Saturday, September 21, 2013


Several long days in the hospital this week prevented me from doing much blogging. Today's hours, for example, 16. I needed to wind down, though, so I thought I'd reflect a bit.
Two new students from New Zealand started this week. They are quite lovely and excited to be here. We've had some very busy days and a lot of great experience - a couple babies with sticky shoulders and a couple babies with thick meconium. A breech that actually wasn't a breech, but the woman had that baby just before she was about to have a cesarean due to the breech positioning....which turned out to be a head-down position. Hmmm.  One of the mornings (I honestly don't remember which) I walked straight into a resuscitation while three other women were pushing out their babies.
But back to today. The morning was low key. Just one baby. It's just after that point that I went home for a short nap because I was feeling a little under the weather. When I returned, the hallways were filling up with laboring women, but they were all hanging around 5 to 7 cm dilation. I had a feeling we were about to be full up in the delivery room. And that is exactly what happened. First, a second time mom with a short pushing stage delivered a beautiful little baby boy. A little suturing needed. No problem. Across the way, a young first time mom was ready to push. After another hour and 19 minutes and some really big decels, she pushed out a beautiful little girl. As I was suturing her, one of the students was working with a multip (5th baby) just across the curtain who was starting to push. And behind me, across the room, a 28 week breech was being delivered by another student. I finished suturing, and helped the student with multip. During pushing, the waters broke with fury all over everyone within a few feet of distance. Not the tidiest birth I've been a part of, but a beautiful baby girl was the result. We've learned to try to be as tidy as possible, because after the birth, we have to scrub the sheets as clean as possible before they go to the laundry. Anyway, that little 28 week breech basically jumped out and was being tended to by the student, who was very frustrated by the lack of medical support. The baby was breathing fine, but he was just 2.3 lbs - such a little angel he was! He definitely needed to be in the NICU though and nobody was initiating that move (coming back to this, he is doing quite well in the NICU several days later).
So we charted, sutured, cleaned, more charting, did newborn exams, gave immunizations, and transferred the babies and moms to bed. Then we cleaned some more. The halls were still full, but by this time it was about 11:30pm and we were ready to get home. Two of the students had left already around 9:00. Just as the other student and I were about to leave, we headed over to the delivery room to look for a notebook we had left, and on one of the beds, alone, was a woman obviously about to have a baby. She grabbed the student and said "will you help me"? A quick check and a couple pushes later, she pushed out her second baby girl. So we charted and cleaned and did all that....and THEN we ran out the door as fast as we could, just after midnight. A wonderful and exhausting day. The best part, I had the following day off! Leni, a friend of hers (her neighbor, really), and myself rented a car and drove around the island of Efate. Best idea ever! For a grand total of about $50, we spent all day visiting waterfalls, beaches, villages, caves, resorts, and then we stopped to watch the sunset just before arriving back in Port Vila. The weather was perfect and the scenery was incredible - it was a much needed day off! I'm so glad I had the opportunity to see more of the island and learn about some of the villages in the area. Everyone was so welcoming. They allowed us to see things after they had closed if in return we'd give them a ride to the nearest village to get a tank of gas. No problem! One man even gave us our money back.
My last day, Friday, was a normal 7am-3pm day with just three births facilitated by Leni and myself. All three had prolonged ruptured membranes, interestingly enough, but all three had beautiful deliveries without complications. After those births, when I went back to my hotel, I took some time to reflect on the last two weeks. I realized how much I learned in that short period of time. I learned new skills and techniques, improved on others, and gained confidence in areas I felt weren't my strong points. I am so thankful to all the women and midwives here in Vanuatu that have allowed me this incredible opportunity. When I was saying my goodbyes on Friday, I couldn't have said thank you enough to everyone for being so kind and helpful and for letting me experience midwifery in Port Vila.
And now it's Saturday and I feel exhausted. Maybe I've got a little bit of a bug, or maybe the last two weeks have just caught up to me. I flew from Vanuatu to Fiji at 9:40 this morning and slept the whole way there. Then, I had (well, have, I'm still here) a 10 hour layover in Fiji. So, I walked across the street from the airport to a resort and laid by the pool for a few hours. That was followed by a nap. I can't seem to sleep enough. In fact, I wish I were sleeping now. In just a few hours I will head to LAX and finally back to Seattle. While I have enjoyed every single second of my trip here, I miss everyone at home and will be happy to return.
Last but certainly not least, thank you to all you lovely midwives back home who helped me get here. This trip wouldn't have happened without your help!

