Monday, March 30, 2009

I feel as though I should apologize or something, after my last post. Upon reading it in the light of day it made me wince a bit. I meant not disrespect re. what midwives do, and I think what I wrote could come across as ungrateful for midwifery care, or worse.


Today I gave a little butt-bath, as I call it, to a newborn girl whose mother was just pleased as punch to have had her. I was grateful that this baby didn't seem to mind her little bath, which is routine here and since she was covered from waist to toe in newborn baby poop, it was not something I could skip today. She just sat there in my hand, and at one point as she was kind of slumped over my right forearm as I tried in vain to wipe the thick, white, waterproof vernix off her back, I realized she was contentedly sucking on my arm (this despite the fact that she had just spent the last 45 minutes sucking on her mother).

I got her dressed up and returned her to her momma, and helped her get settled on breast number 2 for some more.

Then I thanked the midwives here, got some hugs, got some high-fives, promised to write and send pictures (specifically, of Louisa's baby, due in May...), and took my leave.

I wonder if I will ever be back.

Sunday, March 29, 2009

Approaching the End

This may have been my final day at the hospital. It’s also my Magdalen’s 6th birthday this weekend (today, here, tomorrow in the US). A woman at the hospital lost her daughter today. I had been in a labor with N all day. In labor ward 1, M, a 20-something year old having her first baby, was exhausted and struggling to give birth. She was fully dilated at 10:30 in the morning, but was not really pushing for quite a while. She clearly wasn’t having a strong urge to push. Her contractions were sometimes more spaced out than perhaps ideal. When she did push, it was for short stints. She kept telling us how tired she was. We did what we could to help her: position changes, calm and soothing words, not-so-calm and soothing words, we held her legs, arms, body; we were on the bed/table, on the floor, fashioned a birth stool, let her rest a bit, finally got an IV going, thinking it may give her some energy. For the first bit there was at least one other MW in there with us. Eventually they gave up and left us to it, but eventually the OB on call showed up. Then the real nightmare began. Long story short, this OB attempted a vacuum extraction even though the baby was still very high. In order to get the vacuum on, she cut a huge lateral (yes, those of you who know what this means, it was a lateral, not a mediolateral) episiotomy. Not surprisingly, the vacuum didn’t work. Then she asked for forceps and I tried hard not to throw up with extreme fear that she was committing huge injury to this baby’s head. N and I went in to the C/S that eventually occurred, because we just had to see this baby and see what sort of shape he was in. Amazingly, luckily, this baby was so high up and his head had molded (shaped) so extensively and there was so much caput (swelling) that the forceps seem not to have injured the baby’s face. He breathed and seemed relatively OK. N may have written more details on her blog. I am just too tired to write more at the moment.

Through this all, another birthing woman was brought into the other labor room. I heard her being more vocal than most women here while she pushed, and then there was quiet but by then I was back in the thick of things with M. I eventually went over to see the baby in the other room when I noticed the MW was repairing a tear the woman sustained, and lifted the baby blanket and said “oh, one smol beautiful baby.” The MW looked at me and said, without her typical detachment in these situations, “a fresh stillborn.” Her words cut through the air and reached my brain just as I came to that realization myself. A beautiful baby girl, gone. A terrible oversight was made, and she was gone. The MW came over and uncovered the baby for us to look her over head to toe while she told me, her voice stern and angry, that nothing had been done with the results of the non-reassuring heart tones that were documented in the middle of the night when this woman came in. The MW said the doc on call should have been called immediately. Instead, it appears nothing was done until re-checking the baby’s heart tones four hours later. And then the baby was gone, yet even then they did not tell the woman, they just sent her to ultrasound where she was simply told the baby was gone. Who knows if this loss could have been prevented.

That was pretty much it for me today. All I could do at that point was stand in the instrument scrub area and let some tears fall. I would not, could not, give in to the grief. I think because I could feel it was more than just this little girl... It was the little girl I caught two weeks ago and couldn’t even write about, the baby from the other day, the twins, and really, it was just everything. It was getting harassed by some drunks on the way to the hospital today as I walked alone, in the middle of the morning, by some guys who are the community-sanctioned “head of the family,” controllers of the women…the men whose permission, indeed, whose signatures would be sought before their mates would be granted a tubal ligation so they don’t have to keep bearing children. It was all that, and more, and I had no desire to fall apart at the hospital today.

