To Live and Die

It was quiet in the OB ward yesterday. We only had two patients and they had both been in the ward for over a week.  At 2:45 pm a woman walked in with her husband. I’ll be honest and say that my first reaction was “Darnit! I’ve been sitting here doing nothing for seven hours and NOW you want to come in….when I’m supposed to go home in 15 minutes!?!?!” I know right? Bad Emily! 

I asked what was going on and the husband told me that her belly had started hurting yesterday morning. She was five months pregnant.  They must have met the lab man on their way in because they came in with completed labs.  I glanced down and immediately saw that her hemoglobin was low enough to probably need blood, and also, she was HIV positive. They  had gone ahead and checked her husband….he was negative.  I know that Africa is known for its high rates of HIV, but it’s still pretty low in Sierra Leone. Last time I checked it was about 3%, as opposed to 25% in some African countries. I don't think she knew. 

I sent her back to the labor room to be checked while I quickly got some basic information from her husband. When I went into the labor room, it was pretty apparent that this wasn’t just ligament pain, heartburn or some other benign pain in pregnancy. She was contracting. Hard. I checked her vital signs which were fine. She measured at about 21 weeks, but was probably a little farther, as the measurement isn’t as accurate after labor begins. Next, fetal heart tones. I searched and searched. She told me she’d felt the baby move that day, so I kept looking. Finally I found them. 150 beats per minute. Perfect.  I was just about to perform the vaginal exam to see how far dilated she was when she told us (I had a midwife student with me….who ironically enough I’m sure has WAY more OB experience than me! Have I mentioned that OB IS NOT MY THING!??!!)  Anyway, I always get a little nervous when someone says they have to have a bowel movement because the sensation to push the baby out is so similar. We got the bedpan for her and she urinated. We started helping her back to bed when she said she wasn’t finished yet. As she sat back down, it happened. She delivered her baby boy into the bedpan. We maneuvered to get her back into the bed to deliver the placenta.

As I cut the cord and wrapped the baby in a blanket, I asked if she wanted to see him. She did. I asked if she wanted to hold him, but she declined. So I held him close as he took his first and final little breaths. As I was holding him, I took a few minutes to inspect him.  He was perfect. Perfect little hands, little toes, little nose. He was beautiful. He was just too small.

I went to tell the husband that she’d given birth but the baby hadn’t made it. He was visibly upset. This was her fourth pregnancy but her husband said it had been a long time since her last pregnancy. I suspected that her previous children were with someone else and this was the first one for the two of them.

After the delivery I debated about where to put her. Our ward is divided into two sections with one section for deliveries and the other section for women with other pregnancy related problems. We usually try to put the women that lost their babies in the non-delivery section so they don’t have to be surrounded by happy women with their babies.  But the other section was empty and the last time I’d tried to put a patient over there by herself for that reason, she’d asked why she'd had to be over by herself and asked if she could come join everyone else.  Knowing this woman's HIV status made me ESPECIALLY sensitive to her feeling like an outcast. So I made up her bed with the other two patients.  Her husband requested to go home, but she needed blood and even more importantly, she needed to talk to our HIV counselor.  So I asked them to wait. 

This morning I came down to the ward and saw that one of our staff members had delivered a bouncing baby boy overnight. This was a big deal!  She had a five year old little boy that died about 10 years ago. Since that time she hadn't been able to get pregnant.  Infertility is extremely painful in any culture. Here, if a woman is unable to give birth her husband will often leave her to go find someone who will "give birth for him" and she is often labeled a "witch."  My friend and her husband have desperately been hoping and praying for another baby. And it finally happened!  We are all thrilled!!

The visitors have been streaming in all morning. Literally. A constant stream all morning. They're laughing, eating, singing and dancing.  I want to jump in and dance with them! (But I will never do that. My sisters wedding video is humiliating evidence that I should never. ever. dance. Ever.)  As happy as I am for my friend, every time a new batch of visitors walk in, my eyes glance over to this other patient who delivered her premature baby yesterday.  Her baby died yesterday and tomorrow she will meet with our HIV counselor and find out news that will change her life forever. Sometimes it just amazes me the way that joy and pain can be tied so closely together!