Friday, September 13, 2013

Women Inspire

It's Friday the 13th. But don't worry - no freaky stories to be told. I woke up at 4:30 this morning to dogs barking and roosters crowing. Since I went to bed at about 9:30 the night before, I guess I'd gotten enough sleep. The sunrise was incredible, though. I can see it right from my hotel window. I can't wait to take a day off to explore all this island has to offer.
I woke up with enough time for blow-dry my white scrub pants again. It's so humid that nothing really dries here. So I spend about 30 minutes with my hair dryer blasting my clothes for the day dry each morning. I'm sure my neighbors love me. I have to wash them. It wouldn't be okay to wear them otherwise. Birth can be messy.
I look forward to breakfast each morning - since it will likely be my lunch as well. It is included with the cost of my room. And it's actually quite good - eggs, a rice pilaf-type dish, some sort of sausage, fruit, toast, muffins, etc. I eat a little and take the rest with me to the hospital to have for lunch. Even better - after several days of not knowing - I found out I get a free coffee with that breakfast. Espresso even. I feel spoiled.
Everyone at the hospital wears sandals. Even the foreign students, midwives, and doctors. I don't understand this. We go through the charts and see all the infections some have...and even worse, don't see much of what some others have. I've been blasted a few times with a popping bag of waters all over my feet or on my clothes. Needles have been dropped, medication vials crushed on the floor, AND there are a few resident mice and rats crawling around the hallways...Why even take the risk? I don't think "when in Rome" applies in this situation.
Friday was a great day in the maternity ward. These women of Vanuatu are just incredible. They are so strong. Some are so quiet that you barely know they are in labor.  Just a little sound here and there, and then they're all of a sudden pushing - quietly of course. Yeah, there are others that will squirm around on the bed. I've actually seen a few women putting their legs nearly back to their ears - straight, not bent like you'd think). I've almost been booted across the room a couple times. But hey - whatever it takes to get that baby out! Most women's pushing stages are quite short here - we were talking about how it might be due to the fact that they spend a lot of time in the squatting position. This might help form the hips in such a way that the head can get through a bit easier.
Three babies today during my shift. All three were boys. Two of the women required suturing. The first one had her cervix come down to where you could see it, so we used gauze again to put it back in place. This seems to be happening too often, they start pushing before they are completely dilated and just can't stop pushing. The second mom's waters had been broken for nearly 40 hours. The baby's heart rate was hanging around the 180s. She was contracting about every 3 minutes with good strong contractions, was 8 cm dilated, and they put her on Syntocin to augment her labor. I don't really understand why. She would have done just as well without it. We were concerned for this baby, thinking that this mom might have a bit of a longer pushing stage because it was her first baby - would this babe be able to handle it? Well very shortly after they started to augment her, she said she felt like pushing so we went over into the labor ward. She pushed like a champion, and as that head came out, so did the thickest meconium I have ever seen. Meconium streaming out of the nose, the mouth. Covering the face, the ears. When that baby, a large baby at that, came out, we had to do a bit of suction and a little free oxygen - but he started screaming just fine. He pinked up really well. His heart rate stayed up at about 180 for quite a while, with a respiratory rate of 70 (high) and a bit of a temp. Mom also had a temperature, her respirations were 30, and her pulse was staying around 120. It was apparent that the mom had an infection and we were concerned about the baby too. The baby doc came in, though, and said that the baby was fine. Antibiotics were given to the mom. We were really hoping they'd give the baby antibiotics too, but none were given before I left.