I’m sure this all comes across with much more melodrama than I intend. Really, I get that this is life. I don’t regret coming here, and I knew what I was getting into before I made this trip. Tomorrow I will go in to the hospital again. I have paperwork to be signed then, and I may or may not “do a shift.” On Tuesday I start my journey home. A flight to Fiji, three + hours to while away there, then on to Los Angeles and finally home from there. There was nothing terribly admirable about my coming here, nothing amazing. As one of my instructors once put it, a monkey can catch a baby (yes, oh illustriously trained obstetricians out there, it’s true and you know it). It’s just life for people here and I have been but a very small cog in it for a few weeks.

Saturday, March 28, 2009

Mistaken Identity

The other day I went in to the hospital a bit before N. There were three women in active labor (not that the casual observer would know it), each of them 6cm along (a bit over half-way to being ready to push out a baby, but those last cm's are faster to go than the first few). When N came in, she took one in to the labor ward. N writes about this in her blog too. This was to be the woman's second baby, the first having been born 9 years ago. Well...things went sloooowly. In the meantime, the other labor ward had two women come in at the same time - there are the two beds, separated by a curtain. I let the midwives on call take care of those, for the most part. I peaked in on occasion. One of the women in there was the one with whose baby was found to have died. I had hoped she'd deliver overnight but she had not.

I hung about with N and her woman, spelling N now and again, until I got called to take in a lady who was ready to deliver. She came in to the bed next to N's person and after I fussed about getting supplies over there and finding a place to put them, she pushed her wee baby out and that was that. Fortunately there was no tear to repair, because not very long after, another woman came in.

This time I didn't have a chart, so I asked for it. One of the nursing assistants, D, handed it to me. I went on my merry way to deliver a 4th baby to this 40-year old woman. Hmm, I thought, as she pushed. She sure looks young for 40 years old. Oh well, I thought. I checked her and found her to be completely dilated, but something felt...funky. Well, we'll see what's what when she pushes. It was definitely a head that I felt, so I wasn't overly concerned.

And so she pushed. And I could see a bit of head. And minutes ticked by and I am still seeing about the same amount of head. By now I am wondering if I am going to have a shoulder dystocia on my hands, or what. That's when the baby's shoulders get impacted and you have to go through a series of maneuvers to get that baby out. It's not a good scenario, but I went through the maneuvers in my head and was as ready as I could be. When baby is very slow to come out, it could be a sign that there is going to be an issue. Since this was this woman's fourth baby, I would have expected a faster delivery.

And so she pushed. On her side, on her back, not very happily. I decide to apply my hands to the task and find that everything is very...tight. OK, this is a bit odd. But really there's nothing to be done at this point. There's no fetal monitor on her so I have no idea how baby is tolerating this, and I have no assistant to get the monitor on her. I can't stop attending to what I am doing because I am still half expecting this baby to blast out. I glance at my bundle of equipment and see that everything is there.

Finally, slowly, the head makes more progress. By now I notice that N has her woman on the floor…um…interesting. Not something you see everyday here at Vila Central. I ask my woman to slow her pushes down a bit and into my hands crowns a …..small head. And I mean small. There is a tight nuchal cord (umbilical cord around the baby’s neck) and I am thankful there’s no attending midwives there to cut it. Before the next contraction the baby somersaults his way out and immediately lets out a strong wail and has his eyes wide open. Hello, little man! I say. “You have em one smol boy!” Uh, very small. His nose is extremely squished…I try to fluff it up a bit. His ears are practically one with his head. I glance at the soles of his feet, and they look pretty darn smooth. I raise my voice a bit and inform N and I am going to need the warmer for this one. I just thought, you know, I’d really like to get this baby under that heat lamp. I am not sure why.

Just as I say that a MW comes bustling in – “oh yes, he go to warmer! And takes the baby, who is now sort of wrapped up. I say, oh, sure you can go weigh him and please bring him back. The MW looks at me kind of funny and says “emi go to warmer” and whisks him away.

I now ask this woman who has just given birth how to pronounce her name so I can go into the hallway and find her people and get her bag of things from them. My chart says “Iren” and I don’t know if that is Irene or Irehn or what. She says “Delma.” Huh? “What?”, I say. “Delma.” I go out, and look at the admissions board. Sure enough, there is a Delma on the board. I find the chart that has that name on it. Delma is 20-something yrs old. This is her first baby. And she is due in about 7 weeks. EEEK! Wrong chart! I was given the wrong chart, and I had just delivered a 33 week premie. Jeezus H. Here he is:

I have posted an album of photos of the hospital maternity ward on

Thursday, March 26, 2009

Picture added

I added photos of J on the Monday 23 March post.

Tuesday, March 24, 2009

What We Take For Granted

Today sucked.
I woke up feeling ill and just got sicker as the day wore on.
I took myself in to the hospital well after the shift started. N had stayed for the "evening" shift which goes till midnight yesterday. I had gone to bed early and slept fitfully, drifting in and out of dreams of a birth that I thought might be happening. Early yesterday an induction was begun..
Unpleasant story alert. If you are pregnant and squeamish, or just squeamish, or just would rather not be exposed to tales of some of life's really shitty moments, leave this post now.

Last week it was discovered that a 17-year old, about 20 or 21 weeks pregnant, was carrying conjoined twins. They shared a heart and where connected at the chest/belly (thoraco-omphalo conjoined). The doctor discussed terminating the pregnancy with the family, which agreed. I thought I'd surely happen to miss this birth. But when we went in this morning, she was still there, and she was asleep. Her chart read that she was barely dilated this morning, and had been given morphine. A few hours later, however, her water broke and she was wheeled in to the labor room and was fully dilated. Niki and assumed our positions: far from the bed, with our arms crossed firmly across our chests, and no gloves on.

The birth occurred rapidly and without incident. The plan, such as it was, was to have the babies born and then leave them to expire. They were of course tiny, weighing in at 500 grams (less than a pound) total. They made no breathing effort, but the beating of the heart was visible for quite a while. The young woman made an effort to sit up and peer at the babies but she was urged to lay back down (I am typing “babies” though my head keeps thinking “baby”). In what was the worst taste ever, I thought, the doctor took photos of the babies immediately after birth, right there on the delivery bed. There was no reason that I could fathom why photos had to be done right then and there. The babies were moved over to the side of the room and various people paraded in to see. Not that I felt much better. I was there, for no good reason. I tried to give some comfort to the young woman, while she pushed, but she took no comfort. Nor did she show much outward emotion beyond the challenge of birthing.

After that, the day continued on. A woman came in and we led her to the “Admissions” room where we routinely hook women up to the CTG to get a 20 minute “strip” on the baby, i.e., fetal heart monitor tracing. N checked her first, and she was 2cm dilated. I tried to find baby heart tones, then N tried, then we tried up near the top in case it was breech (we were fairly certain it wasn’t but mistakes happen). Then we got a fetoscope and tried that. We found her pulse, going faster than normal, and confirmed that what we were picking up with the fetoscope was her pulse by feeling her wrist simultaneously. Two more midwives came in and went through our routine, including asking the woman if she’s been feeling baby movements. The woman said she thought she felt some in the morning but isn’t sure since then, as she’s been having contractions that have been occupying her attention. I jostled the baby quite a bit, asked it to wake up, show us where it’s heart was…Finally it was obvious she needed an ultrasound. It was now 12:30…technician was, of course, on lunch. Eventually we made it up there, and fetal death was confirmed. The heart showed no movement. This woman had no discernible reaction.

We all marched slowly back to the maternity ward where she was given a bed, and I wrote it up in her chart. There she would stay, to “await events,” as they put it here. I selfishly hope she delivers before I go back on shift.

I left early, my mounting nausea had worsened. I went back to my room and lay there for the most part, too pukey to do any work (business plan writing assignment) or even read. Hours later I am finally starting to feel better.

I miss home.

Monday, March 23, 2009

Monday 23 March

N had quite a day at the hospital on Sunday night while I was gone, with multiple people apparently in competition to see how many of them could be in the pushing stage of labor simultaneously.

I returned from a disappointing, bone-rattling, exhausting, filthy trip to Tanna this morning. I had gone there on an overnight visit to Mt. Yasur on Tanna Island. If it sounds familiar that's because it was featured on NPRs Geo-quiz just a few weeks ago, wherein they described it as the world’s most accessible volcano. Well, I'll just say that accessible does not mean easy to get to.

I went in to the hospital today despite how tired I was from the trip. I got very little sleep the night before. I was put up in a very picturesque thatch wall and roof dwelling, with a lovely mosquito net over the bed. Everything was damp to the touch due to the humidity. Just as I turned off the light and encountered the darkest dark I've seen in a long time, a roaring thunder and lightning, rain, and wind storm moved in and stayed, all night. I think I feel soundly asleep at 5am for about an hour. So anyway, after all that I took myself into the hospital to get back to some routine. I spent a calm hour or so doing the usual cotton-ball making and gauze folding when all of a sudden three of the women who had been 6cm when I arrived all kicked their labors into higher gear.

I ended up solo-ing a straightforward birth of a baby who I thought was going to be stuck but wasn't, and did that mom’s repair, while another woman labored in the next bed (at least there is a curtain), and a primip (having a first baby) worked on pushing her baby out in the labor ward across the way.
I got my mama and her baby all squared away, checked on the woman on the other side of the curtain (not ready to push yet), and then headed into the other room where the primip, J, was working hard during her not-very-close together contractions. The midwife who was with her looked at me then promptly left the room. Guess she needed a break.

J turned out to just be completely dilated. She had accidentally been pushing on a not-quite-completely-open cervix for a bit. The minutes ticked by, and while by Seattle-midwifery standards, there was nothing at all unusual about her progress, in fact, it was just fine, by Vila Central Hospital standards she was pushing for a looong time just 30 minutes into it. I checked fetal heart tones a few times with the CTG machine that sits there in the labor ward, largely unused during births, and heard the baby doing just fine. Js’s grandmother was in the room praying. Every so often I could make out the words “Jesus Christ”. Poor J was fading and telling me she wanted to sleep.

Despite her obvious fatigue, J was more mobile than most during this, and gamely tried different positions. Ok, perhaps “gamely” is too strong a word. But she tried everything I showed her (by demonstrating them myself, on the floor): on hands/knees (which she clearly loved, as these things go), standing/lunging, and even squatting on the bed for a bit. Of course, each time I got her into a new position the MW happened to walk in. The first time she just raised her eyebrows and opened her eyes really wide and said, “oh. Different position. OK. Good.” And walked out. The other times she came in, raised her eyebrows at me again, and walked out again. Despite my telling the MW the baby was slowly moving down with the pushes, by the time the clock hit one hour of pushing, she could not resist giving her an IV with some syntocin in it to augment labor. At about the same time I got J into a McRoberts position (knees flexed way up, J on her back), gave her some manual active guidance , and all of a sudden voila! Baby crowning. Baby was born 16 minutes after the IV was started. I wonder if the MW thinks the augmentation did it.

Apparently while this was going on, the other lady, back in the other room, had pushed a baby head into Niki’s waiting hands, which we now know are capable of releasing a baby’s stuck/wedged/not-moving-no kidding shoulders ☺ . But I’ll let N tell that story.

I got to visit J today, and she was all smiles for me, and I had hugs from the grandmother (who by the way sank to the floor and burst into tears when the baby was born – NOT a typical reaction). J told me she was very sore and was planning on no more babies! I told her that was just fine, but laughed and added that second ones usually come out a great deal more easily. She was having none of it.

Friday, March 20, 2009

We Fit In A Lot

Yesterday we went on a full day tour around the island that was just gorgeous, even if the dirt/stone/rut-filled road got old after a few hours. I posted those photos already, and I don't have it in me to write about it at the moment. If you visit Vanuatu, I recommend the tour. I've never been one for organized touring, but when time is tight, sometimes you just have to go with efficiency, and this was one efficient way to see a lot and learn a lot about this place.

We got home after 5pm, fairly beat by our extreme waterfall adventures (yes, sounds rough, doesn't it?), so we came up with the great idea of going in to the hospital for the night shift. Why not? Let's see what these bodies can do...

Well what they did was a lot of triage of women in early labor. Things got a little exciting when the MW (midwife) on duty shuffled past saying "We have a BBA." Which means a Baby Born...Away? I don't actually know what the A stands for, but it means somebody just came in and the baby has already been born, either at home or in transport. In this case, it was in transport. We all went out there and there was the woman, laying down in the van/bus she rode in on, and her mother was crouched next to her, holding a baby wrapped in the underlayers of the grandmother's skirt (kind of a bloomer-type thing). I unwrapped the baby a bit and a midwife pulled out the instruments we needed to clamp and cut the cord, and then I whisked baby inside while Niki and midwives dealt with getting the mom out of the van and into the hospital. The midwives shot her with syntocin without assessing her bleeding. Syntocin is an arificial form of the hormone oxytocin, which when administered after birth can help minimize bleeding by causing the uterus to contract. In the U.S. the brand name is Pitocin. It is routine care here to administer syntocin to every woman as soon as the baby is born.

Within a few scant minutes, everybody was safely inside. The placenta was soon delivered without incident, and then I was surprised to hear the MW ask the woman if she wanted to stay the night or just turn around and go home! The woman kept apologizing to her baby for giving birth to him en route! It turns out she is a teacher of older kids and had excellent English. It was a treat to have a real conversation with a woman about the birth she just had. I tried to point out the baby was just fine, as was she, and that she did a great job. She also rolled her eyes and kind of chuckled when I told her the sex of the baby. We were talking and suddenly she said "Is it a girl or a boy?!" I said "boy" and she said "Oh!" and rolled her eyes...seems she has several of those already and has only one girl.

Around midnight we wrapped up what we were involved in and got a ride home by the hospital transport vehicle. The two midwives going off duty all but insisted we not walk the very short distance home at that hour, so we humored them. Our walk would take us through a short, densely populated street. There is a kava hut on it, and a shop, and a living compound - kind of an urban version of a village. Even at midnight, though, there were children and women, plenty of them, awake and around. N and I both felt it would have been fine to walk home.

Today we stayed at the room and did some schoolwork - another damned draft of the *^*d(@*#ed senior paper is due this weekend. Then we had a stroll downtown and had a scrumptious lunch at the market with the locals: fried fish, rice. We bought some stuff for our children, mailed postcards (also to said children), got caught in another rainstorm (bided our time in a cafe), then strolled home in time for our evening.

Tonight's entertainment: A Melanesian Feast - the Vanuatu equivalent of a luau. It was really nice, and it was in a real village, which is really in the jungle. We were walked down a path to the clearing where the event was held and at one point I realized just how enclosed by jungle flora we were, and I had a definite sensation of claustrophobia.

As the spokesperson for the event pointed out, Vanuatu (which means "our land") consists of 83 islands, with over 100 dialects, and as many distinct cultures to some extent. What we were experiencing tonight was an example of only one of the cultures.

We ate a great deal of feast food, which leaned heavily toward root crops. There is a lot of starch in the traditional diet here. It was all quite tasty. We also tasted the kava potion and it made our tongue and soft palate/throat numb for a bit. Sadly, no hallucinations ensued. I have posted a few photos.

My days here are full, yet so much simpler. I've been thinking about the hullaballoo that is life at home. School drop-offs, lunches, school pick-ups, endless hours at clinic, after school lessons, homework, shopping, errands, and of course, just to add more chaos to it all, calls to births at random times. I am not ready to drop to the level of simplicity in living I experience here, but there is something to be said for eliminating all of that activity and stuff once in a while. I guess maybe that's what vacations are supposed to be, and were, I vaguely remember, before children. This surpasses any vacation, though. It's more like temporarily leading an entirely different existence.

I hope I can hang on to a bit of this when I return.

Island Tour Pics

You can check them out on Picasa.
I may try to write an update later today.

Also uploaded a 16 second video of a neat plant. It's on YouTube .

Wednesday, March 18, 2009

Posting Photos (1)

I'm not sure where the photos are ending up, but some can be viewed here.

A Little Bit of Everything

Another full day. I started it off by prepping and cooking a mess o’ “island cabbage” we bought at the market last evening before work.

If we had made it in to the hospital by 7AM, then by 9:30 am, when I got there, we would have been a part of 4 births. As it was, I caught one baby today. This one was kind of neat for the fact that the MW who came in and out deferred to my judgment about managing it. It was a bit unnerving, especially when she came over to the newly born, vigorous, crying babe about to suction his mouth, nose, and upper airway and I said “No,” and she said “Oh? No? Ok….”

We also got invited to attend a cesarean section of twins. They do in fact deliver twins vaginally here, as long as they are positioned reasonably. In this set, one was "transverse," which would have presented a problem, potentially. The doctor was still game but since the mother wasn't adamant about having a non-surgical delivery, he went with the section. One of the doctors graciously allowed me to take photos and I got about 30 of them (no, I'm not posting them). I’ve stood in on a couple of c/s but never twins before. I knew the section was scheduled for 2pm and women were just lining up in the ward in various states of labor so N and I were keeping on our toes about timing so as not to miss the big twin event. We thought it was pretty safe to go attend the multip (someone having something other than first baby is known as a multip) at around noon. Baby eventually made his appearance a bit after 1pm, then I had to suture a small laceration (which the floating midwife offered to finish for me when she caught on that I didn't want to miss the C/S). I managed to finish the repair, wash the instruments, yank off my gloves, scrub my hands and get out of the delivery room to see what was going on. I was just in time, as they were wheeling twins-mama down the hall to the OR building (across the breezeway). The midwife wheeling her called me over "Come, come Tina!" I hollered at N to hand off the baby she was cleaning up/dressing, and off we went. We stood around the OR for quite a while while everything got prepped. No one asked who we were, which was kind of odd. Maybe they had been warned already? I'll post a picture of the twins.

Afterward, N and I absconded with a scrubs dress each – WAY cooler to wear in this weather than the full scrubs pants and top getups we’ve been sporting. Oh dang, we meant to get photos of us in our operating room gear but forgot. Eh, it was the end of the day, what can I say?

I got home just in time before a huge downpour commenced.

Ants. Ants Everywhere.

Yesterday seemed like the day the ants discovered me.
My least favorite ant moment: watching them crawl on the naked baby laying under the bili lights for phototherapy. Agh!

Tuesday March 17 in Vanuatu.

Tuesday here in Vanuatu.
The night before we crashed to bed early after a day of births and heat. A month-long slow detox via sweating is how we’ve begun to think of it. It would feel good if it weren’t for the…well…inescapable heat.

Today I hung about young Dr. Robin while he examined a young woman who said she was about 20 weeks pregnant and was having abdominal pain. Dr. R is a tall, very softspoken ni Vanuatu (native to Vanuatu) who will flash a happy smile once in a while and who charts in perfect English as far as I have seen. I listened as best I could to his interview of very few words, then I watched him carefully examine her very small belly which had barely a bump. She could have been miscarrying, or had appendicitis, an ectopic pregnancy, or a number of other conditions. He did an internal exam with which I assisted (trying to hold in place a ridiculous lamp that hangs from the ceiling). His guess was she had an ectopic pregnancy. He sent her off for ultrasound which turned out to show an intrauterine pregnancy with fetal heart tones (i.e., she had not lost the pregnancy). Dr. Robin’s conjecture was that she had a uterine infection going on. The next step was to set her up for observation, which they did in the surgery ward.

There was another induction of labor yesterday begun for a woman who was “post term” –her chart showed she was not quite yet 42 weeks. They inserted ½ a 0.2mg misoprostal tablet and gave her a bed for her to hang out. We put her on the fetal monitor every few hours. When we left the ward at about 5 or 5:30pm she was still hanging about in the hot ward.

At 11am a young woman having her first baby presented with mild infrequent contractions whos water broke at 10am. She was sent to wander the ward. At 4PM she was 4-5cm and was clearly now getting into some labor.

