Tuesday, May 22, 2012

Oh. My. Gosh.

The last week or so has been slow in the OB ward.  Our ambulance was broken which I think contributed to the slowness, but this hospital is no different than others with the ebb and flow of patients.  Anyway, I was bored.  I complained about how slow it was to someone, which any person working in a hospital will tell you that is a big no no.  But I did it. Oh dear.

Yesterday I was working an evening shift, so I arrived to the ward at 3pm.  I was informed by the nurse that we had a woman laboring who was a previous c-section so would need another one for this baby.  The c/s was scheduled for 4pm.  Yeah!! Something to do.  I bustled around getting everything ready for the surgery and by 5pm we were in the OR.  I’m in a race with some guys from the OR to see who can guess the sex of the baby more frequently and was in high spirits when I took the lead by correctly guessing the sex of the bouncing baby boy that was born.  The last c-section this woman had had, produced a baby that was already dead so we were all excited about this beautiful healthy baby. 

Two hours later at 7pm I was sitting at the nurses station when I heard the ambulance siren.  Wait, I thought the ambulance was broken.  I couldn’t tell if the siren was coming or going so I went out to investigate.  When I got outside the driver told me he had brought two women in labor.  Yikes, 2! And one of me.  Ok, show time!

One of them was able to walk and one wasn’t. I took the one that could walk and guided her into the labor ward.  The thing about the ambulance, and the thing about giving birth here in general, is that they usually will not come to the hospital for a normal delivery.  So you know, especially when they come by ambulance, that something is wrong.  I started talking to the woman in Krio but she wasn’t understanding me so I went and grabbed one of the nursing students to help me translate (something for which I would be extremely grateful for later!) 

The history for the first woman is this.  This was her fourth pregnancy and she has been in labor since the night before.  She started bleeding but the bleeding has stopped.  The TBA (traditional birth attendant) who was attending her birth became nervous when she started bleeding so decided to refer.  **** A million gold stars to this woman for recognizing a danger sign and referring her somewhere else!!!****  I checked to see if she was bleeding and she wasn’t. I called the lab to come check her hemoglobin to make sure it hadn’t dropped too much.  Then I called one of the doctors to see if she could come down and do an ultrasound to check for placenta previa.  (Placenta previa is when the placenta gets too low and can go over the cervix.  When the woman tries to push the baby out she puts too much pressure on the placenta and she will start to bleed.  She can hemorrhage and die from this, so it’s pretty serious.  The treatment option is to do a c-section).  The woman’s vital signs were fine and the baby’s heart rate was fine.  Since the woman wasn’t bleeding and it wasn’t an immediate emergency, the doctor said she’d finish her dinner and be right down. Perfect!

By this time they had brought in the woman who was unable to walk by herself.  This was this woman’s 8th (yes 8th!) pregnancy.  She has four living children.  She too had been in labor since last night and although she was fully dilated, stated she didn’t have the strength to push.  Vitals signs?  Good.  Baby’s heart rate?  Good.  Ok, I did a vaginal exam and sure enough, she was fully dilated and the baby was right there.  I tried to pass a foley catheter to see if I drained her bladder if it would help the baby come, but I couldn’t get it in.  Next, I decided to give her a medicine that would help strengthen her contractions.  I’ve been told here that women who have given birth a lot have uterus’ that are just tired and need a little help.  I started the IV and sure enough, about 15 min. later her contractions were stronger and she really started to push.  

At this point the people in the room were myself, the nursing student I’d called for translating, and the TBA who came with the patient.  Although I’ve been working in OB for awhile, up to this point, for one reason or another, I’ve always had someone else with me when it was time to push the baby out.  This time, I was the most experienced in the room. Oh dear.

