today at the hospital we got some serious hands on experience. we arrive in the labor ward on time, waited around for the doc for about 30 minutes and when he finally showed it was the same boring rounds. I heard screaming coming from the other side of the ward so i wandered over just in time to see a laboring mother give birth. the baby's head was crowning as i walked up and it was only a few minutes before the baby was delivered and the nurse was delivering the placenta. as we're standing there, watching the protocol for delivery (which doesn't consist of much) amy and i turn around because we hear moaning from the bed behind us. There, an unattended mother is grimacing in pain and, yes, we can see the head of the baby crowning. luckily dr. ishmael, a visiting doctor we had just met, was there and he tells us to put on gloves. we do as we're told, but amy's glove breaks so she can only stand and watch as I proceed to deliver this baby with his verbal guidance. it was... awesome! the delivery went very smooth. we'd wait for contraction then tell her to push "sukuma!!" and soon the head was cleared, shortly after the body, and then, the third stage of delivery, i delivered the placenta, which I still think looks like alien brains... well, and I kinda think babies look like aliens anyway, so it all fits. The delivery went well, thank goodness! except for a small tear which dr. ishmael was going to have us repair but decided to do himself because he had never repaired an episiotomy before. come again? yes, he says,” i am only an intern and i never did an ob/gyn rotation”. so basically some medical intern just talked me through a delivery that i did solo and he, himself, didn't have much idea what he was doing... wow. They tie off the umbilical cord with the torn cuff of a rubber glove, that was new, and it’s not easy when your gloves are wet and slippery with blood and amniotic fluid. I’m so thankful for my time at glory reborn with Hilary and all of the midwives! I’ve helped out with so many deliveries it made it much easier to deliver a baby on my own, but still intense! I’m just so relieved the mother and baby are well. we weighed the baby, 2.9 kg, he seemed pretty good sized actually, and placed him on a heating table with three other babies. I don’t know how they don’t get switched, they are shuffled around so much and it seems unnecessarily disorganized. it felt really good to help out, that's what we came here for so it was nice to be useful.
The women deliver and not three minutes later are up and getting themselves dressed (as long as there’s no obvious active bleeding). There were so many deliveries today! I can’t believe how fast paced they move, and how unsanitary everything is! A while later we were watching one of the doctors, Dr kasamuni, try to find the source of bleeding of a woman they said came in having PPH (post partum hemorrhage), it was gruesome to watch and as much as I wanted to look away I think I was too shocked and couldn’t. I’ll leave out the details because I already probably don’t filter enough but if you’d like to know how they were going about this repair, feel free to ask. Then a scream breaks my attention and turn to again see a woman, alone on the bed, knees up, pushing with the contraction and the head of the baby is crowning (deja vu anyone?). we looked around, desperate for a doctor to help her, or at least talk us through it as we assist... Amy and I yelled for dr Ishmael and just as he came over the woman pushed again and with a loud cry the baby came spilling out onto the bed. Dr Ishmael took one look at it, looked up at us, said "good delivery!", laughed, and walked away. By now a nurse was there picking up the baby and handing it to the mother and preparing to start the placenta delivery. I think amy and I were probably standing there with our mouths so wide we were catching mosquitoes. And the crazy thing was (as if I haven’t just shared enough crazy things), that the baby was soooo tiny I wasn’t sure it was far enough along to even be producing surfactant, but sure enough it was crying harder than a lot of the bigger babies we’d seen, some of which hardly cried at all (they don’t use those suction bulbs, they wipe the baby’s mouth out with dirty cotton swabs, seriously, and if the baby doesn’t cry they don’t seem too concerned... it's kind of terrifying).
Saw a 40 year old mother of 7 on her 11th pregnancy. Gravida 11?! Para 10! And seven living children. makes you curious what happened to the other three. She was ready for a BTL (bilateral tubal ligation)post delivery, thank goodness. Talk about a high risk pregnancy, between her age, the number of past pregnancies, and the fact that we are fairly certain she is going to have twins, it will be a miracle if all goes well for mother and baby. She is a Maasai woman, and the doctor says that means she has no medical records and can usually not report much detail about medically relevant things. she didn't know her blood type or when her other children were born. All we know for sure is that they were all SVD because she has no sign of a cesarean scar.
