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.

No comments: