quick post just to track the mayhem, and it’s mostly birthy updates for my non-birthy friends reading, skip to the end if you’d like where you will read a bit about after work…
Today I caught the 40th baby born in 6 days.
I had a first time mother who looked very healthy. Baby was coming down OP but rotated and either he had a hand up and shredded the mother on his way around or she had absolutely no tissue integrity…either way plenty of bleeding before baby was born. I actually asked one of the med students to whistle down a doctor because it looked like the placenta may have begun to separate ahead of the birth. I put the Doppler part of the CTG on mom’s belly and got good heart tones. I left it sitting on her belly for the duration of labor. Forgive me please, I know the dangers of Doppler but felt at that moment that I had to decide which was the greater worry and I chose monitoring baby’s immediate well being as my priority. Blood oozed forth and the doctor was poised to move. I had to get bossy with this mom who I had worked with all morning and had developed a connection with so she took my shift from gentle quiet talking midwife to bossy lady seriously. Baby’s head was born and blood was pouring over his face. After the body came I held him in a good drainage position for about 5-10 seconds and watched the fluid run from his mouth. He was vigorous and well but I did not want him to drink in mom’s blood if at all possible. When he seemed to have cleared the fluids I put him skin to skin on mom. I won’t get into it entirely but clearly there was something not right. Her tissue was so friable that even as the doctor sutured the many many tears new ones were opening up. After an hour and half she settled on packing her with gauze and waiting for a couple of hours to see if it would get easier. I left her for all of two minutes to go sit down and do the paperwork and have a drink of water. I forgot my pen so went back into the delivery room and there was mom, standing up wanting to walk to the bathroom. I had already mopped up the quite bloody floor and it was now coated again as she clearly had open tears that bled when she was walking. I slung her arm over my back and half carried her back to bed, got her a bed pan and gave a good finger wagging about staying in bed until we moved her out to the postpartum area. I mopped again and cleaned her off again. A second doctor came in to do the second repair as the first doc was worn down. I was worn down and I had only been holding the speculum and watching the progress (or lack thereof) and mopping!
One of the moments I love at homebirths is that dreamy time after mom has her baby and she is all settled in and the midwives have some time to rest and decompress or fall asleep in a heap all tangled up together on a too-small couch or some corner on the floor. Even when births go perfectly this time is still so valuable. So this birth, which had loaded me with adreniline, left me in need of collapsing in a heap to recover but alas (or awae as they say here…) I never did get that moment and left two hours after the shift was over. The second doc actually removed all of the stitches the first doc had placed and restitched the mom. We finally got to move her to a postpartum bed 6 hours after the birth. We had a big review of the birth after and I told them the only time I have seen this kind of tissue shredding was a mother who refused proper treatment for diabetes. They were testing her blood sugars when I left tonight.
The other birth I did today was in a supervisory role as a nursing student was finishing his last required birth. We had the Aussie med students in with us and it was a nice learning atmosphere. The mother was plagued by muscle cramps in her feet, calves, and arms. I tried unsuccessfully to get her sister to go and buy some bananas for her. So barring potassium all we had was our hands and all of us were rubbing her down. I kept my hand on her belly and she was skipping the contractions—not even able to think about pushing because of the pain of the other cramps. I taught the nursing student how to perch at the end of the bed and let her stretch her foot and leg by bracing her foot on his shoulder. It was a second time mom who was pushing with good contractions and not making any progress. I started to talk out loud about the things I was worried about and as it became clear that the baby was hung up on something and they had finished another delivery on the other side of the room, we wound up with several midwives in the room. I asked “how many midwives to deliver a baby?”…they started laughing and tossing out numbers and we decided it was less than were needed to figure out how to run the microwave and more than were needed for changing a light bulb. I was happy they were there as I knew we would need an extra hand and if the baby had a rough time then several extra hands seemed just fine to me. They loaded synto (what we call pitocin, they call syntocin—synthetic oxytocin) in via an IV and soon the baby was being ejected. Something was still clearly wrong as the baby was so slow to come forward. He turned out to have a tight nuchal cord which had no give at all. There was hardly room to clamp and cut on the perineum but we did it and he came right out. His cord was exceptionally short. He needed a bit of help to get going but came round quickly—a great big baby boy. I did half the suture job and another midwife finished it up as there was a lot of bleeding and I was worn down to the bone and couldn’t even see straight, and was frankly a bit traumatized by the other suturing job of the day.
I bathed some babies and got them into their nappies, got the moms settled in and finally looked up to see how late it was.
Now here’s the not birthy part of the day. I hustled over to the pool for a swim and was about half way through when I heard a loud horn of some sort. It was dark around the pool and in the pool and I am half blind so I had to stop and put my glasses on to see what the continuing blast was about. I looked up and there was a native Vanuatu man in kustom garb blowing a conch shell. I took a look around and it seems I was swimming in the middle of what was about to be some kind of show of kustom dancing and kava drinking for the hotel guests. There were a dozen dancers waiting behind the tree to come out and start the show. I jumped out of the pool, wrapped my lava-lava (sarong) around me and hustled back into the trees behind the dancers. I put a tshirt and skirt on over my swimsuit and watched the start of their show and then walked home, dripping wet, my flip-flops squeaking the whole way. I think, for the record, how amazing it is that I am not too embarrassed to relate this small story… : )