Tuesday, November 13, 2012

Baby Emily

Supposedly, I have numerous husbands roaming around Sierra Leone, as well as lots of little Emilys.     This is for the simple reason that when a baby is born in the OB ward and I have anything to do with it, all the women will start calling the baby my "man" (husband) if it's a boy, or my "namesake" if it's a girl.  Of course chances are high (I'd say REAL high) that I'm not going to marry any of these babies and that once they get to the village nobody really names their baby "Emily"....that weird white person name.  

About nine months ago my neighbor found out that she was pregnant.  I work with her husband and I really like him.  We've had some of those good conversations that make me think "ahhhh.....now THAT's why I moved here!"  When I was talking to his wife about my dilemma in bringing Kadiatu to come live with me, I told her one of my biggest fears.  I was afraid because I couldn't teach her to be a good African woman because I don't know how to be a good African woman.  She said "Just send her to me! I'll teach her to cook, I'll teach her to wash clothes....I'll help you!"  So they're good people.  

So when we found out she was pregnant I quickly did the dates and realized that the doctors would NOT be here when it came time for her to deliver.  Darnit.  I'm not sure......I may have mentioned it here before, but OB IS NOT MY THING!!!

As the time started getting closer, I started getting more and more nervous.  What if I was down there by myself when it came time for her to deliver????  My nervousness is pretty pronounced when I'm trying to deliver a strangers baby...but when it's my neighbor???  It goes up exponentially!!  Before every shift I'd stop by and say "Hey!!  Has your belly started hurting yet?  No?  Alrighty!" :)  My biggest fear was that I'd be down there by myself and something bad would happen!  I'd been following this "case" since the first question was asked..."is she or isn't she???"  I couldn't bear the thought that I might mess that up what she'd been "cooking" for 9 months!  

A couple weeks ago I got all excited because we thought the time might have arrived (and I wasn't working!!) but....false alarm.  Yesterday was my last day of work before I go to Freetown tomorrow......and fly home on Monday!!!  We were all joking that I'd been waiting and waiting and waiting, but the baby wasn't going to come until I left.  Last night the husband called me and the first question I asked was "does she want to give birth tonight!?!??!"  Negative.  Bummer.  

This morning I was up early as usual and about 5:30 heard some noises coming from their house.  An hour later I noticed that she'd come outside and as I watched her (yes, I have stalker tendencies) I noticed that when she started making her little noises, she would also grip the metal pole beside her.  Could this be?  The day before I'm supposed to leave? When I'm not working so wouldn't be the only one down there?  A little bit later she and her husband came to the door and said that she hadn't slept all night because her belly had been hurting so much.   

I had to go down to chapel this morning even though I wasn't working to say goodbye to everyone and give them their early Christmas presents....a pen.  I know, not very interesting but seriously people are always asking me for my pen!  Seemed appropriate.  I told them I would meet them in the OB ward when I was done.  

When she arrived there was another woman in the labor ward who was getting ready to go for an emergency c-section.  I took her to another little room and checked the baby's heart rate...fine. I did the vaginal exam and she was 5-6 cm.  Awesome!!!  She's going to have this baby today!!  I couldn't believe how awesome it was that after literally waiting for weeks, I was going to get to meet him/her before I left!!  I told her I needed to go up to the house for a little bit but would come back down. I figured I had a good 2 hours before things got too exciting and since I hadn't started packing or cleaning yet, I'd work on that for awhile.  

Fast forward several hours, past the oxytocin drip, past the rupturing of membranes, past the normal crying that would occur when trying to push something very large out of somewhere very small etc to being fully dilated and ready to push.  Wait.  Let me hit pause to tell you that my favorite thing she said through those hours of waiting was when she asked the nurse if all women experienced this kind of pain while giving birth?  When the nurse said "yes," she said "Why do these women have so many children?!?!??!!?"  Precious! :)  Also...good question!  

The delivery was not an easy one.  I called the doctor when she was ready to push.  Did I forget to mention that in addition to me not having to be the only one down there, we also have a great Sierra Leonean doctor here right now who was eager to help us?  I had told the doc that I was concerned about the baby having some decelerations (heart rate going down) so as soon as she was fully dilated we wanted to get the baby out.  We ended up having to use the vacuum and do an episiotomy to get the baby out.  It had some shoulder dystocia so we really had to work to get that baby out.  Because of the difficulty of the delivery, the doc told me to prepare to resuscitate.  NOT what I wanted to have to do!

