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.
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
Tuesday, March 24, 2009
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.
I miss home.
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.
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