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 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.

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 .

Posting Photos (1)

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