Push Push Push Push Push Push Push.  Little by little, the head came down.  Finally, out it came.  I reached up a little and felt the cord wrapped around the neck.  I yelled for the hemostats and clamped the cord and then cut it.  I expected the body to come out with one more push (as had happened with every delivery I’ve seen) but it didn’t come.  Crap.  I gently pulled, but nothing.  I started getting a little panicky at this point.  I tried to call the doctor but the call didn’t go through.  I know that even if help comes, it will be too late, as I just have a couple minutes to get this baby out. Now I’d been praying ever since the woman came in, but at this point it was more a guttural cry of desperation to my God! I’d listened to the heart tones of this baby just a few minutes before and it had been strong. Now, if I don’t get this baby out quickly, the last 9 months will be wasted in the last five minutes. 

The only case of shoulder dystocia (when the shoulder gets stuck on the way out) I’d seen  was when one of the doctors delivered a baby that was just about 30 weeks.  The baby had died inside the uterus.  He had had to really tug and pull hard, dislocating the arm etc., but it didn’t matter because the baby was already gone. I was really afraid of doing something to harm the baby.  Finally (and I’m still not sure how I knew to do this) I reached up and grabbed one of the shoulders and pulled it down.  When I did that, it came out. Then I lifted up and the second shoulder came out. 

The baby was not crying, not breathing, and very floppy.  I glanced down at the woman and saw that she wasn’t hemorrhaging then literally scooped the baby up and took off running.  Because Jesus loves me, the generator had randomly been turned on about 5 minutes before so I knew there was oxygen and suction in the OR.  As I glanced down the hall to the OR doors, I saw they were locked so yelled to the nursing assistant to grab the keys.  She flew past me and had the OR unlocked by the time I got down there. I ran to the main OR doors and saw that they too were locked. These doors don’t have a padlock and the lock that locks them is pretty flimsy. I knew I couldn’t waste time going to find the hidden key so I literally used my shoulder as a battering ram and opened one of the doors. 

Now we were in the OR but I didn’t know where the lights were.  Fortunately though, because we’d done a c-section earlier that night I knew the oxygen and suction were still set up.  I yelled for light and the nursing student and one of the other OB patient’s mothers (who had followed us down) brought out their cell phones that have flashlights on them.  I started giving the baby oxygen, bagging him, sucking out all the goop and slapping him around a bit trying to wake him up.  It was so dark that I couldn’t see if his color was getting any better. 

I yelled, “I need Marie!!”
”That other white woman.  Someone go get the other white girl!”  Somebody took off running.

I thought Marie might know how to turn the lights on.  When she got to the OR she didn’t know how to turn the lights on, but I dispatched her to go check on the woman I’d just left when I took off running with her baby. 

All this time I’m continuing to bag, give oxygen and suction.  Finally, our little man opens his eyes and gives us a cry.  We all started cheering.  His color started getting better and he started crying more and more.  I was pretty close to crying myself. 

We left the oxygen on for a little while until I felt we were out of the woods and then got him weighed and dressed.  He was 8 ½ pounds.  In a country where the average weight is about 6 pounds, this was a BIG baby!

I took him back to the OB ward to check on his mom.  Marie had delivered the placenta for me started to help get her cleaned up.  A few minutes later the doctor arrived and I told her about my adventure. She went to check the baby and said everything looked ok.  Thank you Jesus!!!!  The night OB nurse also showed up at this time (she’d heard the ambulance and thought I might need some help). 

Now that the chaos was controlled, we turned our attention to patient number two.  The ultrasound showed that there was marginal placenta previa so we could try a vaginal delivery but it would be risky. Since she’d been laboring for so long but had very little cervical dilation, we decided to just go for the c/s.  I got everything ready and helped bring in the third baby for that day.  Three live babies for three deliveries!!

I’m so thankful for all the help that I had that night. If that nursing student and patient’s mom hadn’t been there, I would have been scre…in big trouble.  I’m also thankful that my God breathed life back into that baby when there was none.  He doesn’t always do that, and I am confident that He is still good when things don’t happen the way I wish they would.  But I’m very thankful for the happy ending in this case!

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