there are days and then there are days

warning: this is a sad one.

“It means a great deal to those who are oppressed to know that they are not alone. And never let anyone tell you that what you are doing is insignificant.”
- Bishop Desmond Tutu


if there was ever a day I needed some encouraging words, today would be it. thanks ma. we had a rough go of it at the hospital this morning. apparently the moms spend the weekend doing all they can to avoid pushing, then monday morning rolls around the flood gates open, literally. we walked into a labor ward packed with woman, every bed full and then some, waiting to be admitted, screaming with contractions, and actively delivering babies. you know those intense scenes in movies where there is utter chaos or some total disaster happening (think pearl harbor just after WWII starts) and everything slows down around that main character… it gets real quiet and slow motion so you can take in the pandemonium… I felt that this morning. I stood amidst the disorder and tried to figure out where to begin.

I’m watching a woman, primi gravidae, struggle to push with her contractions. she’s exhausting herself and the labor is not progressing. I see another woman walking down the hall next to thu, (moving to the area of the ward where she will deliver), stop, squat between the beds, and deliver her baby there on the floor. nurses are carrying newly delivered babies past me, there is a woman with a prolonged rupture of membranes who is not doing well. woman are screaming and it’s stressing me out, babies are crying and I’m relieved. I am trying to support amy as she helps the first woman. I glance back at a mother behind me who has just delivered and is now getting dressed. she is talking on her cell phone. she stands and pulls her skirt the rest of the way down. I turn back to amy and the struggling mother, no progress.

out of the corner of my eye I notice blood on the floor, fresh blood, drips accumulating and coagulating as my mind tries to piece together where it is coming from. then I realize the new mother, standing there talking on her phone, is bleeding, a lot. I can see the blood streaming down her ankles, it is spreading across her feet and turning the bottom of her skirt crimson. thu points and the woman looks down. seeing the blood she had not felt, she calmly hangs up the phone and begins to undress again, slowly, unconcerned with the clots of blood hitting the floor between her feet. we call for a nurse. the nurse comes quickly, glances at the woman, disregards the blood rapidly accumulating on the floor, and gives her a command in swahili. “she needs to pack more cotton”, the nurse says to us.

at mt meru regional hospital, each mother brings a roll of cotton with her when she comes to deliver (she is responsible for bringing other supplies as well – gloves, syringes, kanga’s to wrap the babies, you get the idea). post-delivery the women wad up the cotton and place it between their legs before they walk down to the post natal ward. imagine the very first pad or the original tampon, it is that archaic. but that cannot be the solution for this mother, there is too much blood. I’m staring wide eyed at the puddle thinking about when we learned to estimate blood loss in the labor and delivery elective I took at ohsu. more cotton was not the answer, that much I was sure.

i’m frozen as the nurse walks away. the woman is standing there, half naked, trying to clean the blood off her legs. her cell phone is ringing, it beeps the tune of jingle bells over and over. it is an eerie scene and I’m watching it as if from another place. watching the mother hemorrhage, watching her attempt to clean up blood she is losing all too quickly, watching the nurse get further and further away. I snap back. calling to the nurse as I follow her past more screaming, laboring mothers, I ask, “is it post-partum hemorrhage?” she looks at me puzzled. I try again. “is it PPH”, I say, distraught and frustrated. she looks at me and says no. I decide to be bold, risk offending a nurse (not something you want to do around here), “how do you know?” I ask timidly, trying not to sound threatening. “because I know.” she says, and walks away. great.

dr. ishmael arrives not long after. I am relieved, for the moment, and explain to him what has happened with this mother. he says yes, it is PPH. we get her started on fluids, no bother with a blood transfusion, but better than nothing. I check on her periodically throughout the rest of the day. as far as I know she does well. lucky. scary. surreal.

not so lucky is our primi gravidae (that’s what they write when it is the mother’s first pregnancy) mom who is still struggling to deliver. she can’t figure out how to push properly, she’s in excruciating pain, and there are so many other mother’s needing attention, she keeps getting passed over. amy and I explain the situation to dr. ishmael. he says it is bad because the baby is no longer in the amniotic fluid. we know this, we know it is bad, it is what we’ve been trying to tell the nurses! he does nothing to help. In fact, he walks away and we do not see him the rest of the day.

thu is at the other end of the ward, delivering more babies. they are coming so fast we are struggling to keep up. I walk between the beds, following the screams of mothers pleading for a nurse, help, anyone. I am checking each woman, looking for crowning heads. third mom I examine and the baby is almost there, she is contracting and pushing and looks up at me saying, “please pray for me”. I tell her I will, that it will be ok, that she’s doing great. I look around, no supplies, nothing prepared, and I’m alone. I yell for thu and fortunately she comes. i ask her to search for supplies. I have my gloves on in seconds and am doing what I can to help the mother, trying to prevent a tear. two contractions later and the baby’s head is in my hands, the membranes completely covering it’s face. I frantically peel them away from it’s mouth. sukuma!! the mom pushes again and the body comes spilling out. a big baby boy with a cry that almost brings tears to my eyes. thu shows up now, tells me there are no sterile supplies… wait, she sees the baby and moves on to the next laboring mother, never mind. I show the mother her beautiful baby, set him on her chest, say “good” and smile at her. she thanks me. eventually I clean her up, get her dressed, and walk her down with her healthy baby to the postnatal ward. carrying that perfect baby down there, him looking up at me, blinking, so warm in his blanket, it was peaceful. the first peace I’d felt all morning. but then I had to leave him with her and it was back to the mayhem.

our poor primi gravidae mother, she is still struggling. it’s been long, too long, an hour, two hours? what time is it? when did we get here? how long has she been laboring… what about the baby? stressful doesn’t do it justice: nerve-racking and we feel so helpless. that is the worst thing about it all. the nurse is finally there, amy is doing what she can to comfort the mother as the nurse takes over. I return in time to see a last desperate attempt from the nurse: episiotomy, and forceful pushing on the mother’s stomach as she pushes in desperation as well. it’s violent and awful and when the baby comes out it is blue and lifeless and I have to walk away. I’ve already had too much this morning, and there are so many other mothers in need of help. I am doing no good watching this futile effort to resuscitate the baby.

tragic. it is tragic because it could have been prevented. why didn’t they do the episiotomy earlier? it didn’t make sense to me. the nurses who had been checking on her from the beginning should have known, should have done something sooner. maybe the baby would have made it. instead there is a small corps wrapped in a kanga, only the toes sticking out, set under the scale where they weigh baby after baby born healthy and well on this day. that is the hardest thing we’ve dealt with thus far, obviously… a loss that seems all too preventable. the mourning mother was too much to watch. I felt like my heart had been ripped out. that physically pain in your chest that you can’t explain, like that place where your heart should be is actually hurting. you can’t comfort that. turn away and her forlorn cries still echoed throughout the labor ward. no one should have to experience loss like that. and to add to the pain, the nurse did a rough job of repairing her episiotomy. I felt my toes curl uncontrollably in my shoes as I watched her writhe in pain with each stitch of the enormous needle. I consciously told myself to relax, loosened my grip on the gloves wadded in my hands, breathed a little, and walked away. more mothers needed help.