First Day and First Catch

Just back from my first day in the hospital. A nice mellow morning of monitoring a women that was being induced since her dates showed she was over 42 weeks, cutting and folding gauze, giving BCG vaccinations (for tuberculosis) to the babes before discharge, and getting to know the midwives, nurses aids, and the general feel of things around here.

The woman whose labor I monitored today was very sweet. She speaks perfect English, which was a nice way of easing me into my first birth here since I could actually communicate with her. This was her fourth birth. She received her first dose of misoprostol intravaginally at 8:25 this morning and started having mild contractions around 11. I left for lunch and a swim around 12:15 since it seemed that things were still in the early phase, returning just before 2 to hear that she was 5cm. Her mother excitedly waved me in to the room and the laboring mother, clearly in a active labor, looked at me and said, "I'm at another level." That was clear and we moved her into the "theatre" or one of the delivery rooms. The nice thing about this room is that it is air conditioned so on a hot day such as today, it was refreshing for all involved. She climbed up onto the table, Sister Leilangi (the head midwife) checked her while I gowned and gloved up. A small anterior lip of the cervix was all that remained and then I was instructed to break her bag, by snagging it with a pair of forceps. That was a new use of this insturment for me, but here, where resources are precious, anything reusable is of great value (versus the disposable amni hooks we use to rupture membranes on other occasions). Within seconds her sweet babe's head was on its way out with her little hand up by her ear and her cord around her neck. With the next push, out she came, covered with vernix (the white creamy waterproofing agent that babies who are generally 40 weeks or less still are covered in- so clearly her dates were off, this was NOT a 42 week babe).

This woman has 2 other girls and 1 boy, and when she was in early labor, I checked her pulses since she didn't know if it was a boy or girl. Her sense was a girl, her mother thought it looked like she was carrying a boy. I thought her belly looked like a girl, but my reading of her pulses said boy. Clearly this is reading of pulses is not one of my strengths (yet). I'll keep working on it :)

One thing I'll really need to get used to here is all the needle pokes for mom and baby. All mom's here receive syntocin (synthetic oxytocin) immediately after giving birth, followed by ergometrine if her blood pressure is normal- both to control bleeding. There is very good logic to this here since prevention of hemorrhaging is of utmost importance- blood transfusions are hard to come by from what I hear and the blood is not super-purified like we have in the states. So the benefits definitely outweigh the risks of giving the meds.

For the babes, within the first 10-15 minutes they receive injections of vitamin K, hepatitis B vaccine, and BCG vaccine (or alternatively they may receive this before departure the following day- depending on whether the vial of vaccine is open at the time of birth and therefore needs to be used, otherwise they will open one vial and do all the babies at the same time the following morning). So yes, lots of pokes within a short period of time for both mom and babe.

I'm amazed by the efficiency here! It has to be this way since they are averaging 200 births PER MONTH on this island! I can't believe that 2400 babies each year are born here! This is not a huge island. Last April was their biggest month this year so far and they had nearly 300 babies that month!!! That's average 10 births per day! So today was my first catch and there is no question that second, third, fourth and beyond will likely be tomorrow or the following day. This is exactly how I like it- jumping right in.

Now, a shower and off to my first experience of a nakamel, or kava bar, to drink and be merry.... or perhaps very relaxed. Will let you know how it goes....

Arrival in Port Vila

Hey there, Molly here. Just a quick note that I have arrived as the latest midwifery student, to the smallest International airport I have ever been to, with the sweetest group of women singing a Vanuatu welcome song. A fabulous crew of baby docs (aka medical students) and midwives-to-be milling around the Port.

Last night, an outdoor, local showing of "The Age of Stupid" on a screen with the backdrop of the ocean, starry sky and setting moon- a bright smiling crescent in the western sky. I am disoriented without familiar stars, but at least the sun and moon still travel in their usual directions....

For any of you who have seen this movie, I found myself thinking how ironic it was to see this movie within 4 hours of arriving- a painful reminder of the enormous carbon footprint I had just created to get to Port Vila. I guess all those years of bikecommuting have perhaps offset my latest (and largest) carbon footprint (maybe.....). For those that haven't seen it, it's about global climate change and the dramatic and cumulative effects of our individual choices (like traveling around the world). So yes, carbon footprint aside, my hope is that I can make a larger (more sustainable) imprint here in Vanuatu with the care I provide for the local pregnant women and their babies. And have a lot of fun all the while.

So on that note, off to the hospital for a brief orientation and to drop off the 40lbs of medical supplies that I lugged here. Planning to spend the rest of today getting settled and oriented, swimming, and start in the hospital tomorrow bright and early.

Happy belated Fall Equinox over there-we're marking the Spring Equinox down here :)

Leaving For Malekula

Today Kelly and I leave for Malekula. We have been invited to join Project M.A.R.C. for one week and will be staying on 'The Alvei'. I am excited to see this very remote and traditional island and excited to join this organization even if it is only for a week. Many stories about Malekula and my final two weeks at Vila Central Hospital when I return!

xoxoxCarrie

Each Day I Am Learning...

at Vila Central Hospital. I have, lately, been delivering babies that are very healthy and normal but I am also involved in labors that are very different from what is within my comfort zone as well as my scope of practice in the States. At the end of last week I came into the hospital late in the evening to begin a shift. When I arrived there was only one young girl in early labor. She was 1cm, but was admitted to the hospital at an early stage because of a genetic heart defect. Her heart condition is known as Ventricular Septal Defect (VSD) and there was a concern that, even though this defect had been surgically corrected in 2006 (when she was fifteen years old), she might not be able to tolerate the stress of labor well and her baby may not either due to improper functioning of the maternal heart. The doctors who were monitoring this young girl’s case were worried about strong contractions and their impact upon both mother and baby so we were to give her 5mg of morphine if labor became too intense for her. Certainly labor is intense for any woman, but there are always women who seem to have a more difficult labor than others. This was one of those women. This poor thing, from 3cm onward, was wracked by the most intense contractions that, at most, gave her one minute of relaxation and peace in between. Ni-Vanuatu women are some of the strongest women I have ever met, this girl being no exception, but she was in such extreme pain, her cervix dilating so quickly, that she was just falling to pieces. I did something that is very rare in this hospital and I sat and held her hand for the duration of her labor. Usually the mothers are not particulary interested in being coddled, but this was a very different and intense case. The mother dilated from three to ten centimeters in a very short amount of time, under two hours, and her baby was delivered very quickly. The baby made no respiratory effort initially, though the heart rate was very good, and in just a couple minutes and with a little bit of oxygen, this baby boy to begin breathing on his own. He has remained quite stable and happy and although there was concern that he may also have some sort of genetic heart defect, this has been ruled out. He will need to have surgery at some point for bilateral syndactyly of his hands (both his second and third and his fourth and fifth digits are fused together, giving him a type of claw hand) and of one of his feet, but he is otherwise quite healthy and normal.

The next labor of the evening was fairly straightforward, although the mother ended up tearing rather significantly with the baby’s passage through the birth canal. I have learned to suture through my education quite a bit, but what I have not been able to always reinforce through practice in the States, I am reinforcing here since the Sister’s will watch over my shoulder and give me advice on my suturing. I have begun suturing quite regularly here and have even gone to sleep dreaming of various tears and how to fix them...great for learning but not the best for sleeping:) 

Catching Up...

Though Vanuatu’s weather is mild all year round, technically it is winter here and a busy season in terms of tourists coming from Australia and New Zealand to escape the cold. As is typical in winter, there are many little viruses going around and I came down with a pretty mean virus that had me in and out of bed for a week. It started with a sore throat and progressed to a fever and body aches that waxed and waned and left me felling fairly miserable for the last week and a half or so. It seemed that as soon as I thought I was well again, I’d work a hospital night shift (where two of the midwives were also sick, one of them so sick that I’m not even sure how she dragged herself in, and I know for a fact that she could barely drag herself home). The hospital, thankfully in a way, was not as busy as it can sometimes be, which gave us a bit of a reprieve.