At 11:30am we had someone come in who thought she was in labor. “Yu lookem blood mo wota?” (Any bloody show or did your water break?” and “Wanem taim soa I start?” (What time did your contractions start). Niki and I decided she wasn’t in labor, just dehydrated. Which was a good thing because she may have been preterm…not clear which due date to go with, and there were two. We put her on the monitor and did a vag exam and sent her home.

We joined the midwives for lunch, having been invited to share their island cabbage soup and white rice. And more breadfruit, prepared a different way from our first taste of it. The women on the ward get some fabulous smelling cooked island cabbage for lunch every day and I have been eager to try it. Tonight we bought a huge bushel of it that I will cook up. It should feed us for lunch for several days.

Another primip (woman having her first baby) came in in early labor.
And a woman having her 2nd baby came in in early labor.
All this and we got out of there with only one baby born after being on the ward for nearly 10 hours today. But no matter. I have now met all my clinical requirements for graduation and licensing in the state of Washington (woo hoo). It’s a nice feeling to know I can stop documenting every hiccup I observe and every baby I touch.

Monday, March 16, 2009

Catching Babies

It has been a busy, hot, tiring couple of days.

Yesterday I almost caught a baby (see previous post). I had my hands on the baby head as it was emerging and then moved out of the way when the midwife on duty came in. Today I managed a birth beginning to end, though I opted to observe rather than do the repair of the tear that the woman sustained. This is a picture of me with my mama from today...her name was Luisa. This was her 2nd baby. Her first one was a boy born in 2007 who died at 10 months of age from possible gastroenteritis. Today she gave birth to a cute little girl.

I wonder what these women coming in and having their babies with us around think of us. They seem so unperturbed by everything, including the white chicks in the scrubs present at their births, sometimes intimately involved in their births. It is certainly worlds apart from our cares and concerns back in America. Back home we see people "shopping around" for care providers, choosing smaller practices so they really get to know their provider, having long prenatal appointments with their midwife. Here, prenatal visits are 5 minutes long, women probably seldom learn the name of the midwife who caught their baby...and midwives mop the floor after the birth.

I knew there would be many challenges to being here and being a part of the care of these laboring and birthing and postpartum women that is so very different from what I know. I am not surprised by this, and try to observe it and let it go. I can't change it. There is nothing I can do to convince people to stop bathing the newborns constantly, stop slathering them in commercial lotions and dusting them in talc, nothing I can do about the ugly conditions of the maternity ward itself. But I can let in the goodness that is here: the incredibly strong newborns that take to the breast of their worn out mamas with the gusto and expertise of a 2 month old, the midwife who would share her breadfruit dish and taro cake with us. And I suppose I can do my part to tell a woman she's being strong, to look in the eyes of a new little one and wish it strength and health, in the weeks I have here before returning to my incredibly privileged life back home.

A few more pictures posted:

Sunday, March 15, 2009

The First Baby!

We had our first Vanuatu baby today. We headed in for the afternoon/evening shift at 3pm today to discover that there had been a birth at 2:55pm. We helped with some of her postpartum care soon after the baby was born. I’ll spare the non-clinician readers some of the details. At just under an hour after she gave birth, after her baby had had a nice long first feed – a champion little sucker, he was! – I got her into a wheelchair and moved her to her bed in the postpartum area of the ward.

Then before we quite knew it, a lovely woman, pregnant with her second baby, was shown into the labor/delivery room. She was 6 cm dilated, and the midwife on duty was preparing to “AROM” her – to break her bag of waters/amniotic sack. That’s the routine here. There was pretty thick meconium in the water – ‘mec’ being the baby’s intestinal contents. It accumulates in the baby’s intestines and is part red-blood cell breakdown products, part what remains from the swallowed amniotic fluid. Babies sometimes pass mec when they reach a certain maturation point, and sometimes they pass mec because of some “distress” during labor.

After the midwife ruptured the woman’s bag we got her somewhat settled and got an electronic fetal monitor on her after AROM was completed…a bit different from how we do it in the States. The midwife left the room. The laboring woman was having frequent contractions and she was making soft “owie” sounds with each one. Her sister was in the room, and we were chatting between contractions (the sister and us, not the laboring woman), and rubbing the woman’s back during contractions. Did I mention they have air conditioning units in the delivery rooms? It’s a glorious thing, as we were thoroughly drenched in sweat about 5 minutes into the shift. I noticed at one point that there hadn’t been a contraction for a while and the woman was quiet, and I told Niki I think she might be complete (completely dilated). I thought it was pretty darn fast, but the sign was there. There’s this great thing that happens for some women when their cervix is done dilating. They experience a bit of a break in labor, some call it the “rest and be thankful” phase. I call it the “make sure everything is ready” phase.
The woman said something I couldn’t understand and her sister translated for me: she’s going to push. Then, something along the lines of the following took place (Niki was able to recall the conversation for me to transcribe here):

Tina: she pushing!
Niki: I’ll get the midwife!
Tina: Yes!
Niki returns…
Tina: there’s head
Niki: I’ll make sure she’s coming
Tina: …quickly…

I looked around trying to spot something with which to support the woman’s perineum and the baby’s head as it was being born, and eventually noticed the “mid-bundle” sitting there, still all wrapped up. This is the pack of supplies for the midwife to use during the birth. I tried to get it open with one hand while keeping one eye on the soon-to-be-emerging baby head. I got it sort of open (all the while I am thinking, irrationally, “I hope it’s ok that I am opening this”), but didn’t see the gauze I needed so I just used my (gloved) hands to support everything as best I could – when finally the midwife swooped in.

The baby was born soon after, but not before the head emerged with a tight cord around his neck which the midwife cut before the baby was born. Baby still had a fairly purple face when we left almost three hours later.

She ended up losing more blood than is ideal so she rested in the labor room for a couple of hours before we moved her and the baby to her bed. Then we helped clean the labor room, made up the delivery bed, and mopped the floor.

So it begins.

Friday, March 13, 2009


Some photos of the the voyage and environs of Port Vila can be found on Picasa.

Vanuatu, Day 1

Thursday, March 12, 2009

The First Day at the Hospital

We were there at 7am, had a tour, helped with some paperwork, and joined "rounds" at 8am. The day turned out to be very quiet. We accompanied the group of women being discharged today to the administration office, accompanied by a student nurse who carried the maternity ward log. This was given to the cashier who figured out what each woman owed for her stay. Then we all traipsed over to another building, the Women's Health clinic, where they sat through a brief presentation on birth control methods were each given appointments to return for their "family planning" appointment. Two of the women being discharged did not come to the family planning clinic with us, as they had had tubal ligations following their deliveries. One was 27 years old and had just had her 4th baby. There are many posters around the hospital recommending limiting childbearing to the ages of 20 to 35.
We also each bathed a newborn, and measured (head and chest circumference and length) and weighed the babies being discharged.
The heat, humidity, and being on my feet all day was enough to wear me out. After a walk to the supermarket and back, then a walk to dinner, we are ready to call it a night.
Perhaps tomorrow we'll see some births.

Wednesday, March 11, 2009

We Made It

We left Seattle on Sunday evening March 8, catching a flight out of Seattle at 7:00pm. We had a bit of an adventure making our connecting flight in LA, the flight that would take us to Fiji where we made another connection to our flight to Efate Island, Vanuatu.. All ended well and we enjoyed a flight somewhat longer than 10 hours, most of which we spent stretched out on our own rows of seats.

It was still early in the day here Tuesday when we arrived. We settled in to our room a bit and then headed into town on foot, mainly to keep ourselves from falling asleep. A heavy rainstorm had moved in but it seemed it would go on for a while so we borrowed umbrellas and off we went. The rain was absolutely torrential. We explored town a bit as best we could and bought a few items including a very large avocado at the market. On our second day we checked went by the hospital to introduce ourselves and announce our arrival. We spent the rest of the day at Hideaway Island, a nearby snorkeling sport. This proved to be an unfortunate move, as we ended up missing the birth of triplets, the first of which was born breech, followed by her two vertex (head first) sisters. All were a very decent size in the 2200-2500g range, and we did get to at least see the babies and their mom the next day.

Photos from our first day are at: