Sunday, January 4, 2009

First Shift

6.50am Stroll up to the hospital, bags of supplies in hand.
Maternity ward found at the end of rutted dirt driveway, front door surrounded by discarded hospital beds and other miscellaneous furniture. Postpartum ward is PACKED. All 12 or so beds occupied by women, their babies in giant nappies and swaddled in LAYERS of blankets - for the love of GOD women, it's 95degrees in here! Assorted family members lying about on woven mats or up preparing food for the women - no food service here!

7.10ish meet three midwives (including tall, handsome and clearly quite shy, male midwife), 4 docs (2 OB's, one Ped, one Gyn).

7.30 Rounds. Gyn doc snaps me up and begins quizzing me enthusiastically(socratic method, anyone?) on postpartum visits - "History, examination, investigation and don't forget to wash your hands!!", then begins quizzing the other docs (felt a little weird). Discharge 10 women. Hospital has seen some 32 babies in the last 5 days including two preterm babies, a set of twins and breech baby. Round on surgical Gyn patient transferred emergently from another Island two nights ago. Poor lass had been bleeding for three weeks (!), ultimately her ruptured tubal ectopic pregnancy evulsed into her uterus (ack) and she bled three liters into her peritoneum before emergency surgery saved her life. Her Hgb this morning was 3.2. Holy shit. Needless to say, she was a) lucky to be alive, and b) feeling pretty crummy this morning.

9ish. back to the maternity ward where three women were in various stages of labor. hung out with midwives, helped a 4day pp woman learn to hand express milk, then cupfeed her pretty awesomely lethargic and dehydrated baby who hadn't nursed effectively um, EVER. NB Weightloss central. She and her baby were readmitted.

11ish. Mama #1 G1P0, complete, not having fun. Assisted MW with birth. Hope like crazy that my probably not well understood gentle words and back rubbing made up somewhat for the *slap* and sharp instructions to "yu no cry out" from my colleague during the end of her labor. 25 minute-ish 2nd stage. Vigorous baby, tiny by our American standards (~6lbs). Seriously actively managed third stage. MW proudly displays intact primiparous perineum - no sutures needed at all. I admit I'm impressed.

2ish. G2P1 stalled at 8cm for ~3hrs (I guess this counts as stalled here). Complaining of crushing back pain, I'm suspicious of malpresentation. Suggest she gets on hands and knees on the bed for a few contractions. I'm amazed, she tries it, then tries wall swaying! She pushes out large 4.6kilo babe a short while later. Baby girl met with auntie's exclamation of dismay: "Shit." When we peek between her legs. Mama starts sobbing. I spend the next 5 minutes telling baby girl and everyone else in the room how beautiful she is and how lucky we are she's here.

3.00pm. I'm supposed to go home. But the third admission, another G1P0 is "fully". I can't help myself. I poke my head in to the labor ward, and ask the MW if I may assist. We spend the next hour speaking gently and encouragingly to her (I think this particular midwife may be one of my favorites) as she slooooowly (by ni-van standards) brings her baby down to her very looooong perineum. An hour later an inch long midline episiotomy is performed, and minutes later another vigorous babe slides into the world. I take care of the babe (they are weighed and their vaccinations - HepB and BCG - and vit K given as mama delivers her placenta) and then swiftly return her to her mama. I hold her so baby and mother may look at each other as MW completes a stunning repair of the episiotomy with 1.0 vicryl.
Then baby to breast, opens wide, latches.

4.30ish. Head home. Smile on face.

Other things. Three women, three births, almost 10 hours. Heart tones were taken once on admission (a CTG strip) for each, then perhaps once more at the onset of second stage. In the case of the woman pushing for an hour, I think I was instructed to take heart tones once again. Placentas are deposited immediately into the trashcan on the right. Sheets are washed, by hand, by me. I have a new love and respect for chux pads. We have no idea just how lucky we are.

**Paul - you want to bring some stuff, and you can get your hands on disposable underpads, then bring as many of those as you want!! **

Can't figure out though, how to get gloves onto my sticky, sweaty hands.

So. Short version: day one, no drama. Lovely women, good midwives, beautiful babies.
Oh yeah. And 1970's squat hospital architecture. 95 degrees today. 1 fan in the whole place. Blessedly someone put two struggling air conditioners into the delivery rooms which helps. Anywhere except (ironically) in front of the resucitaire where we put babies immediately after they're born (the whole dry off/look over/listen/wrap up thing) it's hotter than hades.

Too much fun, peeps. Too much fun. Oh, and Emily - everyone sends you their love and best wishes for your baby!!


Emma Someone said...

Keep up the amazing writing, and know that I *wish* I was there.

Loving Pecola said...

Ohhhh (hugs) my heart was lifted reading this. Babies, babies, everywhere! Keep writing :o)


M said...

hehe sounds like a great riot:)
6lbs is tiny by American standards?? eek, N was 5'9!