Two Mondays ago, Kelly and I went in for a day shift and actually had no deliveries, although we did admit several women who were in early labor. We left that day feeling a little gypped, although I thought it was likely for the best since I was feeling pretty lethargic. Tuesday was a bit better in terms of how I was feeling, but Kelly and I have decided to take one day during the week where we go and do something fun on the island in order to break up our hospital time. We had decided to go to Hideaway Island, which is a popular resort area here with, what we had been told was incredible snorkeling. We invited a couple other ‘Baby Docs’ as well as some crewmembers from ‘The Alvei’ and had a wonderful time. There was minimal sand on the beach, just broken up coral, and the water was beautiful and warm with plenty of fish to see. We later had dinner on ‘The Alvei’, which was so much fun as I love being on that incredibly beautiful tall ship and the company is always great.

On that Wednesday Kelly and I worked the night shift and immediately upon arrival each of us delivered a baby. Both births were very uncomplicated, both sets of babies and mamas completely healthy, which is always lovely to see. Unfortunately the night was not all good, and if anyone reading this blog is sensitive to the details of death as it relates to birth, I recommend that you skip this section of my writing; I don’t know any other way to tell this story other than exactly the way it happened.

When I came in that night I saw that we had admitted a woman whose baby was determined to be dead when she arrived. This mother came into the hospital in labor and it was estimated that she was, at most, seven months along. Since she had no prenatal care, this was a rough estimate and this was to be her fourth child, but she had never felt the baby move in utero. This would be uncommon if she was actually seven months along, so either her dates were very incorrect or the baby had been dead for several weeks; either of these scenarios were likely. After I had finished delivering my first baby of the evening, the midwives asked me to deliver this woman’s child in the admitting ward. Although I felt nervous about this, never having delivered a stillborn, I said that I would. I went to rouse the woman from her bed just as she was complaining that her labor had changed from upper abdominal to lower abdominal cramping. I brought her into the admitting room and closed the curtains so that she could have some privacy between her and the rest of the hospital. She brought a woman with her (who I originally believed to be her sister but who I later found out was a friend, employing this woman as her housecleaner). The woman who was with the mama spoke English well, so she did some of the translating, which turned out to be extremely helpful. When I examined the mother vaginally I found that she had what we call “bulging membranes”, i.e., the amniotic sac that surrounds the baby in utero was still in tact and was bulging beyond the cervix. It was difficult for me to determine this mother’s dilation because the membranes themselves we bulging as far as 2cm into the vaginal introitus. In a mother who is full-term, the baby is too large to go that far until the mother’s cervix is completely open, however, in this situation, with a small baby who has been dead for potentially a while, the cervix would not have needed to be completely open.  I decided to rupture her membranes to help her labor progress so that she could have her baby more quickly. I have done this many times in healthy pregnancies and the fluid is usually clear. At most, I have seen meconium, which in the States can sometimes cause a mother to be transferred to the hospital but here in Vanuatu (since I am in a hospital) we just deliver the baby regardless of the amount of meconium. When I ruptured this mother, the fluid was completely bloody. I have never seen anything like it and it was an effort to keep my face straight and to not display any sign of panic. I felt that I displayed every sense of calm until the mother and her friend asked: “So the baby will be okay?” WHAT?!  