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