Yep. I'm working the weekends. But it's so worth it. A shorter shift today. Two lovely, very strong women had their babies. The first one was a first time mom. She had had several CTGs throughout two days that showed regular early (and occasionally late) decels. They continued to monitor her every 3-4 hours and gave her IV fluids. When I arrived this morning, she was about 6 cm dilated. Not too long after, she was feeling pushy. Babies heart rate continued to go down...into the 60, 50s, 40s. Thank goodness these women have short pushing stages. Just a minute later she pushed out a beautiful baby boy with great APGARs. That's the 7th baby boy in a row. She had a few bad 2 degree tears that took an hour to repair. Partly because I go slowly, but partly because it wasn't straight forward. Unfortunately is was about 100 degrees in that room, with a bright light shining down on me, and 95% humidity. I sweat easily, so you can only imagine what I looked like when I finished. Then finally a girl! A sweet young woman arrived at the hospital having had no prenatal care and unsure of her dates. She was measuring 34 cm. Baby didn't feel too small though. That baby was also having several decels. We brought her into delivery. She was nearly complete and ready to push. After a very short pushing stage, she delivered a sweet little baby girl - probably about 37 weeks gestation. They named it after the student midwife from New Zealand who's birthday it was today as well. I also have a little baby girl named after me. They like to do that here - name their babies after you. One of the midwives from New Zealand that's been here for 3.5 years has dozens of babies named after her. She started requesting that they start using her kids names instead.
We got done early, got showered up, and are relaxing by the pool and listening to live reggae music. Tonight we'll go down to a local pub and watch rugby and celebrate the student midwife's birthday with a bunch of other locals.
I am so appreciative for the experiences I'm having here. It has been so wonderful and the women have been inspiring. I look forward to starting my second week. I can't believe how fast the first week has gone by!

Thursday, September 12, 2013

A few rainy days later...

