The babies keep coming...

Hiya,
again I must say Vanuatu is GREAT! I love it here. Not only am I getting a super tan (yes!), the island life is awesome and the birthing experience is great. I worked the night shift Thursday night/Friday morning from 11pm-7am. I caught 3 babies and had some crazy experiences. The first baby came out fine, no issues whatsoever, no tears.

The second baby had some meconium staining in the water, and a tight nuchal cord. I didn't want to cut the cord on the perineum knowing it may already have a hard time breathing. The head came out, and no tear. THen I went to summersault the body out to keep the cord intact. I was supporting the perineum also, but somehow she ended up with a 3rd degree tear. I could see the shiny white rectal capsule and did not feel comfortable suturing that myself. I asked the midwife to help, and she had never seen that before either. She ended up suturing it, but I feel if I had to I would have done it the same way. The woman was so calm and patient and did not bleed much.

The third baby came out fine, no tears. The umbilical cord was super thin and weak. After I saw a little separation bleeding (meaning the placenta is ready to come out), I was tractioning the cord (not even very hard, I have done it way harder on other women before with no issue). All the sudden, the cord broke off, there was not ever a snapping feeling. It broke off right at the base of the placenta. I was like "Shit!" but didn't say it outloud. Some of the amniotic membranes were dangling out, so they were able to be grabbed gently with forceps and the placenta gently worked out. It was scary for a few minutes there though. After that, all was well.

Yesterday I did a half day horseback ride. It was the best ever! I went with a woman from my resort, and we rode in the jungle, over some plantation areas and in the ocean. We took the saddles off the horses and just wore our bikinis and literally rode in the ocean. Not just the horses feet, they were practically swimming. The water was over the horses back, so I had to hold onto the mane to stay on. It was the best ever, and the horses didn't seem to mind at all! Today my adductors are a bit sore, but well worth it! And the horses don't know how to nicely canter, they full out gallop. I haven't run that fast on a horse since I was 15. Awesome.

Today Susanne and I are working at the hospital from 3pm-11pm. This is our first afternoon shift. Hopefully there will be some action. Hope all is well out there.
Peace and love,
Samantha*

more babies...

Hiya,
so Susanne and I "worked" the night shift last night from 11pm-7am. We got there at 11pm and there were two first time mommas who were in early labor. We made about a million cotton balls (all the cotton balls and gauze are hand made here) and then the midwife in charge told us to go home and sleep and she would call our mobile if the mommas were ready to push.

At 3:30am we got a call and ran over to the hospital (a 4 minute walk from our hotel). As soon as we walked into the labor ward a baby was crowning. This was the first baby I have seen born in the cul (the membrane sack has not broken and is covering the face and head). It took a moment with an amniohook to get it off the little baby's face, but he came out happy and no tears.

Moments later another momma (a new one who came into the hospital ready to push) was on the bed and pushing. She came out occiput transverse, but fit just fine. There was a minor perineal tear which I sutured. Yay. Then we got to leave the hospital again (1.5 hours later) and go back to sleep. I felt like a surgeon being called in to do a procedure and then leaving.

Our buggy ride on the island was wicked fun! It was a total mud mess and it rained the whole time, but it was so fun. I drove most of the way, through jungle and on a black sand beach.

Today Susanne and I did our first scuba dives. We did a practice dive in a pool to learn the tricks, then a reef dive. Amazing!! We saw all sorts of lovely coral and millions of fish. We have two more dives lined up for next week. Tonight we will work the late night shift again, so hopefully there will be more babies.

All is well here. Lots of fun stuff coming up, but will post more about that later.
Peace and Love,
Samantha*

7 babies and counting...

Hello! While this is a slow time at the hospital, we still have been catching babies. I have helped 7 come into the world, all without any real difficulties. It is amazing how quickly women labor and push here. I have only sutured once so far, which was good practice, but I have been supervising some nursing students in training as they suture. So I help them decide where to place the needle, what needs to be reconnected to what, ect. They don't really learn the subcuticular stitch, so any tear of the perineum gets a continuous stitch with a big knot. It doesn't look the best, and it is probably uncomfortable as hell, but it gets the job done. They pretty much suture all tears (even small first degrees) as the risk of infection here is high.

I have been helping do a lot of newborn exams (which ONLY includes head and chest circumference, length and weight). Also, all babies at birth get a vitamin K shot, hepatitis B vaccination and BCG subdermal (for TB). I feel bad poking the little cuties so much. I have seen a couple infected cord bases, which smell terrible and the babies are put on antibiotics.

Oh holy goddess, yesterday a woman in labor vomitted up a 6 inch long round worm! It was so gross. Of course I got a picture of me holding it (with gloves)! It was still alive and squirming around. The midwife in charge said that is not too common, and she has only ever seen one other worm (a tapeworm which was pooped out).

We were supposed to do our first scuba dive today, but it has been monsoon raining and we decided to postpone. Tonight we will go to a Kava bar with some ex-pats and then have a BBQ at the resort we are staying at. Sounds good to me. Hope all is well with everyone who reads this, if anyone does :)
Peace and love,
Samantha*

I love Vanuatu!