After quite the struggle, the baby came out.  It's heart was beating strong, but it wasn't breathing.  We bagged it for awhile, the doc gave a medicine through the vein in the umbilicus and finally it started breathing on it's own.  It didn't have that strong, angry cry that we love to hear, but it was trying!  

Now for the gender. Oh the gender.  Part of the excitement of delivery here is revealing the gender. I often get in trouble because I'm always so excited to tell the mother and father the sex of the baby that I don't ask them for the kola (money) that is traditionally paid to the midwife before telling them the sex.  Since I'd feel weird asking for that anyway, if I don't really forget, I just pretend that I did.  :)  

A few months ago my friend had an ultrasound that said the baby was most likely a girl.  Later she had another one that also said it looked like a girl.  When I told one of my friends that my neighbor was going to have a girl he said, "Well, I will still pray for a boy."  So it became a thing.  Emily and the "machine" versus my friend.  When the baby was born and I got to say it was a GIRL....I won. :)

The most precious thing about this is that a couple months ago my neighbor started telling people that if it really was a girl, they were going to name it Emily.  Now, as I mentioned above, people tell me that quite frequently but I never really put much stock in it so when they would tell me that, I would just nod and smile.  As the time kept getting closer and closer though, both the husband and the wife kept talking about it.  Last week I was talking with the husband and he said that if it was a girl, Emily, but if it was a boy the were going to have some problems because so many men were vying for the baby to be named after them.  When this little one was born today, people started saying, "Yeah!! Baby Emily has come!"  

So here she is.  My first official "namesake."  Baby Emily.  

Reasons I'm thankful for today? 
1) This baby was born JUST in time.  Literally the day before I'm leaving.
2)  I wasn't working so I could just help and try to encourage...without all the stress of being "in charge."
3) We had a doctor there who is very knowledgeable
4) We have a vacuum and scissors to do episiotomies
5) After breathing for her for awhile, she started breathing all on her own and shows no sign of any kind of anoxic brain injury from the rough delivery
6)  I got to see the looks of delight on this daddy and tired mama as they posed for their first family photo :)  Thanks Jesus!!!
Don't worry, I took one without the crazy white lady in the picture too.....

Saturday, November 3, 2012

Can I See That Hand?

Last night I was in the OB ward, minding my own business listening to my IPOD when a pregnant woman had the audacity to walk in.  At first I thought she was just visiting someone until I saw her bend over in what seemed to be some kind of distress and I went over to investigate.  Oh yes, she’s come to give birth.  My stomach did the drop that it always does as my adrenaline starts pumping. I asked if she’d had an operation before (hoping it would be a clear case of “take her to the OR quick quick like a bunny”…shout out Alanna!)  But alas, no previous C/S. 

She came with an older lady who was a TBA (traditional birth attendant) so since the pregnant woman was in a wee bit of pain I directed my questions to her.  “When did the belly begin hurting?”  “An hour ago.”  Huh. An hour ago?  Something didn’t make sense.  TBA’s never bring patients that quickly to the hospital unless there is some major problem.  Also, the woman seemed to be in quite a bit of pain for the labor to have just started an hour ago.  I asked the TBA what it was that made her come and she said she just wanted to get the woman checked.  Ok………

I took her back to the labor ward to check her out.  When we got there I again asked when the pain had started and this time the patient responded that it had started at about ten that morning.  OK!! That makes a little more sense!!  I started with the exam and when I got to the vaginal exam realized…something was fishy.  At first I thought it was the cord that I was feeling and had a moment of panic. Last week I lost a baby with a prolapsed cord (when the cord comes first) and it really really really sucked.  I did NOT want to do that again.  But as I started feeling around, I realized it was the hand that I was feeling.  Instead of the head being the presenting part, the hand was.  Oh boy.  Something else I’ve never seen before.  Oh, have I mentioned that OB IS NOT MY THING yet in this blog?  In case someone forgot…..there you have it. 

