Saturday, May 14, 2011

First time for everything...

As soon as I arrived and made friends with the head midwife, I gave her my phone number and told her to call me if there are any imminent deliveries. In my 6 years of medical training I have only seen 2 deliveries!! My friend Chad likes to brag that he's seen more babies born than I have because he at least got to see the birth of his three kids. Since the maternal and neonate mortality is one of, if not the highest in the world, this is an area in which I desperately need some experience.
I got a call yesterday saying telling me that there were two women who were fully dilated and would probably give birth any minute. I went down there immediately and found two women in the labor room. One woman had a really small pelvis and you could tell her baby was big! She reported that she'd been in labor for three days so they were going to take her for a c-section. The second woman had also been laboring for awhile but they thought she might be able to deliver vaginally. It was decided that I would go with the midwife to the c-section, until she checked the second woman once more and determined that she was ready to push. I positioned the end..... and had a front row view!
We could see the baby's head but the woman was having a hard time pushing. She could not have been more than 17 or 18 years old. Every time a contraction came, the midwife and other nurses would yell for her to PUSH!!!! She would push but....nothing. This went on for several minutes and then they started getting angry and telling her she was lazy. I felt really bad for this girl but had to chuckle a little to myself at the thought of OB nurses in the States yelling at their patients and calling them lazy. Ha! Might not go over so well! :)
After some more minutes of this pushing/hollering the patient told us what the real problem was. She said that there was a devil at the end of the bed telling her NOT to push. Wait. What?? At first I thought she was talking about me! The midwife assured me that she wasn't. Phew. Apparently she had been saying this in the village and that's ultimately the reason that they called the ambulance and had her brought here.
Then the nurses really got to yelling. "This is a MISSION hospital!" "The devil has no power here!! " "There is NO devil telling you not to push." "You MUST push!" Etc. etc.
At this point the tension in the room has gone up dramatically. What started out with nurses chuckling and then getting upset about her lack of effective pushing has now turned into a dangerous situation because we need to get her baby out!
They decided to try a vacuum and brought out a manual vacuum machine. After trying several times without success (I made sure to keep my mouth shut as the vacuum popped off the head multiple times....and I was REAL close and personal!) they decided that they need to take her for a c-section. Since the lights (generator) hadn't turned on yet we knew they didn't have the first girl on the table yet so we sent someone to tell the OR to take this girl first.
I followed them into the OR and pretty much just tried to stay out of the way. They put the girl to sleep and cut her open. As soon as they got to the baby a huge amount of meconium (stool/poo) came out and we knew that baby was going to be in trouble. They also found the cord wrapped around the neck.
As soon as baby came out my friend Patience (the midwife) grabbed baby and took him to the isolette. He wasn't crying and didn't appear to be breathing on his own, although he had a strong heartbeat. They immediately started bagging him and trying to stimulate him to breathe. After a few minutes they checked his oxygen saturation and saw that it was at 21%. (Normal is 92-100%). This was not good. His color was also worsening despite the bagging. He was almost as white as me. They worked on him for about 30 minutes with no real improvement. His oxygen saturations went as low as 5% and never got above 60%. At this time we are about to stop when the surgeon who performed the C-section came over and started bagging. He worked hard for the next 10-15 minutes and I figured his forearm must be geting tired so I offered to relieve him. Then he left.
Now at this point I know that this kiddo is gone and there's nothing left to do but I definitely don't feel like I have the seniority to "call it." So I just keep bagging. They have now brought in the second girl for her c-section, put her to sleep and are getting ready to make the cut. And I'm still bagging. There's no one else around as everyone else is occupied with the second case. I wonder if everyone is just thinking that the apoto (white girl) is one of the ones who thinks everyone can be saved and won't give up. I've seen enough death in the States that I don't really have that perception....I'm just not sure what to do!! So I just keep bagging.
Now the second baby is delivered and they need to bag this one as well so I take it over to them...and my job is over. In hindsight I wish that I would have picked up this little one and held him as his heart stopped beating. He looked so perfect!
I was sad that this mother had lost her baby. I was even sadder when I found out that this was the second dead child she had delivered. But I wasn't devastated. I wasn't destroyed. Although I've seen plenty of death in the States I've never bagged a baby before....never experienced the death of a child before. That was new, and I felt like I should have been more affected. Then I started to worry! Am I becoming too desensitized? Have I lost my compassion? Have I allowed the fact that even if this child was born perfectly normal, he had less than a 75% chance of reaching the age of five make me calloused?
I thought about that a lot the rest of the day and evening. I'm still thinking about it. Today I decided that in order to survive here, I will become slightly calloused. Just like I did when I worked in the ER/ICU. However, I'm begging God to help me not to lose my compassion. I don't want to be destroyed by the pain around me, but I also want to be willing to enter into that pain with the patients that I can. Lord give me wisdom and discernment to respond in a way that glorifies You.

1 comment:

  1. Emily.... we always enjoy reading your blogs. I can't imagine what daily life is like for you over there, but your blog helps give me a little perspective. You are constantly in our prayers. We love you and miss you sweet girl! -Jen & Amar