Return of the cankles...

You know how babies have such chubby legs that their calves blend into their ankles? Those are cankles. And we have them, again.

Why, you may ask, do you have cankles, again? Well, we were on our feet today for 10 straight hours catching non-stop babies in low-budget imitation Crocs (rubber garden footwear that are apparently very fashionable here in Vanuatu).

Perhaps it’s the thrill of Good Friday and Easter weekend, the full moon and beginning of Spring, or something was in the water today in Port Vila, but Vila Central Hospital was hopping with birth hormones! Today we started with a full house after our busy day yesterday, and momma after momma walked in the doors in very active labor. The nurses went about their business discharging many of the mommas who were either ready to go or ready enough, so that we could make room for the incoming mommas.

The first momma to start off our morning came in visibly working hard, which is actually quite different than most women here. They tend to labor quietly and take many events of labor in stride. Apparently our first momma, who was also a first-time mother, was in transition and she was completely dilated and pushing within half an hour of walking in the door, and had her beautiful baby half an hour later into Caitlin’s skillful hands. Our second momma to walk in the door, literally minutes later, was also a first-time mother and flew through transition to having her baby about an hour later without a tear. Our third momma, who had been there since earlier in the morning, was having her fourth baby through thick meconium and had a very stoic laboring style. It also happened to her birthday, and she was very happy to have had Kat as her fantastic midwife!

The fourth momma was also having her fourth baby, minutes after walking in the door, and Caitlin did a fantastic job single-handedly managing the birth. Simultaneously, I was managing a birth of a second-time momma who walked in the door and stated that her baby was coming. The baby was born literally 12 minutes later! Clearly the day was filled with many laboring mothers, beautiful babies, and a great amount of faith in the birthing process. Additionally, there were many opportunities to hone our skills in perineal support (with some new tricks), cord reduction (unwrapping the cord from around the baby’s neck), and suturing.

Our sixth momma was actually someone who we sent home two days ago because she was in very early labor. She came in today at 8cm, but unfortunately her baby was having severe decelerations to nearly 50 beats per minute (normal fetal heart rate is 110-160 bpm). The doctor on-call broke her water (ruptured the amniotic sac) and discovered very thick meconium, and made an immediate decision to perform a Cesarean section. I was called in to help with the baby who was born with an Apgar of 1 (some heart beat but below 100, not breathing, limp, pale, and no grimace). It took at least 10 minutes of resuscitation to stimulate a normal heart rate and have the baby breathe on her own, which feels like 2 hours when you are eye to eye with a small creature that is barely alive. Once she was breathing on her own, with difficulty, I brought her to the warmer, placed her in the head box with oxygen, and sat with her as she decided to join us. She was later moved to the nursery and given antibiotics, and her mother came soon after to the ward to recover from her surgery.

One of our last adventures, literally as we were preparing to walk out the door, was with our very first momma who decided to take a shower and passed out. We helped her to bed and realized she was losing a great deal of blood. As a team, we carried her to a wheelchair, brought her to the labor room and proceeded to express several handfuls of clots from her uterus, with the help of one of the midwives. I placed an IV and she rested with several bags of fluids under observation. Our day ended with giving babies baths and bringing them to their mommas to cuddle. No giggles this time…..just cute little cankles to match our less cute ones.