We did pelvic exams like it was our job today… well, actually, it is our job. But anyway, so the british students that started the day with us leave at noon and Dr. Ishmael asks aren’t we going to leave as well. We were confused… no… there are still mother’s lining up to be admitted and active births going on. He was very surprised we intended to stick around past noon. It is odd to be in a place where they are impressed if you wait all the way until 3pm before heading home. Dr. Ishmael taught us a lot today. He walked us through the admission process, everything from vitals, to the abdominal exam, to the pelvic exam. One interesting thing unique to an area like this is that was document whether the women are circumcised or not. yes, it is true, certain tribes and religions here still require female circumcision and they like to monitor this at the hospital because if a female baby is born, they try to encourage the women, if the child must be circumcised, to have it done at the hospital where the chance of infection is much lower. This all seems very backwards and difficult to rationalize but I supposed the hospital has to work the local religious beliefs. I can’t delve into this issue now, it’s getting late but we all feel very conflicted about the whole thing...
Anemia is a huge problem here because of malnutrition, malaria and hookworms (the top three causes according to Dr. I). We check the tip of the tongue and the conjunctiva of each woman to make sure it is not pale. When we do the exams it seems everything is estimation. Only the blood pressure cuff really works, and I suppose the thermometer, but they usually do not use it and just estimate a normal temperature. As long as they can hear the fetal heart beat using this archaic plastic cone you place between your ear and the mother’s belly, they will estimate it to be 132 or 136 and sure enough if you look down the cart of admitted women it alternates those average numbers for FHR. They estimate height of the mother, they estimate fundal height and gestational age with their hands, they estimate the size of the baby just from looking at the mother’s stomach (small, medium or large? Are we talking babies or French fries?!). Everything is so arbitrary, subjective, imprecise! It was driving me crazy! But I suppose it works for them, for the situation, for the available resources. We saw a lot of deliveries go right today, despite the adversities these women face in the hospital. I suppose the bottom line is that birth is a natural thing that women have been doing since the dawn of time, whenever that may be.
Part of me thinks, from what I’ve seen in the hospital here, you’re almost better off giving birth at home with a friend present. It will be about as much assistance as you get at the hospital and you’re exposed to less contaminants and possible infectious agents. Plus you won’t be giving birth directly next to a mother, screaming post-delivery, and who’s amniotic fluid is dripping off her bed and spreading under yours while a nurse in a plastic apron tries to mop it up with dirty water… chaos. The labor ward is chaos. I was shocked, but seriously loving it at the same time. I dig pregnant bellies and got to get my hands on lots today. Plus we got to carry babies down to another room where they got an oral polio vaccine, that was cool, and where one of the nurses laughed and told amy and I she could totally see the resemblance between us and the babies. I like people with a sense of humor : )it is also really nice to be able to comfort the mothers. i think that will end up being one of our biggest roles. i like to place my hands on their cold legs, rub their backs and dr. ishmael is teaching us, move slowly and explain as best i can in swahili what i am doing. once you gain their trust their whole demeanor changes and it makes the exam go much better. the doctor's look at us a little confused, but maybe it will open their eyes to the idea that these woman are human being too, and they're scared, and they deserve to be treated well.
Thu went to see a few cesarean sections today, which is why I haven’t mentioned her much. you’ll have to see her blog for those details though from what she told us it might be one of the wildest things we’ve seen yet. All I know is part of her story involves the doc playing the “i'll take you to the candy shop” song on repeat with his cell phone as he operated. And the electricity going out just at the start of the third cesarean section, at which point they waited an hour for it to come back on then just called off the surgery. I wasn’t aware it was that easy to call off a cesarean section. I mean, when you go into labor you go into labor and if there’s a reason to get the baby out via c-section before that it seems postponing the procedure would not be the best idea. But what do I know, im only one year through medical school…
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