Hello! Wow, this is my first blog ever. Kind of exciting. Susanne and I made it safely to Port Vila, Vanuatu on the 6th of October. We had a night layover in Auckland, with a free hostel booking. We walked all over Auckland and had a good time.

Vanuatu is amazing. The people are SO friendly, everyone says hello and waves at us. There are more white people here than I expected, a lot of ex pats and tourists.

Our first night here we went out to an outdoor bar with a kiwi guy we met on the plane. We tasted the only local beer, Tusker, a lager. Not to be confused with Tusker from Kenya. After a few beers we were all feeling great and decided to go to a nightclub, haha. It was kind of ridiculous. They played music like U2 and John Mayer, who are good, but kind of hard to dance to and definitely not nightclub music.

We have been going to the local farmers market, which is open 24 hours. There are so many beautiful fruits/veg/eggs/chickens there. We have tried several new and interesting vegetables that I have never seen before. Yum.

We have worked the past 3 days at Vila Central Hospital in the maternity ward. All of the sisters (midwives), nurses and staff are so nice. It has been pretty slow in terms of births, and I have only helped 3 babies come into the world so far. I did get some suturing practice, which was great. The women here are naturals at birthing. Their labors are short, and their 2nd stage (pushing) is super short. They make very little noise and pretty much only give birth on their backs.

The first baby I helped with was OP (occiput posterior) so it came out face up. Babies don't fit as well through the pelvis this way, so the mama had a lot of back pain. They call this presentation FTP (face to pubes) here, which is cute.

I am learning the local language, Bislama. It is a lot like English, and pretty easy to understand. My favorite little saying: pullem good wind (take deep breaths), sit sit (literally shit shit, which is synonymous with pushing).

Ok I could go on forever, but this is long enough for tonight. Now I am going to enjoy my dinner of lentils and sauteed vegetables. Yum.

Peace and love,

Samantha*

My First Week in Port Vila

Sorry for the delay in updates. I’m enjoying the amazing hospitality so much here in Vanuatu that I haven’t had a chance to get online. Volunteering at the hospital here has been an incredible experience and I am learning new things every day. I thought I would give everyone a highlight of my most memorable experiences over my first week. I've also included a few photos. The first is a picture of Hideaway Island from the ferry. The second is me at Mele Cascades. To the left is a picture of the labor room here at the hospital.

The first that comes to mind is a really sweet twenty-year-old primip (first time mom) that labored for a little over seventeen hours before she was fully dilated. Back in the US we wouldn’t think much of this, but here it isn’t common for it to take that long. Due to the amount of time it was taking her to dilate, she was put on syntocin to augment labor. She had the classic back labor throughout indicating a baby that was occiput posterior. By vaginal exam it was also clear by palpating the baby’s fontanelles that we had a malpositioned baby. Throughout her labor she would ask me “how much longer?” and I kept answering by shrugging my shoulders and saying “if only I had all of the answers.” For a first time mom who was going through agonizing back labor on a syntocin drip without any pain relief, she was an amazing trooper. I was in awe of her determination. When it came time for me to go home for the day and she was at 8 centimeters, I decided I would wait to leave until she delivered. Four hours later she was “fully” and ready to push. While I was managing her labor, another mother who was in preterm labor at 32 weeks was delivering on the other side of the labor room. The doctor on call had been paged to her delivery so once she and her baby were stabilized she came over to see if she could help my mother. My momma had been pushing a little over one hour and had made progress, but it was decided that assisting her with vacuum extraction was indicated. This is the first time I had seen a vacuum extraction so was excited to gain the experience. Before the vacuum was used the baby was at 0 station and with only two pushes the baby was delivered. We had been using intermittent monitoring of the baby throughout labor with no indication of distress and were surprised with thick meconium on delivery. Smol baby girl “Allison” required deep suction and a few minutes of resuscitation before fully coming into her body. This became the first little baby named after me and I feel deeply honored. Allison’s mom was truly incredible in her strength and determination. Afterwards she thanked me for believing in her and apologized for complaining too much and I told her that she should be very proud of herself and that I felt she didn’t complain much at all. She looked at me and said “really?” It is hard for me to express my amazement and sorrow at how much pain these women endure and are expected to not show it.

During my first week at the maternity ward I assisted thirteen women in welcoming their little ones into the world. For many of these births I was accompanied by nursing students here in Vanuatu. Many will graduate as RNs in a few months and will then return to their respective Islands here in Vanuatu. As a part of their training, they are to perform twenty deliveries. Due to the shortage of medical personnel here in Vanuatu RNs perform many of the same functions as doctors and midwives in their local villages. During my stay here I have been given the honor and responsibility to help train these students in the art of normal delivery. They are incredibly excited to learn and are catching on quickly. It has also been a great opportunity for me as well, because as they say you only truly know it yourself when you can teach it to others. I have made it my mission to reduce the number of umbilical cords that are cut on the perineum to reduce the number of resuscitations required. So far I have somersaulted four babies out with nuchal cords that were too tight to reduce. I’ve worked hard to explain the process to the nursing students and they are very appreciative indicating that they have seen the difference and lack of need of resuscitation that is common with cutting the umbilical cord on the perineum. I’m hoping that they will be able to practice the skill while I am here so that they feel comfortable somersaulting a baby out with a nuchal cord. Many will be in very remote areas with very little medical equipment or assistance in the event a baby is experiencing respiratory distress during transition.

