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.