I've had a few days at the hospital now and I'm feeling much more settled. I understand the routine better, which midwives are in charge, which meds are used and where they are, and when it's okay to take a coffee break. I have really enjoyed each day and have already learned so much. The time flies. A couple of the days I have walked into the maternity ward and was directed right into delivery, where I would stay for hours.
On Tuesday, the delivery room was full, the beds were full in the postnatal area, with mattresses on the floor, and the hallways were full of pacing mothers. Women were coming in with strong contractions, we'd put them on the CTG, and they'd have their babies a couple of minutes later in the admission room. That same day, I was with a second time mom pushing at only 7 cm. I was having her try to breathe through contractions. I told the head midwife my findings when she popped in, but the mom was feeling pushy so she encouraged her to push. She thought she must have been complete. A minute later, we see her pushing her cervix into the vaginal vault. That woman had a mild hemorrhage, but did end up pushing her baby through that 7 cm cervix within 10 minutes. On the bed next to her, a woman's cervix presented at the vaginal opening postpartum. I remembered seeing that once before, that shiny, smooth, purplely colored flesh. We used gauze to push it back in and hold it in place. Also on this day, a woman transferred from the island of Tanna via plane. She was with a Canadian doctor that works in the only hospital on that island. The doctor said that the woman had been bleeding, and contractions had started afterward. The baby sounded okay the whole time, but started to get tachycardic near the end of the trip (Nifedipine was administered on the way). She was immediately hooked to a CTG and an ultrasound was done. A large placental abruption was noted and she was taken in for an emergency cesarean. The baby struggled to come around. She had a strong heartbeat, but has not wanted to breathe on her own. They say she needs advanced care that they cannot provide here in Vanuatu. She has been in the NICU, dad by her side, for three days now, still not breathing on her own. Her last oxygen stats I saw were sitting around 75%. The mom had a large hemorrhage, but she survived. And still on the same day, after 11 hours of being at the hospital, a mom at 31-32 weeks gestation came in feeling like "sit sit". We brought her right into the delivery room, checked her cervix, and she was complete and at +1 station. Just a few minutes later she gave birth to a beautiful baby girl. This little girl wasn't ready to breathe yet, however. Her heartbeat was strong the whole time, but no respiratory effort. We had to breathe for her for about 6 minutes (it felt like a loooong 6 minutes), but she started to breathe on her own and is now thriving. During that resuscitation, we asked for a peds doctor or a head midwife or anyone to assist - nobody came. About 30 minutes after the resuscitation, the doctor on call showed up. By that time, the baby was nursing well and everything was fine. She didn't even need to go to the NICU in the end, though she was quite small. EGA was 31 weeks.
After that long, busy day, I headed back to my hotel, had some food from the restaurant (a salad with a side of veggies, because I felt like I needed some good nutrients, but didn't want to pay a fortune), headed back to my room and did some laundry in my sink. I didn't bring enough scrubs, I've found. And I brought the wrong color. Don't wear white. I was told that the midwives wear white here, and a couple of them do, but dark colors are much more appropriate. So I do a lot of clothes washing with shampoo and hand soap in the sink. It works surprisingly well though!
The next day, Wednesday, was evenly spaced with births and a little more low-key. Chris, the New Zealand midwife, took myself and Leni to get some good Tanna coffee at a local resort. It was such a great change from the instant coffee I have been drinking. I do love my coffee. This day was a great suturing practice day. Both first and 2nd degree tears. I'm learning some great new techniques. We got done early today (7am to 5pm rather than 9pm) and Leni and I headed straight down to the market to buy some fresh fruit and veggies. I was so happy to have some delicious grapefruit, tomatoes, raspberries, and other colorful foods.
Thursday was a low-key day. Just one birth. The placenta came out duncan with incomplete membranes. We did our best, with a speculum, to get the membranes trailing out of the external os. We got all we could see, but knew there was some left inside. The head midwife suggested 20 IU syntocin in a bag for her. So that's what we did. They are running out of syntocin here. There isn't any left in the pharmacy and there isn't much in the delivery rooms. There are also very few IV catheters, and the only ones available are the 18 gaugers. Not always the best to use on some of these veins. We got done early today and are having a relaxing evening at The Coconut Palms - the first real evening of relaxation. As I look up, I see a clear sky and I know the stars will look incredible tonight. I'm so excited. Behind me, a man in traditional Melanesian tribal attire is giving a talk on Kava Kava, a common drink here in Vanuatu. I look forward to a busy and educational rest of the week.