After my first six days at the hospital I decided to take two days off and explore Vanuatu. Due to the resort being full with a wedding party, I was given the opportunity to spend a week at the house of the resort owners out on Mele Beach. Their house is really close to Mele Cascades and Hideaway Island, two very popular tourist destinations. I took my first day to explore both and really enjoyed the beauty of Mele Cascades’ waterfalls and cascading pools and the colorful fish all along the coral reefs off of the shore at Hideaway Island. I wish I had a waterproof camera to share the beautiful sea life with all of you. My second day off was spent preparing for my second week by going grocery shopping and relaxing on the porch out and walking along the beach at Mele Beach. While I was at the open air market in downtown Vanuatu, I was stopped by one of the family members of a momma I assisted and presented with a papaya as a thank you. My heart was filled with such love and warmth. The NiVanuatu (native people of Vanuatu) are an incredibly giving people.

Greetings from Vanuatu

To my family and friends, I have arrived safely in Vanuatu after a little over thirty hours of travel and have spent two wonderful days in the Maternity Ward here. The people of Vanuatu are incredibly welcoming and have made me feel at home from the start. I plan to take some photos soon and post them to let you witness the beauty of Vanuatu -- both the people with their warm smiles and the lush vegetation and spectacular views. Here is a brief summary of my first day:

Day 1: Wednesday, Sept. 15th 2010

I arrived a few minutes before 7 for the morning rounds. This is the time when the charge nurse gives her report from overnight to the new nurse coming on duty. I learned that they had quite the busy night at seven births and that we currently had five women in labor. It turned out to be quite an exciting first day. A midwife from New Zealand was able to give me a quick tour of the ward and location of supplies. Then we were off... As we were finishing up our tour a mother in active labor presented at the front desk so we began the process of checking her in. I set her up on a twenty minute CTG strip, took her vitals, and checked her cervix. She was a primip (first time mom) and 8 centimeters dilated. Things appeared to be proceeding quickly so we brought her back to the birthing rooms. Within an hour and half she had a small anterior lip, but not quite complete or fully as they like to call it here. The mom desperately wanted to push, but we instructed her to pulum gud wind (take deep breaths) and not sit sit (push) with the next few contractions. She was soon complete and then pushed for a little over 35 minutes which they consider a long time here. Moms here are incredible pushers and generally push for less than 10 minutes. I think the mother expected to not push for so long and kept asking when the baby would come.

As I was managing this momma's delivery, the other three beds in the birthing suite became occupied as three momma's began pushing. I quickly finished up with my momma and went to see if I could be of assistance in the other births. The next baby to be born had a nuchal cord that was not able to be reduced. They aren't familiar with somersaulting the baby out, so instead the nurse clamped and cut the cord on the perineum. This little baby boy then required ten minutes of PPV (positive pressure ventilation) before he took his first breath. I can't help but wonder if he would have had a smoother transition if his cord had remained intact during the delivery. As I was assisting with this delivery, two more babies were received into loving hands.

My final catch of the day occurred right before I was getting ready to go back to the hotel for the day. It was a mom I had been following her progress all day and she was fully and wanem sit sit (wanting to push). She was a first time mom and proceeded to push her baby out in seven minutes with only a minor first degree laceration. Mothers here are amazing to watch. They push very effectively and are quite stoic in the process.

I had a great first day at Port Vila Hospital. I met many lovely midwives, nurses, and nursing students. I also had quite the crash course in getting familiarized with the Maternity Ward -- where supplies are located, proper hospital procedure, and very basic bislama. I look forward to the next few days and becoming more and more acquainted. Stay tuned for more updates on my experiences here.

Thanks for reading,

Allison

Special Thank You To Jim Key and Tim Dempsey from Orion Medical Supply

The Thursday before I left on my trip to Vanuatu I received a wonderful donation from Orion Medical Supply for the Maternity Ward at Port Vila Hospital. Jim Key, who is an incredible guy and very supportive of local Seattle midwives, was able to put together a sizable donation of chux pads, sterile and nonsterile gloves, sterile lubrication, and hand sanitizer. Having spent two days at the hospital I can tell you that these supplies are in great need and extremely appreciated. I can't thank Jim Key enough for all of his help. Special thank you as well to his Manager, Tim Dempsey, for his assistance in the donation. If you practice in the medical field in the Pacific Northwest, Orion Medical Supply is a great company with which to do business.