Really, don't read this if you are pregnant...
SO last night when i walked in there were three moms pushing (with visible baby heads) and only two midwives working. i had to beg the third mom to slow down her pushing both to protect her perineum and get my gloves on. I caught her baby exactly 2 minutes after i walked in the door and found out her name afterwards. This was her 6th pregnancy and she had a minor postpartum hemorrhage after her placenta was born.
Then there was a mom with suspected malaria (remember that is supposedly does not exist in vila) who had been in prodromal labor for 3 days. She was really having a hard time and suffering with her labor. She kept begging me to help her. It is awful that there is absolutely no pain meds to offer those moms who do need it. She finally gave birth at 10:20. her baby was born with the most mec and the most unusual meconium (baby poop) i have ever seen. He had well dissolved mec, thick mec, terminal mec and some mec that looked like bright yellow breastfeeding poop all mixed together, (i asked the pediatrician about this later and he thought that maybe the baby had a problem with its liver and was passing billirubin already). I gave her pitocin, and methergine (as is the norm here) and she had an IV of pitocin going as well as we all thought she was a post partum hemorrhage risk due to her long labor and spaced out contractions.
As the malaria mom (evelyn) was birthing a woman (may) came in pregnant with breech twins. and yet another mom (lilly) was pushing by herself in the delivery room across the hall. There are still only two midwives on shift with me. we are the entire staff and are also trying to care for two sick babies in the NICU, the other 3 laboring mommas and the 10 postpartum mommas and babies. round about this time another mom came in saying she needed to push.
so i went to catch lilly's baby, one midwife was calling the on call OB to do a cesarean on the twin mom and prepping her for surgery and the second midwife was checking the mom who came in pushing in the admission room. evelyn was breastfeeding her baby.
after catching lilly's baby i ran to the other delivery to check on evelyn. i was concerned that she might have a postpartum bleed because of her prolonged labor. i checked her fundus and it was high indicating bleeding. sure enough i was able to expell some big clots and this brought her total blood loss to almost a liter. one of the midwives continued fundal massage while i ran to grab the OB who thankfully had just arrived to do the cesarean on the twins.
he took the mom into the OR and figured that despite the the pitocin and methergine she was still bleeding too much to survive a hysterectomy. She was fully in shock and not conscious at this time. they did general anesthesia and discovered that her uterus just would not fully clamp down to stop the bleeping. he inflated a balloon in her uterus to put pressure on the bleeding vessels and gave her more drugs to tighten the uterus muscle. he estimated that she lost another 2 liters. of blood in the OR. Her hemoglobin was 4. there was no blood to give her so a nurse with O- blood was called from home to donate blood on the spot to give evelyn a transfusion. That is some amazing dedication. She ultimately had two more transfusions. This was the closest i have ever come to seeing a woman die.
Meanwhile the twin mom was laboring away. May's first twin was well in her birth canal. I went into the OR with her and it was determined that we should try for a vaginal birth since the first baby was so low in the birth canal. We could not get any heart tones so the OB cut an episiotomy and delivered the first double footling breech baby girl. he let me deliver the second double footling breech baby girl! i also delivered their fused placentas. Each baby was depressed at birth and needed resuscitation. In this case the word deliver is more appropriate than catch or receive my personally preferred terms for what i do at a birth. there was definite manipulation on my part and the OB's.
It was now 3am and i was now roped into helping the pediatrician (who came in a big hurry - just 1 hour after the call) start IVs on evelyn's baby (who was now in obvious respiratory distress probably due to meconium aspiration) and May's twins since they had needed resuscitation after birth and were clearly preemie despite being 38weeks by dates. The two night shift midwives were both catching babies and there were still more laboring women in the hall.
I finally stumbled home at 4am after working more than 12 hours on my feet. I could not sleep due to the adrenalin still coursing through my veins. I had caught 4 babies, seen a mom nearly die and seen and caught/delivered my first breech baby. i truly hope i never see a night like that again.
SO last night when i walked in there were three moms pushing (with visible baby heads) and only two midwives working. i had to beg the third mom to slow down her pushing both to protect her perineum and get my gloves on. I caught her baby exactly 2 minutes after i walked in the door and found out her name afterwards. This was her 6th pregnancy and she had a minor postpartum hemorrhage after her placenta was born.
Then there was a mom with suspected malaria (remember that is supposedly does not exist in vila) who had been in prodromal labor for 3 days. She was really having a hard time and suffering with her labor. She kept begging me to help her. It is awful that there is absolutely no pain meds to offer those moms who do need it. She finally gave birth at 10:20. her baby was born with the most mec and the most unusual meconium (baby poop) i have ever seen. He had well dissolved mec, thick mec, terminal mec and some mec that looked like bright yellow breastfeeding poop all mixed together, (i asked the pediatrician about this later and he thought that maybe the baby had a problem with its liver and was passing billirubin already). I gave her pitocin, and methergine (as is the norm here) and she had an IV of pitocin going as well as we all thought she was a post partum hemorrhage risk due to her long labor and spaced out contractions.
As the malaria mom (evelyn) was birthing a woman (may) came in pregnant with breech twins. and yet another mom (lilly) was pushing by herself in the delivery room across the hall. There are still only two midwives on shift with me. we are the entire staff and are also trying to care for two sick babies in the NICU, the other 3 laboring mommas and the 10 postpartum mommas and babies. round about this time another mom came in saying she needed to push.
so i went to catch lilly's baby, one midwife was calling the on call OB to do a cesarean on the twin mom and prepping her for surgery and the second midwife was checking the mom who came in pushing in the admission room. evelyn was breastfeeding her baby.
after catching lilly's baby i ran to the other delivery to check on evelyn. i was concerned that she might have a postpartum bleed because of her prolonged labor. i checked her fundus and it was high indicating bleeding. sure enough i was able to expell some big clots and this brought her total blood loss to almost a liter. one of the midwives continued fundal massage while i ran to grab the OB who thankfully had just arrived to do the cesarean on the twins.
he took the mom into the OR and figured that despite the the pitocin and methergine she was still bleeding too much to survive a hysterectomy. She was fully in shock and not conscious at this time. they did general anesthesia and discovered that her uterus just would not fully clamp down to stop the bleeping. he inflated a balloon in her uterus to put pressure on the bleeding vessels and gave her more drugs to tighten the uterus muscle. he estimated that she lost another 2 liters. of blood in the OR. Her hemoglobin was 4. there was no blood to give her so a nurse with O- blood was called from home to donate blood on the spot to give evelyn a transfusion. That is some amazing dedication. She ultimately had two more transfusions. This was the closest i have ever come to seeing a woman die.
Meanwhile the twin mom was laboring away. May's first twin was well in her birth canal. I went into the OR with her and it was determined that we should try for a vaginal birth since the first baby was so low in the birth canal. We could not get any heart tones so the OB cut an episiotomy and delivered the first double footling breech baby girl. he let me deliver the second double footling breech baby girl! i also delivered their fused placentas. Each baby was depressed at birth and needed resuscitation. In this case the word deliver is more appropriate than catch or receive my personally preferred terms for what i do at a birth. there was definite manipulation on my part and the OB's.
It was now 3am and i was now roped into helping the pediatrician (who came in a big hurry - just 1 hour after the call) start IVs on evelyn's baby (who was now in obvious respiratory distress probably due to meconium aspiration) and May's twins since they had needed resuscitation after birth and were clearly preemie despite being 38weeks by dates. The two night shift midwives were both catching babies and there were still more laboring women in the hall.
I finally stumbled home at 4am after working more than 12 hours on my feet. I could not sleep due to the adrenalin still coursing through my veins. I had caught 4 babies, seen a mom nearly die and seen and caught/delivered my first breech baby. i truly hope i never see a night like that again.
1 comment:
Michelle, this post brought ears to my eyes. How lucky they are all to have you and how hard it must be to do all that. My heart goes out to those women and at the same time I want to cry at how fortunate I am. Amazing stuff you are doing, woman, keep blogging, I can't get enough!
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