Saturday, September 7, 2013

Just getting started - Day 1

I fell asleep to reggae last night, which was being played live downstairs at our hotel. It felt like they were playing at the end of my bed, but I was too tired to care. That's just a side note really. I had my first day at the hospital today. I arrived at 6:45 am because I was told to arrive at 7 to do rounds with the midwives and doctors. I should have known that that meant rounds would be at about 9. I enjoyed meeting everyone while we waited though, because they are just so incredibly kind. They all say hello to everyone at home and appreciate the flavored coffee that was recommended as a gift. They also say I should speak Bislama with those of you back home who now speak it. You know who you are. I was given another tour this morning and then there was a lot of waiting. We waited for the doctors. We waited for women that were slow to dilate. We waited for things I didn't even know we were waiting for. The nurses were watching a downloaded movie on the television, while women paced the hallways, families cooked in the kitchen, and the shifts continued to change over. Finally, two doctors came to do rounds and I was told about all the things, surgeries, deliveries, and strange and peculiars that had occurred during the past week. A couple of huge fibroids that surprised them during a cesarean that caused them to do a strange-looking T-shaped incision and will likely lead to a hysterectomy; a couple sets of twins, one term, one preterm, but all healthy; and several tubal ligations, which seems to be encouraged and quite common. I was surprised by this - 21 year old girls getting tubal ligations. The access to and/or education about contraceptives is very limited, but tubal ligations are just so permanent. I won't harp on this. I'll move on.
Today was simple and easy. This really means uncomplicated, because we all know no sane laboring woman will say "that was easy" afterward. And that's not to say being there wasn't tiring, because I always find myself pretty worn out after any birth. The adrenaline just gets you. Three babies were born during my 9 hour shift, all within a couple hours of one another. The first I was helping with, when the midwife said she was going to step out for a moment. I continued to be with this young woman as she was finding her "push." She appreciated some manual pressure to guide her, and soon enough the head was crowning.  Eventually, two midwives came into the room and said "your assistants are here." They were going to let ME be primary. I was surprised, even though I'd heard stories of this. I was happy to do it, though. I felt ready, because birth is birth, no matter which country you're in. One of the midwives got into the young woman's face and strapped her feet down on the foot pads. A few minutes later, that midwife left the room, and her feet were unstrapped so as to pull her legs back and open up her hips. Seconds later, the head delivered - LOA it appeared, however strangely enough, that head that was facing mom's left thigh turned ALL the way around to face the right thigh while letting his shoulder free. Very owl-like. Happy, healthy little baby boy. Next, in the room across the hall, a woman was pushing so I popped my head in to see what was going on. The midwife in that room asked if I wanted to do the delivery. Of course, I said yes! Less than 10 minutes later, a tiny little baby girl was born. The mom was supposedly 35 weeks, but this baby was just over 3.5 lbs. She had a decent suck, nevertheless, and was "labeled" SGA rather than pre-term. Again, across the room, another woman was pushing.  Then, all of a sudden you could hear a huge gush and a good-sized baby girl was born with a lake-sized amount of water behind her. She was vigorous and healthy. The midwives were more than happy to allow me to suture, but today I wanted to learn their styles before I jumped right in. I've always found suturing to the be the thing I'm a little hesitant about. I've always found, all the same, that after I start, I actually enjoy the art of doing it. I'm sure I will get plenty of suturing experience here.
        After leaving the hospital, I took a little walk into town, which was mostly closed down. I grabbed some snacks from the only open mini-market, some peanut butter and crackers, and headed back to the hotel to read and relax.
Things I took away from today: 1) Despite being located in the middle of the South Pacific, the midwives in Vanuatu practice much like the midwives in Argentina, but with more patience. I found that to be very interesting.  2) While I think active management plays an important role in some births, I wonder about the role it plays in those placentas that are really hard to get out (something I experienced today). 3) The people of Vanuatu are so lovely and I look forward to the rest of my days here.

Wednesday, July 17, 2013

Overview of the trip

We left Vanuatu Saturday and I have been reflecting on the experience since then so I wanted to write a last post about it.

Being a hospital that serves ~300 birthing women each month, serving a large number of women living in poverty, with hepatitis B, STIs, and HIV being rampant, it amazed me how well the outcomes were!
Most of these women, despite the odds, would just birth their babies, and their babies would nurse without issue! There was a lot of preterm SROM (spontaneous rupture of membranes) and preterm labor (likely from all of the stis)…
The don't have pain releif in labor, except when cesarean is required, so the women just deal with it. And they know they have to deal with it, so most of them did just fine. A lot of them have a friend or mother there to help support them through labor... and I spent a lot of time rubbing backs, holding hands, and talking mommas through the pain...  Their c-section rate is around 7%

I witnessed 20 births while there for 2 weeks. I worked the day shift (night shift is when most babies are born) and we took a few days off (after really exhausting 14 hour shifts, or stressful births).

This is a brief overview of what I witnessed (mainly for those people thinking of going to Vanuatu J)

1-cord prolapse (well, 2 if you count the mother that I spent time giving her labor support while she was at the hospital for induction after she had a prolapsed at home and lost her baby, I did not witness her birth though, only helped her with labor, then postpartum was amazed by her kindness when I saw her rubbing a laboring mom’s back (a stranger) in the hall just the day after she birthed her still baby)

1-set of twins

1-footling breech (twin A)

1-postpartum hemorrhage

1-intersex baby (baby had a uterus and ovaries but external genitalia appeared male)

~15 times suturing

A handful of resuscitations (on newly born babies and on a preterm baby in the nicu)

A handful of IVs (and two 16 gauge ones!)