So the hand is presenting first.  Now what? When I did the vaginal exam I noticed a meconium stain (when the baby starts pooping inside the belly) which is a sign that the baby’s in distress.  I listened to the fetal heart tones they were 186.  Too high.  Another sign that the baby was in distress.   I knew that our doctor was in surgery so there was no way we could take her for a C-section right now anyway. I ran down to the OR to see if they were almost done. They weren’t.  Shoot. Well, I told the doc that when he was done I needed him to come down to the OB ward. 

Ok. So I can’t take her for a C/S right now.  What next?  I decided to do an ultrasound.  If the baby was breech than I was pretty confident that only a c-section would save this baby.  But if the head was down, is there any way she could push it out?  This was her fifth time giving birth so shouldn’t she be pretty well…..expanded by now?  I did the ultrasound and sure enough, the head was down.  I grabbed my book to see if I would get any inspiration there, but all I could find was how to deliver the foot first.  Blast.  Ok Emily, think.  The hand is coming first, the baby is in distress, and the woman is not fully dilated yet.  We need to get this baby out, but surgery is not an option right now. 

So what do I do until surgery is an option?  I can’t just sit and do nothing!  Ok, here’s the plan.  I’m going to augment her labor to try and get her fully dilated to see if there’s ANY way this kiddo is just going to slide right out.  After I started the drip I tried to see if there was any way I could push that hand back up there so the head would come first.  Negative Ghost Rider

Fortunately just as I started the oxytocin, the doctor showed up.  Thanks Jesus!!!  I told him about my exam, what I’d done, and my concern for the baby.  C-section it is.  Since I’d been pretty sure that’s what we were going to end up doing I’d already started all the preparations so as soon as they closed the other woman up and cleaned the OR we could take the woman right to the OR to pull this kiddo.
Because of the distress of the baby we wanted to be quick about it so instead of doing an epidural we used local anesthetic.  That’s right.  We used lidocaine to numb the incision area and cut into the woman while she was wide awake.  Don’t you want to have surgery over here!??!!  Usually they will give a medicine to knock the patient out, but in cases of c-sections they try to wait until after they’ve pulled the baby out because any medicine they give the woman will affect the baby as well.
Unfortunately this woman didn’t appreciate being cut open like a fish and started fighting.  In cases like these they take the risk and go ahead and give the sleeping medicine because if the woman starts fighting than everyone is in danger. 

As they pushed the medicine my heart sank a little because I HATE it when they have to do that (which they have to do pretty frequently......turns out most women don’t like being cut open. Weird.)  I almost always have a harder time with the baby when this happens.  Since this baby was already in distress I knew that this wouldn’t make things any easier.  Sure enough, as they pulled the baby out he wasn’t breathing.  

I took him over to the little incubator and immediately started bagging him.  I listened to his heart and it was beating, but slowly.  I knew that the medicine they give during surgery usually wears off in about 15 minutes, but the 15 minutes of waiting is FOR. EV. ER.  Also, I wasn’t sure how much of his present situation was because of the medicine and how much was because of the prolonged, stressful labor.  So I kept bagging him and slapped him around a little bit to try and make him wake up and scream at me.  Finally, his color started looking better and he started moving around a bit more.  Eventually he started breathing on his own and I just put some oxygen on him to give him a little extra help. 

All of the sudden, all the power went off in the OR.  The solar was finished.  A few months ago we got solar power for the entire hospital.  There is generally enough to do two surgeries and if we have to do more than that we run the generator.  Unfortunately this time the solar decided to cut off right in the middle of surgery.  And the surgeon was in the middle of sewing this woman up.  So what did we do?  Well obviously, myself and another guy pulled out our cell phones that have lights on them and shined the light at the woman’s incision.  After about 30 seconds of this I just started busting up laughing.  Is this really my life right now?!?!  When a fly was attracted by the light and kept trying to land on the woman’s open belly I started laughing even harder.   Fortunately my co-workers weren’t offended and we all started laughing at the absurdity of the situation.  Ten minutes later the generator came on and there was light.

Like to remember these ones!!!
My little patient wasn’t doing so great off the oxygen so I took him back down to the ward so I could keep him on the oxygen.  His right hand was extremely swollen, bluish in color and cool because the circulation had been cut off for awhile while he was in the birth canal.  However, by the time we got down to the ward he was moving all his fingers and crying a little. I think he’ll be A-OK.   It’s always an adventure………