request we exchanged e-mails and they told me that they would really like to see me before I leave and wanted me to be able to see baby Uriah again. It made me feel wonderful; I actually ran into the sister in the supermarket a few days later and almost felt like a local as we both greeted each other with large surprised smiles and the traditional kiss on either cheek. I look forward to meeting up with them in the weeks to come.

I have been blessed to help out with many more births over this past week, in addition to assisting the Vanuatu nursing students with their required births and skills training. It has been a great combination to be perfecting and learning new skills myself, as well as teaching and reinforcing knowledge with these great young students. I have formed relationships with a few of them and I love it when they come and ask me questions about IV's, injections, bleeding, newborn breathing patterns, or anything in between. I have watched as some of them catch a baby for the first time. And sometimes it is a group effort. In fact, a few days ago one of the students did his first catch and after inspecting the perineum we noticed that the mom had a first degree tear, the midwife there at the time turned to me and said, "okay and now Kate will sew this up". I was glad to work on my skills again and this time it didn't take an hour.
More beautiful babies are in this world!

Saturday was quite eventful... I got to catch 3 babies and in between help out with a few other mom's. I was sitting at the front desk writing up the birth report and entering names and statistics into the one of many books they keep records in, when a Vanuatu woman quickly walked to the desk speaking in Bislama, the words that I understood were "blood and come now!" I followed her to the showers where I found a mom who had given birth about 2 hours earlier (with the help of one of the students), she was standing in the shower and there were a few very large blood clots at her feet. I had her sit down immediately and quickly went to get another midwife to help out. We got her into a wheel chair and took her back to the labor ward, where she passed out in the chair just before getting to the room. See quickly came around and we got her up onto the bed to assess her bleeding. As we re-inspected the perineum I pointed to something that looked "different", the midwife replied "oh that's the cervix" however I just wasn't convinced so I continued to inquire....turns out what we were looking at were retained membranes (hence the bleeding-even a very small piece can make a woman continue to bleed, or get an infection), once the piece was removed and a bag of fluids had been put into the woman she was doing very well. I stepped out of the labor ward to find a very concerned looking man and I asked him if he was with "Celine", he was very pleased to have me tell him that his wife was going to be just fine and thanked me (more than once) and I could see and feel that relief sweep over him.

Not too long after this, one of the nurses asked if I could help pick up one of the postpartum mom's who had "fallen out of bed and wee'd all over the floor". Poor woman, she has been at the maternity ward for almost 2 weeks now as her newborn needed extra help and was in the nursery. Women stay as long as their babies do (we have someone who has been there 52 days!). This mom had been waking every 2 hours to hand express milk and then feed her newborn. When we got to the unusually obese woman she was on the floor next to the bed and very confused. I thought she may have had a seizure, but after asking more questions to those around this was ruled out. We moved her to a room closer to the front desk where she could be monitored closer and called the doctors in for a consult. She has very high blood pressure, very low hemoglobin, and was extremely fatigued (among other medical concerns). After getting a unit of packed cells she seems to be doing much better- I give her a big smile anytime I see her walking about.

Just after this happened I brought a laboring mom into the delivery room, to assist I broke her water and soon after she was ready to push out her son. I had just finished sewing up a first degree tear and making sure baby was feeding well, when I turned around to see another woman in the labor ward getting ready to push her little boy out. I was there in time to catch him and make sure all was well (according to her dates she was only 35 weeks). No suturing this time =). 8 hours at the hospital and I was ready to head home for dinner.....yet there was a mom of twins who had been admitted earlier that day and I really wanted to be around for the birth so after dinner I returned to the hospital for another 6.5 hours. No twins tonight but I got to help a postdates (43 weeks) mom have her 3rd boy. She arrived at the hospital and had her baby in her arms 2 hours later.

I was able to assist another 17 year old with the birth of her sweet son. Her water broke the night before she came in and I took her case. She was not contracting and by her dates (which are often off here, even by a month) this young mom was only 33 weeks gestation. She received steroids to assist in the development of her unborn babe's lungs. After 36 hours of ruptured membranes she also was started on antibiotics to prevent infection (not common practice for us). Finally after being at the hospital for days the doctors decided to begin induction. Everything happened very quickly for her and as I was supporting her while she was having a CTG (Cardio Toco Graph- records the heart beat of the baby and contractions), she literally was getting contraction on top of contraction and was climbing the walls and crying. The trace of the heart rate didn't look great and intuitively something felt off so I called in the midwife for a consult. We did a check for dilation upon my request and found that babies head was right there!! I didn't even think we had time to move her into the delivery room but we wrapped her in the gown that we had handy and quickly took her across the hall. In about 5 minutes this young mom had her screaming (very term looking, which means at least 37 weeks old) baby in her arms.

I was still waiting for the twins to arrive. Earlier in the day when I was looking after the mom of twins- who would be pikinini's number 7 and 8 for her she started speaking to me in Bislama....after a little while I smiled a big smile and said, "sorry, my Bislama is small small" to that she replied, "I said, that I like you very much". It was heart warming, I told her that I would love to be around for the birth of her babies. So when I left the hospital to have dinner with my 2 midwife friends from New Zealand on a nearby island, I made sure to put a pair of scrubs in my purse so that I could have the bus take me directly back to the hospital that night. When I got back, still no twins but there was an emergency ectopic pregnancy removal about to occur. I went into the operating theater for observation. After the removal of the one fallopian tube this woman had remaining I left the operating room with a heavy heart- that was not was I was expecting to see, although I was happy that this woman was alive because a ruptured fallopian tube can easily lead to death. It was about midnight, I had shared the banana's and passion fruit that I had bought at the market earlier with the Midwives on duty, the pregnant mom of twins, and her support people (one who happened to be her first born 18 year old daughter). Then I decided to take the Midwives up on their offer to lay down in one of the two private rooms that they have (for mom's), making sure that they knew to wake me if the twins decided to become more active. I felt like I was back on call again! Kind-of exciting, waking every so often to the sounds of newborn cries from the babies near by.

More on the twins in the next entry....stay tuned.

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