I said to the mother, to her friend, “Did the midwives talk to you when you were first admitted?” The friend looked at me, said “No, not really. Is the baby okay?” The mother looked at me expectantly. Oh my God Oh my God Oh my God. “I’m so sorry. No. Your baby has died. I’m so very sorry.” It took every part of me to hold it together. I was angry. I was sad. I was afraid. This mother started to cry and her friend started to cry and I thought: WHY didn’t they tell her?!?! They told me she knew?!?! I excused myself from the room and said that I would be back in just a minute. I went to the front desk where the midwives were charting. I asked them if they had told the mother that her baby was dead upon admittance. The looked at me, confused. “Yes. Of course we did.” “She didn’t know! She had no idea!” “It’s okay,” they said, “Now you’ve told her. Just deliver her baby. Was her amniotic fluid bloody?” “Yes,” I said. “Okay, that’s normal for a baby that has died. Let us know if you need help.” I gathered myself, went back in, and the mother said she wanted to push. “Okay, you can go ahead and push.” I knew that she was not fully dilated, 8cm at best, but this baby was also not full-term so she really didn’t need to be 10cm (fully dilated). In one push she had delivered her baby…to the neck. Oh my God. When I had done her vaginal exam I had assumed that the presenting part, the part closest to my fingers, was a head. I knew that it had not felt the way that it should, far too soft, but I thought that this was due to the baby already being macerated or that the child was physically deformed, which had caused the death in the first place. It had not occurred to me that the baby was breech (bottom down rather than head). But yes, this was a frank breech where the baby’s bottom was delivered first and the feet were up near the ears. The cord was wrapped around the neck, which I easily pulled down over the baby’s body, but the problem that occurred was one that is very common with breech deliveries: she could not deliver the head. Whenever a baby is breech, the utmost care is used because of this potential problem. When a full-term breech is delivered  (which I have not had experience with since it is not within my scope as a midwife in the States), the woman must be, without a doubt, completely dilated. The head is the largest part of a baby, and if it is not the first part to got through the birth canal there is a risk of the baby having oxygen supply cut off because of the head getting caught behind the cervix after the body is already delivered. That is why most breech babies are delivered via c-section; there is a lot of fear around delivering breeches and not a lot of skill in delivering them left. Since this baby was already dead, there was not the stress of delivering the head in order to prevent death. That being said, this poor mother was stuck with her half-born, stillborn child. She was not dilated enough to deliver the head. I explained this to her friend who then explained it to the mother. “We need to wait,” I said. “You’ll be done soon.” She looked up at the ceiling. Away from me.  At this point there was a midwife in the room. We waited and waited. She pushed occasionally but her contractions were smaller, more spaced out. She wasn’t dilating any further. It had been half an hour that she had delivered only part of her baby, who was tiny and macerated. I asked the midwife if we could please please just give the mother some Syntocin so she could just be done (Syntocin is a drug used to increase contractions and augment labor). It took fifteen minutes for the midwife to decide that, yes, we could give her Synto. Once it was given the baby’s head was pushed out rather quickly. The baby was tiny, only three quarters of a kilogram, with deformed skull bones. I wrapped her tightly in a blanket and gave this little girl to her mother, who cried softly. She asked if it was her fault. “No. Of course not. Sometimes these things just happen.” After the birth I checked the mother’s blood pressure as we routinely do. I pumped the cuff up to 16o and heard nothing through the stethoscope. Hmmmm. Is it broken? I pumped it up again, much higher, apologizing for the tight squeeze on her arm. 240…..over 160. WHAT? No way. I took it again. The same. “Has anyone ever told you that you have high blood pressure?” “Yes,” she nodded. “Are you on any medications for it?” “No.”  This brought about a whole new list of concerns. Is she going to have a stroke right here? A seizure? WHY HASN’T SHE BEEN TREATED???  I checked her chart. No one checked her pressure when she came in so I had nothing to compare it to. I went to the nurse. She called the physician on call. I had checked the mother’s reflexes, looked for indications of clonus, and she didn’t complain of blurry vision or pain under her ribs (all signs of pre-eclampsia/eclampsia). That being said, for mothers with pre-eclampsia, the greatest risk for seizures is within 24 hours of the birth and the blood pressure, alone, without other symptoms of pre-eclampsia was more than enough to be alarmed. The doctor rang back. He prescribed 20 mg of Nifedipene. You have got to be kidding me. We give that to mothers who have blood pressures of 140/90. That won’t make a dent in her pressures. The Nifedipene exerted little to no effect in an hour. The doctor switched to a drug called Hydralizine, which is much stronger. The mother remained in the hospital for three days, being closely monitored before discharge.

