The Downs and Ups

THE DOWN'S:

It has been a while since my last post in part because I have found it challenging to put words to the experiences that I had over the past week/weekend. I will try to recount the events as I experienced them, with the disclaimer that the following stories are sad, hard to read, and at times hard to re-live. I also want to make sure to note that I believe that those involved have done the best they can with what they have and know, although I would have handled the situation in a different manner. With that said this part of the post involves death and I advise skipping to "The Up's" at the bottom if you don't want to read about it. I am going to try to keep it brief.

I came to the hospital last week to find that a planned c-section had occurred for the purposes of ending a pregnancy. The mom was 30 weeks gestation (same age as the little one I delivered the first week I was here...who is still doing well). She had an ultrasound earlier in the week and the findings were that her baby had severe hydrocephalus (a condition where there is water on the brain and swelling of the head occurs). Sadly, they do not have the resources or ability to put a shunt in, as would be done in many other parts of the world. Knowing that the newborn would not survive and that the size of the head would continue to grow larger if the baby was allowed to continue in utereo, the family and doctors decided to do the C-section as a termination. The issue, was that most knew the baby was going to be born alive. I was not in the room for the section but one of the students (who I have become close with) was and she re-counted the events for me that left her quite sad. When the baby was born one doctor wanted to suction him to help him out, and another doctor said "no, just leave him." He was alive!

I was in the labor ward when one of the midwives brought the little bundle in, all covered in blankets. This little boy was very much alive, still breathing, and giving small whimpers. She said the doctors said we are to leave him here and she set him on the cold receiver (which had not been turned on). I walked out of the ward to get the story on this little one who looked just fine to me, although there was liquid on the brain that you could palpate. Once I realized that he was being left there to die, I couldn't help but return to the room to put my hands on him, uncover his sweet face and gently talk to him. Mom was still in post-op. After discussing the case with a few others who felt deeply touched by the situation I turned on the warmer and another midwife gave the little one oxygen. He gave little crys. I walked out of the room momentarily and then returned to find that the doctor had turned off the warmer, taken away the oxygen and exposed his little body to the air. I was in the room when the father walked in and I heard as the doctor described, "baby no good". The family knew that the boy wouldn't survive but I am unsure how much they understood of just how alive he would be, when he was born.

After the dad left, the midwife asked me to weigh the little boy. With tears mounting behind my eyes I picked him up, wrapped him again and gently carried him to the scale. He was 3 1/2 pounds. I cried as I brought him back into the ward, and I refused to leave him uncovered. He opened his eyes as I walked back with him and I saw that him mom was being wheeled back from surgery. I set him on the warmer.

The student who was so disturbed by the on goings at the c-section had left the surgery and saw me in the labor ward crying, she said, "Kate that is exactly how I felt". However, within minutes I had to very quickly collect myself as another woman was brought into the room, pushing! We needed the warmer (which doubles as the resuscitation area- if need be) to get ready for this next baby so we put the 30 weeker in a bassinet in the same room where he continued to give small crys. The head was right there for this mom of one, yet I could tell that part of her bag was still intact so to make it easier for the baby to come out, I broke her bag. A thick black substance like I have never seen before came out (an extremely bad sign), very old meconium. Next thing I knew the little boy was born but had clearly passed away at least 1-2 days earlier. I checked for a heart beat anyway and another midwife called a doctor in to confirm that he was in fact deceased. He also had some serious malformations. I was unaware that prior to coming into the labor ward, no one had listened for heart tones on this babe (there may not have been time).

One other time I have been involved in the birth of a still born, however the family was aware of the situation. I have never had to give a mom the news before. I was told that she was 35 weeks but after looking at her chart saw that by her dates she was only 27 weeks along (although the baby did look closer to 35 weeks). We later found out that she had a fall one week prior where "water came out", she did go to the antenatal clinic when this happened. She also reported that she hadn't felt baby move since the day before. I wiped the little boy down and wrapped him as best I could and handed him to his mom, telling her that I was so so sorry for her loss. It was terrible! And the other little boy was still in a bassinet in the room, alive but quietly and slowly leaving his body. It is an indescribable feeling to be surrounded by that.

After the delivery this woman's mom left to get clothes to dress the deceased boy in (as they do here) so she was alone and in visible shock. I asked her if there was anything that I could do for her. She couldn't answer me verbally but I know she understood me. I gently rubbed her back. After a while I was instructed to also weigh this boy- this was one of the hardest things I have ever done, I gently took him out of her arms and spoke to him as I walked to the scale, again in tears!

I returned and gave her the boy to cuddle with again. Her husband was a teacher so he was at work. I took the other baby (from the c-section) out of the room and brought him to his parents and extended family to spend his final moments with them. I let them know that he was still alive but I was unsure how long he would survive. He died about an hour and a half later with his family. The other boy stayed in a private room with his family for most of the day.

There were two more births that I helped with that day (that went very well) however the day had still taken a toll on me and I felt I needed to take some time away. I cried a lot that day. Many of the staff felt greatly effected by how the case with the boy with hydrocephalus was handled and there has been much discussion, reflection, and prayer. For the most part I am very impressed by everyone out here yet that day was a hard one, a day that has really made me thankful for the resources that I am privileged to have, should I need them. I have 2 step siblings who have a half brother that has hydrocephalus, when he was born he was "the size of a coke can", he is now 16 years old and a track star. I took the following two days off to reflect.

Another "down" to share, before we get to the good. Early this week a woman (almost 40 years old) came in, in labor with her 7th child. That is what she told us....although, her belly was flat, she said she was due the following month but had been having contractions. I palpated her abdomen but didn't feel anything, and we couldn't get a heart beat. With the help of another midwife I asked a few questions, "had she felt the baby move?" Yes, a lot. "Had she taken a pregnancy test?" No. "Had she sought pre-natal care?" She had been to the clinic once at the beginning. We thought it best to call in the doctor on-call to address the case. The midwife told me that this was the third case she had experienced like this. The doctor arrived and brought in his portable ultrasound machine to show the woman and her husband (who had brought all of the clothes and supplies along for her and the baby) that there was in fact nothing in her abdomen. It was very very sad, they thought she was in labor and in fact she was not pregnant! I am not quite sure what this woman's mental situation/stability was.

I returned home after a very long day (12 + hours) to find that a pair of my flip flops that I had left outside my door for the past 3 weeks, had been taken. Without energy to get that upset I was a bit annoyed and went to bed.

THE UP'S:

I woke to find that my flip flops had been returned. They were in the same place I had left them before heading to work early the morning before. I guess someone just wanted to borrow them for the night! This made me laugh out loud.

As I mentioned briefly before, I am happy to report that baby Sonya, the sweet little one who was born into my hands at 30 weeks pre-mature is doing well and needs less supplemental oxygen on a daily basis. She is still in the nursery and mom still stays at the maternity ward to give her hand expressed milk to the little girl every few hours. I have seen the young mom helping others out with their babies as well.

I got asked if I wanted to attend a portion of a 3 day conference that was occurring in town. It was about the state of maternity and neonatal care in Vanuatu and more specifically Efate (the island I am on). There were members from the WHO, UNICEF, UNFPA, doctors, pediatricians, midwives, and nurses in attendance. I came to the session on the Role of Midwifery Care. The statistics were interesting and the presentation really got the director of the WHO generating ideas for how to improve the numbers of midwives in the area and the conditions under which they work (long hours, understaffed times, etc.). I was glad to attend.

Last week the ambulance went to pick up a mom and her newborn who was 'BBA'- Born Before Arrival; this was her third baby and the previous one was a c-section. Baby was unintentionally born at home with the assistance of a traditional birth attendant (a community midwife, who has learned via experience). All is well with the new addition and mom.

Later in the week I attended a very lovely and loving labor. I have only been to one other birth where the partner has been in the labor room, and it was their 4th baby. This time, it was the mom's first pregnancy. She was a young 20 year old and her boyfriend was at her side, holding her head up, encouraging her, giving her sweet kisses the whole time! It was so nice to see. His mom was also there helping her along. When the baby came out she needed a little extra assistance to come around. I was so happy when she finally gave a cry and really came into her body. The uncle entered the room not too long after and I don't know if I have ever seen someone so overjoyed and excited for the family, her was laughing and crying at the same time! I helped this mom breastfeed for about an hour. Dad made sure to get my name and took photos of me on his cell phone. They had been discharged by the time I got to work the next day, (another sign that all was well) so I am unsure if there is a little Kate around or not but none the less, it was a beautiful birth with great support.

I have been able to help support the student nurses along their training and be by their sides assisting as they help deliver more babies and practice their skills. It has been rewarding to see how far some of them have come in just a few weeks!

One of the midwives met her 20 year old niece for the first time when she came to the hospital for antenatal care this week. She lives on another island, the family had moved there right after her birth so this midwife never got to know her. It wasn't until she checked the unusual name with the name of the father of the young girl that the midwife realized this was the daughter of her brother! I am not sure if she has had her baby yet but I hope the aunt got to be there if she has.

Also, I walked into the labor ward to see a woman pushing and the midwife asked if I wanted to do the delivery. Of course, yes! As I was coaching and supporting the 23 year old through the delivery the midwife informed me that she had delivered this young woman (23 years ago!!). That was really special!

And finally for now... there have been 70 births in the first 11 days of March here at Vila Central Hospital. This is actually down from last year (if you can believe it!) which means that the sex education that they have started to provide at some major events here (i.e. Independence Day- which is 9 months prior) may be working! However, I have also been told that some use the condoms that have been handed out, for fishing bait "because the spin so well in the water" =) Hopefully they are also being used for the intended purpose.

Can't believe I have only just over 1 week to go! This has been a truly amazing experience, one which I will forever be blessed to be a part of. I have told the midwives that if they ever make it to Seattle they will have somewhere to stay...in fact MANY places to stay as all of us that have experienced their kindness and tutelage would probably all be wanting to house them!

Thanks for reading!