I suppose I should bring some sort of closure to this, now that I have left my adventures in Vanuatu far behind and have returned to the Pacific Northwest.
My final day there I decided to go in for a few hours before leaving for the airport. Three, count them, three women were all on the verge of birthing their babies as the minutes ticked by, closer and closer to when I had decided I really had to return to my room to shower and catch my airport ride. Finally, I gave up and took my leave, for the second time (I had said goodbye the day before, as I hadn't planned on going in again). Apparently less than half an hour later one of the babies was born. Of course, my ride to the airport was a half hour late, so I missed the birth for naught. No huge drama, but still...
It took three flights to get me back home, and almost 24 hours of travel time.
It snowed/sleeted the day after I got home.
I have had a blessedly slow reentry to life here, as slow as the two happy, healthy children with whom I happen to live, and who have been home for school vacation week, will allow.
I miss the lushness of the island, the constant sweating (very cleansing), the smiles of the women at the hospital (oh, if I only knew what they were thinking when they smiled at me), the words of thanks expressed after catching someone's baby, and those babies.
I don't miss the constant sweating, the multitude of bugs, the peculiar smell at the hospital, Medol - a "wide spectrum hospital grade disinfectant" with active ingredient 4-chloro-3, 5-xylenol (as I have since learned, thanks to http://www.fao.org/docrep/005/ac802e/ac802e0j.htm), or being smacked in the face daily with the reality of life there.
I would go back, and I wish I had had more time to spend there.
Monday, April 6, 2009
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.
~~~~
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.
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
Picasa.
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
Picasa.
Thursday, March 26, 2009
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