I am left wondering things that I wonder often here. Any person looks, when they are distressed, for someone to blame. Blood pressure that high, untreated, can certainly cause a lack of perfusion to the placenta and result in fetal demise. Is it the mother’s fault for never receiving prenatal care? If she had, the elevated pressures would have been caught and treated. Why wasn’t she treated sooner? She said doctors had told her before and that she wasn’t on any medications. Would it have mattered? Maybe she couldn’t have afforded the medications to begin with. There are so many other questions. I ask myself these questions and then I let them go, even as I understand that I will never have answers. If I didn’t let it go, I wouldn’t be able to go back.

 

Lovely Weekend

I have been very fortunate to meet some amazing people while I have been staying in Port Vila. On Friday night Kelly and I were invited (by an American midwife, Olivia, who has visited Vanuatu a few times and worked in the hospital here) to a kava bar called "Felix". Kava is a medicinal herb (an anxiolytic and sedative) that is drunk here recreationally and kava bars are very common. Traditionally only men were allowed in the kava bars, and that is still the case on most of the islands (where a Ni-Vanuatu woman would need to get permission from the village's chief to drink kava) but on Efate it is common for tourists of both sexes to go (and still rather uncommon for Ni-Van women). The kava experience was pretty great, a little gross, and pretty funny since there is a whole ritual around it. You can buy a small or large "shell" of it, and the kava itself has a sort of grey-green dirty dishwater appearance. You are supposed to shoot it, swallow, then spit (which you will want to do since the taste isn't the best). Usually people, it seems, chase it with water or beer. The taste may not be the best, but the effect, I think, is pretty great. Usually your lips and your tongue go a bit numb or get a little tingly and you feel very mellow and relaxed.  I also noticed that when I stood up I had very poor balance as though I had had too much to drink (I swear that I didn't!)

Another great person that Kelly and I have met is named Seamus, and he is part of an organization called Project M.A.R.C. (Medical Aid to Remote Communities). Project M.A.R.C. participates in many medical endeavors throughout Vanuatu and when they do, they commission a ship called 'the Alvei' (a beautiful tall ship that was built in the 1920's, I believe, and then completely gutted and re-done on the 80's) to take them to whatever island they're going to. Next year they are involved in a project on the island of Santo, which deals specifically with training some of the traditional midwives there as well, I believe, in training new midwives. This project, of course, is of particular interest to me as overseas medical work has always appealed to me (and essentially brought me to Vanuatu). 'The Alvei' had recently gotten into port here and Seamus invited many of the 'Baby Docs' as well as local volunteers (Peace Corp and AusAid) to a bbq on Saturday so that we could meet each other, the crew, and learn more about M.A.R.C. It was an incredible amount of fun and Kelly and I have since been invited to join the ship in Malekula (a remote island of Vanuatu) for a week later this month where we would have the opportunity to facilitate a discussion among local women there in regards to sexually transmitted infection prevention, maternal health, the importance of antenatal medical care, and prevention of domestic abuse (to be truthful, I have no idea about how this last topic will go since the rate of domestic abuse is, as I have been told 110% as it happens in every single home). Kelly and I need to make a decision as to whether or not we will be going and meeting the ship in Malekula in the next day or two.

 

Seven Babies!

I went into the hospital at 12am with Kelly (the New Zealand student midwife), hoping to attend the birth of the girl who had taken a long time to dilate from four to five centimeters. I am so fortunate to have met Kelly, not just because she is lovely and fun, but also because it is dangerous for either one of us to go alone to the hospital in the dark. I have heard (though I have trouble believing) that Vanuatu has the highest rate of assault on aid/volunteer workers than anywhere in the world. Granted, I am on only one island out of almost eighty that make up Vanuatu, and it is a very touristy island, but it is always better to be more rather than less cautious.  So Kelly and I walked the two minute walk hospital in the blackest pitch of night (I’m not even kidding…you cannot see people until they are one inch from your face), and arrived to see that the girl we were waiting on had only had her baby half an hour before we arrived (damn it!) and they had cut an episiotomy (DAMN IT!) because she had had a “long” second (pushing) stage. That being said, she was very happy and lying peacefully with her new baby boy.

 Although Kelly and I were disappointed to have missed that birth, we could not be too upset since we actually ended up being involved in seven births over our nine hours at the hospital! Kelly delivered the first baby of the evening while I assisted (albeit not for very long because I was called to deliver another baby). This woman was desperately wanting to push but we had to stop her because she was not fully dilated (although close at 8cm). The birth, itself, was a little concerning also because there was thick meconium in the amniotic fluid (babies with meconium in the fluid are usually under some stress in utero or post-dates and it can often lead to respiratory distress if the meconium is aspirated during delivery). Fortunately this baby was born and suctioned right away and had no respiratory problems whatsoever.

 The next birth that I was called into was the labor of a thirty-nine year old woman who had undergone no prenatal care for this, her fifth child. With that being the case, I had no idea what to expect (you expect that the baby will be completely fine, but there is no confirmation of this and so I needed to expect the unexpected). I performed the vaginal exam on her, assessing that the baby was, in fact, head down and that the mother was fully dilated. She began to push. And push. And push. She pushed much longer than most moms who are having their fifth baby should have to do! As I was waiting for the head to descend to the perineum, I noticed (oh, crap!) that the baby’s umbilical cord was pinned between the baby’s head and the mother’s pubic bone. This is a very dangerous situation in that the baby’s oxygen supply, until it is born, is through the umbilical cord. Because there is no continuous monitoring of fetal heart rate done here, it is difficult to say how long the cord had been pinned and if the baby was okay; the cord was not pulsing, which is not a good sign in terms of blood moving through it. One of the midwives, Sister Lydia (who is initially gruff and them so incredibly lovable!) was standing elsewhere in the labor ward and I told her the situation and asked her what I should do about this cord situation. She said, “Push it back!” (“Right,” I thought. “Duh. Push it back!”) So I did. And the mama had her baby a minute or two later. And that crazy little baby came out direct occiput posterior (with the face pointed up, or as I like to say “sunny side up”), which is not the ideal way for a baby to come out! This, combined with the umbilical cord situation, was why the pushing stage took so long. Much to my relief, the new baby boy vigorously cried right away. He was just fine. This reaffirmed to me what one of my favorite midwives back in the States always says: “Babies come out.” They do…and most of the time they are just fine.

 Baby number three of the evening was a baby that neither Kelly nor myself delivered. After our first two births of the evening, the maternity ward received a phone call. “Can you please come outside?” the caller said, “There’s a baby on the bus.” WHAT?! Kelly, myself, and Sister Lydia all went to the door to find a mother, who had just had her baby a short time ago, with some members of her family. We quickly ushered the mother into the labor ward and Kelly managed the mother and I managed the baby. The mother had not yet delivered her placenta, although she said she had given birth to the baby at least an hour ago, but she was luckily not bleeding and birthed the placenta quite easily and quickly. The baby, who I think must have been delivered outside on the ground (she had dirt and twigs on her), was wrapped in very wet and light sheets. When I unwrapped her under the warmer, her umbilical cord had been cut but not clamped. This is not a good situation since babies don’t have a significant blood volume and can bleed out through their cords if they are not clamped. Luckily this baby had bled only a little and seemed quite alert. She was actually one of the most beautiful babies I have ever seen with the plumpest little lips and the most exquisitely long lashes; she did not make a sound, just watching me as I inspected her from head to toe. I actually would have preferred her to be crying. Neither she nor her mother made much noise; I think that they were both in shock. This was confirmed when the temperature of the baby was taken and confirmed to be approximately 94 degrees F. No way. Since I was called to deliver another baby, Kelly kept taking this baby’s temperature and in the next few hours it only got as high as 96.7 or so; this was with skin to skin contact and being under a warmer. When Kelly and I left the next morning this baby was still under the warmer and her temperature and other vitals were being monitored every hour. When I go back to the hospital on Monday I hope to see that she and her mama are just fine.

 Baby number four came to a nineteen year old primip (a mother who was having her first child).  She was fully dilated and ready to push, so I gowned up and got ready. Although she was ready to push, this young girl really didn’t want to. I was telling her (and Sister Olina was REALLY telling her) that she needed to push only with contractions and when she did, they needed to be long and strong pushes. Here, it seems that most mothers just push their babies out, whether or nor they have pushed out a baby before. Because of this, I believe, the midwives here are not as patient as midwives are in some other places. It is not unheard of, and I have seen more than once, that mothers in the States can spend greater than two hours pushing when they are having their first child. Two hours for one’s first child is, in fact, average. I am saying this because this young mother was pushing (though pretty lightly and ineffectively) for about half an hour when Sister Olina, who was watching me over my shoulder, began asking me if I wanted to cut an episiotomy. Please understand that I respect and admire the midwives here as well as their expertise so very much. I am learning here so quickly that it cannot even be put in to words. That being said, was I going to cut into this nineteen-year old girl and this nineteen-year old perineum after half an hour of pushing? HELL NO! Of course, I didn’t say this. Instead I said something like, “Weeeeell…let’s just give it a little more time.” Sister Olina shrugged as though to say, “Okay, have it your way” and since the baby wasn’t in any distress (we checked on the CTG machine), we let the mama keep pushing. And pushing. And the mama was ignoring my coaching and rolling her eyes (maybe at my crappy Bislama, which IS getting better everyday. It really is!) So Sister Olina asked me, every five minutes or so, if I was ready to cut an episiotomy yet. No! I wasn’t! It hadn’t even been an hour of pushing yet! Finally, I looked at this mother and started getting angry. Not at her, but at the fact that I was trying to help her and she was only giving me these itty bitty pushes. So I started getting louder and more forceful and in ten more minutes she had her little baby girl. So she had her beautiful baby, which she had worked so hard for, and I had my small victory: that she did not tear. Not one little bit. Later I came in to check on how breastfeeding was going and the new mama’s mother handed me her new granddaughter. I cooed over her for a couple of minutes and went to hand her back when the grandmother asked my name. When I told her she said, pointing to the new baby, “This is Carrie, too.” The new mother nodded in agreement. They decided to name this new baby after me and I am beyond honored.

 Babies five and six came almost at the same time and so Kelly delivered one and I delivered one. Kelly attended a beautiful birth and luckily she was done attending to that mother and came into the other labor at the tail end. I say this because this baby had a shoulder dystocia (which occurs when the baby’s shoulders become stuck behind the mother’s pubic bone. This is very serious and though there are handful of maneuvers to try and remedy the situation, the clock is ticking so that the baby doesn’t run out of oxygen). Luckily the dystocia was fairly minor and as Kelly tried to shove the scapula of the anterior shoulder externally on the mother’s belly, I kept sweeping for it internally. Finally I was able the grasp the baby’s anterior shoulder and pull him out. There was only about two minute’s worth of sweat pooled on my back, which is not to bad for a dystocia!

 Baby number seven, though happening at the hospital that evening, was actually an event that happened at home that morning. A seventeen-year old mother who had undergone no prenatal care (I’m not sure that she knew she was pregnant) woke up and told her mother that she was feeling very ill. She said that she had cramping and generalized stomach pains. She asked her mother to take her to the hospital. Her mother, evidently, said that she did not like going to the hospital and decided instead to go to work. Shortly after the mother went to work, the daughter felt the urge to use the toilet and before being able to sit down on it, squatted and delivered a rather small baby. From what I gather, the placenta was born almost at the same time. This baby, only 1.2kg, cried for a little while (though I’m not sure for how long). She was never detached from the placenta and she died later on in the day. When the mother got home from work, they all came to the hospital. 

Life is different here and I’m not in a position to judge the people around me or comment upon the decisions that are being made. I have been fortunate to have this experience at the hospital, to be provided with a glimpse into a culture that is not my own, but I am not part of this culture and never will be. Over time I will understand it better but I will never really be a part of it. That being said, I am also not quite a tourist. Though I am fortunate to enjoy fun things and the beautiful weather while on this island, I cannot pretend that I only see the ease in living here.