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.

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