Some teaching, and alot of listening and learning J

Several lovely births, several women I supported during labor but did not attend their birth, several prenatal, and postpartum visits, several times changing bedding or scrubbing birth goo out of sheets, or charting…

I am so grateful for the experience of going there. Although I most certainly would have adrenal collapse if I were to deal with the amount of stress they experience on a regular basis, I am glad I could experience it in a small dose.

When my family picked me up from the airport, my baby Owen (16 months) was mad at me.

By the time we got home he started warming up to me, but he got mad at me any time I would offer to nurse him, and he wanted David only that first night…

That was completely heartbreaking.

Fortunately the next day we had a lot of close time together and the next night he went back to breastfeeding! He now is as loving as ever, and I am enjoying many snuggles from him and my sweet, sweet Jude (who is 5 years old, and has been very understanding and loving the whole time).

It was the hardest thing I have ever done, leave my husband and 2 young sons for 16 days (2 days travel and 14 days there), and I will never do that again. But, it was worth it, just this once, to have this amazing experience.
The picture below is some of the staff and us when we went in to say goodbye

Tuesday, July 9, 2013

I never imagined I would see all I have seen and experience all I have experienced here in a short week and a half. I got what I came for, and so, so much more. As hard as it has been being away from my husband and 2 boys, this trip was worth it, the experiences have made me feel really truly ready to practice on my own, and I have new skills to go along with it!
This place is amazing, and really dramatic and stressful, and joyful. Someone could seriously make a reality series based on Vila Central Hospital, and every single day they would have an excess of captivating footage of all the crazy, and all of the amazing-ness that goes on here.
An intersex baby was born yesterday, he/she has an older sibling with the same thing. What are the chances?! Congenital Adrenal Hyperplasia, never thought I'd see it....
Yesterday I also spent some time in the NICU with a 30 ish weeker, he is 10 days old and had been going downhill... he had 2 episodes where he stopped breathing altogether, and both times I was alone (just checking in on him, this tiny little person) and called someone else in to help me resuscitate him. We did, and after got him on skin to skin and he started rooting and breastfed! Today he nursed again too, and I think the skin to skin and small amounts of breast milk are helping him some. They also gave him a blood transfusion which is helping.
I've been a bit frustrated by the lack of the nurses being willing to push for something with the Drs. For example, the chart said with that baby, nothing by mouth because of the apnea. But, baby was rooting and self latching when put on skin to skin! The nurse said no, don't feed him. So I marched down to the peds department of the hospital and spoke to the Dr who gave the orders, told her baby was rooting and self latching, and she said "great, we thought we were going to lose him yesterday!" so went back and told the momma that yes, you can feed your baby, because thank goodness he is now strong enough to try to get it!

Today, Elias and I attended 3 births, then in the afternoon after getting to the point of complete exhaustion, we decided to stay and attend a very premature twin birth, we very actively participated in the positive outcomes for all 3 ladies involved (and I am sure daddy was happy too :) and I am so grateful for the experience. Elias led the resuscitation, in the most amazing way! And initially he was surrounded by people that he had to teach how to help him resuscitate, but of course he handled it well and eventually got that baby breathing (and also got a umbilical catheter in!). And I managed the vaginal delivery of twin #2 after the OBs attending said they couldn't get the nuchal arms to budge and would need to do a cesarean section, I just asked them if I could try too, and they said yes and they went to go prep for surgery.

On top of the crazy births, I have gotten a lot of amazing easy normal births, crying healthy babies, and a ton of suturing experience!
Also good is I have had to do a few IVs, and got two 16 gauge needle IVs in first try! Only tried because they were out of 18s, and 20s... they run out of supplies pretty quickly here...
And today we got to attend the birth of a baby born in the caul (in an unbroken bag of waters)!!

Today is Tuesday at home, we arrive home Saturday, I can't wait to kiss my boys!

The first picture is me giving twin B oral vitamin K, the 2nd is Elias giving some to twin A

Friday, July 5, 2013

Busy baby hour! Scope of the hospital...

Yesterday was a mellow morning and afternoon, I spent most of my time cleaning, stocking, helping the staff  and hearing about their lives, admitting a couple preterm SROM mommas, spending some time in the prenatal clinic, and labor sitting with a 43 week momma that had been having late decels for hours. Around evening time she started feeling like she needed to push, so we moved to the delivery room, baby was OP and she had a cervical lip that kept coming down, it took her awhile to get him to move (eventually he turned). We had her cycle through running start position and mcroberts, and kept a close eye on baby, who at some point had sustained very low heart rate...  well, eventually baby was born completely limp, no respiratory effort, and pale, skinny as heck with a large head (very obviously IUGR for 43 weeks). His cord was pulsing strong so he stayed attached to mommy for 10minutes, we ended up giving him some breaths on mom, and some oxygen breaths when cord stopped pulsing.  We gave him apgars of 1m- 3, 5m- 5, 10m- 6, 20m- 8. Eventually he came around and about an hour and half after birth he started nursing! Hooray!

Because they are a hospital, their scope of practice is much further than what I will practice back home, the experiences are educational, but still with some of these I would have transferred awhile prior.. Such as when she had an ultrasound and was found to be severely IUGR, or when she hit 43 weeks... long before birth, but even if it was during birth, the late decels would have clued me off to transfer.... We consulted with the Dr on staff so many times with her, and each time we were told to keep going. On the positive side of it, he got to stay on mom and get all his blood, and oxygen from mom while we did breaths on her chest, and only for a few minutes did he go to the warmer for oxygen and breaths and vitals assessment... that is the benefit of having midwives in hospital (and also some rare special OBs do this...but so few), baby is going to have a much better chance because neccesary resuscitation was done with cord attached.

Since they do ultrasounds so minimally here, and their ultrasounds are very, very basic, I'm not even sure they would have done anything different for baby, such as inducing when they realized he stopped growing... Ultimately it turned out ok this time, but that won't always happen....

Then, a little bit of time went by and bam! 4 babies in an hour!! We ran from one room to the other! Very, very fun! And each were quick, easy, normal deliveries, the babies cried right away, and the perineums were intact! I think Elias and I needed a run of healthy, easy births to restore our faith after the 2 prior (the cord prolapse and the 43 wk limp baby).

So off we go to another full and crazy day!!

Wednesday, July 3, 2013

Cord prolapse

I figured I would probably have to deal with some crazy stuff while here, it seems everyone else that has ever told me stories about Vanuatu talk about the one ever lasting memory of the crazy scary emergency that happened. Mine got to be cord prolapse, well at least I hope that is the scariest it gets while here… I might like and easy breech or twin though… but no more emergencies please!


I caught 3 babies today, the 3rd right before Elias and I were going to leave. I wanted to leave early because yesterday we were at the hospital for 14hours, running around doing a million things. It was this momma’s 4th baby and I figured it would be quick and easy then we’d go home.


Let me give you a little background, yesterday there was a mom who had a cord prolapse and the baby died, same thing like a week or twon prior (as told to me by someone working at the hospital, we weren’t here yet). I think most people reading this know that cord prolapse is a very rare emergency (it seems to happen here a lot more often) where the baby's cord falls out through the vagina (or just past the head) gets compressed between the baby's head and moms bones and most often baby dies because they don’t do a c-section quick enough.


Well, she started feeling an urge to push, I checked her and she was fully dilated, the head was low but not coming lower because of what felt like a huge bag of water over the baby’s head. I figured she’d give one good push and that bag would break and flood everywhere, or be really thick and inhibit descent. So I routinely checked for the cord over the baby’s head, as we are taught to do. Elias put the Doppler on baby, all very routine... during a contraction I barely touched the bag with the amniohook and it broke it, I controlled the descent of the head a little (didn’t have far to go at all, but with a G4 I figured she’d have so little resistance to baby coming quick). Baby's heart rate started tanking, I checked and felt a cord along the top/side of the head (with all of that fluid it flushed it down further toward the opening), we flipped mom to knee chest position and called the dr for emergency c-section, but supposedly an ER CS takes like 30-40 minutes here (supposedly that is what happened last week) and the baby would already be dead (or we would have to hold the baby’s head up until the surgery was ready and would be quick), so I shoved my entire hand up momma (as she quite audibly complained  because it f***ing hurts to have somebody's hand inside you next to your already huge baby head), pushed the cord back inside as far as possible, kept trying because it kept slipping and baby's heart was low, I was really persistently trying to get it to go around baby's neck and stay, and eventually it did! Heart rate went up and we had momma push like a crazy woman... the cord was still tangled and had some dips and since baby had been deprived of oxygen for so long we didn’t know how baby would handle everything, .... I was so, so scared that the baby would die... but ~30 minutes after the cord had first prolapsed the baby was born and cried pretty quickly (30 minutes is way too long to not know if this little baby is going to live), after the birth everyone was still and quiet. I am so thankful he lived. He complained a little while and then started smiling... No kidding, he started smiling, and babies don't commonly smile when they are awake and newborn… they smile in their sleep or when they are older... but he seriously was smiling, several times. He laid there on mom and the cord pulsed for so long, I really think it was quite beautiful that it pulsed so long to give him all the oxygen he needed that he was deprived of :)

What a day! I am tearful now just thinking about the poor momma that had lost her baby yesterday and how this sweet smiling little boy might not be alive right now...


Monday, July 1, 2013

Done with day 2

Wow. What a day. We spent 12 hours at Vila Central Hospital today, all day on our feet going between laboring, prenatal, and postpartum moms and babies. It was the equivalent to any sauna I have ever been in, hot as hell and humid. It was pretty challenging working that long in the heat and not taking the time to eat at the hospital or sit... so now being fed, clean, and laying down feels quite heavenly.

When I pictured the hospital and Vanuatu as told to me by the many midwives that have come here before me, never in my thoughts had I imagined it being so poor, and so dirty...and all the bugs everywhere, even crawling all over the hospital. It is so different from anything I have ever seen or experienced, and I am very grateful to have this amazing eye opening experience.

Something else I didn't expect is how friendly and kind everyone is. Almost every stranger we pass on the street say some greeting or start up a conversation. People are also being very understanding of my funny sounding Bislama, its getting better with every encounter I have though (hehe, only when people talk slow).

One of the births I attended today was a first time mom that had been in the hospital since the day before with SROM, she was contracting all night but mildly. I went to check in with her and she had had some bright red bleeding that had soaked a menstrual pad, I took her over to the monitor and listened to baby for a bit, she had more bleeding, quick slight drizzles. Then baby's heart rate was lost off the monitor and when I found it it was 50, I called in one of the head midwives to see about er c/s, baby's heart was still so low, about 80. After about 5 minutes without the monitor tracing baby, and my frequent checks finding 50-80, baby came back up to normal. I put an iv in, the dr came in, and said keep her on the monitor and if it happens again let me know, check her dilation in a couple hours. I stayed with her closely, mostly monitoring babe and giving support, she'd say to me "oh mummy it sore, so sore" and grab my arms, sometimes pulling me in to hold onto me during a contraction. About 2 hours after that scary as hell decel she started to push! We moved to the delivery room and had a lovely birth of a very healthy and strong baby (after an hour and 20 minutes pushing)! I loved that it all turned out ok, for many reasons (I felt quite bonded to her after our morning together), but her birth happened right after a mom who had decels to 70, a c-section, and a baby with meconium aspiration and apgars of 2 and 5. A good reminder how birth is always different.

Well, I need to get some rest before another long and amazing day tomorrow.