A Day in 3.5 Hours
Friday morning! We have seen so much happen already this week as we interceded for life in the hospital, what on earth was going to happen next? Well more then we expected I would say, but then again we never know what to expect. Throughout the day we delivered seven babies, and four of them were within twenty minuets of each other. And although I only “delivered” one women there are three main women that I would like to write about. So I am going to write a bit about each of them, but keep in mind, the stories of every women were all happening at once!
Value those who devalue
After gathering together in prayer, as we did every morning before work, we set out to deliver some babies and love on some princesses of God kingdom. As I set out to check on some moms I noticed one being rather loud yelling through all of her contractions.. “Primi.” I thought “She doesn't know any better and she is wasting all her energy on shouting, I'll go breath with her for a bit and see how she is going.” I started walking in the direction of the sound when I noticed the nurse just in front of me was going to check on the same mom I was, but it was all to soon that I noticed who the nurse was. As she turned I saw her protruding pregnant belly. She was the nurse from the birth of Daniel Obadiah.*
“SMACK!” I saw her slap the mother hard across her bear thigh. I felt my jaw drop but no words came out. The nurse started shouting at the mom in Swahili wagging her finger in her face as she then pointed to her own pregnant belly. I stepped in. “Excuse me, but what are you saying to this mother? What is it that she needs?” I asked. “She is hungry!” The nurse snapped at me. “Put an IV in her and give her some fluids.” The nurse turned back to the mother and started ranting off to her again, but this time instead of wagging her finger in the mothers face she started jabbing the mother in her abdomen causing her enough pain to curl into herself. “Hey!” I said to the nurse. It caught her off guard so she stopped and turned towards me. I stepped in between her and the mom and took the moms hand in my own “If the mother is hungry giving her an IV is not going to help her, nor is any of your jabbing and slapping! This mother is crying out in pain, do you think causing her more is going to silence her? You are pregnant yourself and I'm sure you would not like to be treated like this when you are in labor, so why do you treat these women like this?!” Her only reply was a chuckle as if I were child upset at her for hurting a fly and walked away. So I turned back to the mother, “pola sana mama.” I said as I rubbed her red leg. Soon after one of the other students, Joy, went out and bought the mother some food. About twenty minuets later Joy delivered her sweet baby girl. Then the mom had PPH but didn't want to be touched anymore, so I sadly had to hold her hands down with all my might so that Joy could massage her uterus and expel the blood clots to prevent farther bleeding.
Upon returning home I started talking with my roommate, Amy Dawn, who had just returned from visiting with a mom who she “delivered” the week before. She shared with me that when she asked the mom what she expected when she went to the hospital the mother shared with her “I thought I was going to get a slapping.” But thankfully Amy was able to change that for her just as Joy and I did for the mother above.
What I learned from it:
As for the nurse in the story above, God showed me that I need to value her just I am with the other women. I got her name, Marget, and I started talking with her to find about what she has to deal with. It is sad that someone who is that pregnant should have to continue working so hard. And with her hormones all over the place I'm sure the yelling women can be more then annoying. So as she shows devalue to others it makes me wonder, who has valued her?
Two women, Two Babies but only two hands.
So now lets back track in time just a bit. The morning was still just getting started and Joy had just returned with food for the mama in the last story.* Now I was just across from her with another mother I just started to check on. I had just started taking her vitals and timing her contractions as I was doing so. But before I could finish that and move on to palpating her and checking for the baby's heart beat, Emily came in. She brought with her a mother form the ANC ward. “G.6 P.5 fully dilated.” She said and sat the mother on the bed next to the mother I was checking. I knew that meant this lady's baby was coming asap... but I knew the baby of the mom I was checking was coming very soon as well. Oh dear.
Mwajuma was the name of the mother Emily brought in and Masokola was the mother I was already watching over, but as I looked around me I saw that from the other two students in the room Jen had just delivered a baby and Joy was just about to deliver one herself and our staff Rachel was running between them trying not to touch anything with her blood covered gloves. I observed this as I quickly prepared the things that would be needed for these next moms to deliver their babies. Cotton, cord clamps, razor blades, kidney dish, oxytocin drawn up and now I slipped on my sterile gloves and stood between the two moms waiting to see who was going to be first.... just what I feared.... “HEAD..S! TWO BABIES HERE AND I CAN ONLY TAKE ONE!” The beds were so close together that I had no choice, so I reached my arms out and caught a baby in each hand!
Okay maybe it didn't go that way, but it would have made for a great story and I really did consider doing so. None the less I went with the head that started winning the race, you learn early on that you should never mess with a G6.
Little Susan Grace (As I named her) came out, well very graceful. She let out a beautiful cry as we laid her on her mothers tummy and Mwajuma just smiled and admired seeing her beautiful little girl for the first time.
By this time Tiffany and Bek had heard my cry and were now with Masokola right next to me, but Masokola's baby had not come yet. When they looked to see the head crowing we realized it was not a head, this baby was breach! None the less the baby was small and Tiffany was able to deliver it, only to realize there was another baby inside! “Twins!” Tiffany told the mom in excitement as the first little girl was whisked away to make way for the next one. “Huh?” Masokola looked at Tiffany not understanding the English. “Mbili Watoto!” Tiff said pointing at her still protruding belly. “Aya!” She said as she threw her hands up in exhaustion and shook her head as to protest the thought of pushing another baby out all over again.
Mwajuma saw all of this happen to the young mom and she couldn't help but burst out in innocent laughter at poor Masokola's dilemma. She seemed to laugh as if she had been in that same spot herself once and was imagining the humor of what she might have looked like herself. She looked back to me and we continued to have a little chuckle together.
For a moment, no one knew
By Kaitlin & Tiffany
Time ticked on and the laughter ended as I cleaned Mwajuma up and started to prepare the bed for the next women. At this point the room was full of commotion. Jen's mother had retained placenta, Joy's mom had PPH , the second twin from Tiff's mom had yet to come and there were other laboring women in the room close to delivering. Four babies were now taking up all the room laying close together on the baby bed all waiting to be checked on still. I ran and helped with what I could as I continued to help Mwajuma, who was in much pain, clean up and make the move to the waiting area. As soon I felt things had “calmed down” enough I went to do my check ups on little Susan grace, but instead of picking her up and loving her I had to pick her up and hand her off along with all the other babies.... “Clear the table for CPR!”
The second twin had now come, and she was flat. APGAR 0. Suddenly all the babies were whisked away, checked or not, and little Madeline took the table. She was suctioned, rubbed, flicked, pressed, filled with air and prayed over and over as her big sister Josephine laid alone in the corner of the bed. She laid quite and still, the sadness in her eyes seemed to say what none of us wanted to admit, her little sister was not going to be with her any longer. But she was also so at peace that she seemed to know were here little sister was, with Jesus.
We played the part of Madeline's heart and lungs for half an hour before Doctor Fatuma came over. She had seen the miracle at the start of the week and now she spoke up in the midst of sounds of repetitive counting and the air bag filling up only to be pressed empty again, “No miracles today?” She asked with both hope and sadness in her voice. Madeline was soon pronounced dead.
The birth of the twins took a toll on Masokola's body as her uterus had a hard time contracting down, her full bladder didn't help either, thus making her continuing to bleed when it should have stopped. Wanting to help Masokola's bleeding to stop asap, both Tiff and Rachel asked the nurse in charge for advice and was told to hook up Ringer's Lactate for her. After hooking up the IV for her, Rachel held on to Masokola to support her and helped her to the bathroom to empty the mom's bladder with Tiff close behind them holding the IV drip high. But to no avail, Masokola was so weak from the blood loss and birthing process that she pleaded for Tiff and Rachel to take her back to her bed for she couldn't bend or squat without feeling faint. After a couple tries to encourage her to empty her bladder to no avail, Rach and Tiff then gently helped her back to her bed and immediately changed her IV drip that was quickly depleting.
As Masokola was getting situated on her bed, Tiff stood solemnly next to the baby table for she had to tell Masokola that her 2nd daughter did not make it. With a heavy heart she gingerly gathered Madeline into her arms and walked towards Masokola's bed only to stop in her tracks and asked our staff Rachel if she could explain about Madeline for Tiff didn't feel she could do so without crying. Rachel then took baby Madeline and one of the student nurses as a translator to Masokola who perked up at the sight of a bundled baby coming her way. Tiff watched Masokola's eyes widen just a fraction in surprise when she realized that Madeline, her 2nd child, was not alive anymore before tears of grief pooled and escaped from her sad brown eyes down her cheeks, pass her lips that were pressed hard together as if trying to retain a cry of anguish trying to escape. That first tear traveled down to the end of her chin and splashed onto the konga that wrapped Madeline's small frame. Tiff watched with grief and wonder as dear Madeline's mother shifted her child into the crook of her left arm that had the IV in and began to gently and lovingly trace her baby's plump cheeks, soft chin, brows, small nose, delicate ears, and the rest of her face before stopping on the child's lips as if to hush Madeline who may or may not have protested at having yet to be fed. At that gesture, Masokola's tears then started to pour down freely from her eyes that never left little Madeline's peaceful face till she heard a sniffle and looked up to see that Tiff's face was streaked with fresh tears. Not wanting to have the mom feel awkward, Tiff quickly turned her face away from the mom and busied herself getting her things ready to do a final check on the mom before we all had to leave for the day. After a bit of fumbling with her blood pressure cuff, Tiff took Masokola's vitals and was happy to see that her bleeding had slowed down, her blood pressure, heart rate, respiratory rate, temperature, and fundal height had improved considerably.
When all that could be done was done, Tiff then slowly walked over to the baby table once again, and for the first time that day, picked up little Josephine and silently rocked her little frame whispering apologies for the passing of her younger twin sister, prayers for God to watch over her, and words of encouragement and love over the little babe. As Tiff did that, for the second time that day, she silently cried over the loss of Madeline, the loss of a daughter for Masokola, and the loss of a sister for Josephine.
For a moment no one even knew Madeline existed and now our harts were burdened just knowing she was gone
Who Nose What Can Happen In a Day
It looked like it was going to be a rather slow day in the labor ward. Then again, we all know how fast that can change. After a time of prayer we set to out to do some basic checkups. There were only a few laboring women there so we were going to take this chance of a slower day to get some cleaning done.
I found a young mother who had not been attended to yet; “Jina lako nani?” I asked. “Halima Talaya” She responded under her breath as she cringed with another contraction. I took her vitals and checked her babies heartbeat, then I left to find her card among others crowded into an old box on the table. Reading what little information the card entitled I learned that this was her first baby, and she was only 17 years old, but age was no longer surprising. As a matter of fact that didn't seem so bad after meeting some 14 and 15 year old girls, or finding out that this is their second child and they had the first one was one when they were 11!
Her card stated that she came into the hospital two days before and was recorded to be at 3cm dilation at that time. Now it had been 46+ hours since she arrived and she was said to be only 7cm dilated four hours before. Halima was tired, dehydrated and only becoming weaker. Her contractions were strong but few. This was obviously a case of prolonged labor, but it had gone unnoticed like so many others. Oh how the harvest of babies here is plentiful, but the workers are very few.
I returned to her and continued to stay with her. I prayed over her and filled out paper work as I encouraged her and held her hand during contractions. I talked with her through a student nurse and found out that she wasn't married, but was engaged to the baby's daddy. I assumed that is where the small thin gold ring on her middle finger came from. Although women here, married or not, didn't often wear rings.
Within another half hour she said she felt ready to push. I started to gather the things needed from Halima's "purse"; cotton, cord clamp, oxytocin, injection needle, razor blade, gloves, suturing kit and the fact that she even brought cleaning spirits was a very nice touch. I also looked for the cleanest kangas possible to wrap her baby in. I wondered as I gathered her things what on earth a “western” hospital would do if they caught you bringing in these kinds of things. In the mean time the student nurse fetched what the hospital was able to provide- A kidney dish and a clamp.
Now my gloves were on and we encouraged Halima to push. The baby's head came good and slow allowing a good amount of stretching, and soon he was out and up on Halima's belly with a good cry! “Hongera Mama!” We all cried. She smiled big and tilted her head as much as she could in order to get a good look at her new son, although she didn't know yet what the sex was. She reached her hand out and tapped me on the arm “Asanta sana” she said and then went on to say it to all the other nurses standing by.
We began to clamp the cord but the clamp was broken, oh well it seems to happen all the time. My gloves were too dirty to use so the nurse next to me used her own, She tore the rubber lining off the wrist of her glove, but it broke, so she tore the rubber lining from her other glove, success! I held the cord as she tied it off with the rubber lining in her slippery hands and then we cut the cord with the razor blade Halima brought. I held the baby up and showed Halima the sex. “Wakika or Wakuma?” I asked. “Wakuma.” she said with a smile. And then he was sent away to be weighed and have his vitals checked.
The birth of Ishmael was a rather normal one, but after he was born, I had enough time to look up and see how busy the ward had become in only an hour. One baby was being resuscitated, another women needed suturing, a breach was half out, a stillborn was coming soon, they were trying to get a cannula into a mom for the fourth time, another mother needed a catheter, and now that my mother had delivered her placenta, she was still bleeding a lot! Who could help me in this mess. Not to forgot everything I saw happening only made up for one side of the ward, I had no idea what was going on on the other side.
I massaged her uterus, expelled colts and checked for tears. Her bleeding would not stop. I was finally able to grab a doctor and explain. He went straight away to manual removal of clots. Here you don't assume the least and climb to the worse, you take care of what could be the worse and work your way down to the least. I held Halima's hand and she bit her lip to keep from screaming as the doctors hand scraped along her uterus.The doctor did manage to get the rest out and her bleeding stopped, leaving her estimation of blood loss at 500mls. Borderline PPH.
Once all was said and done I quickly took her vital signs, sudden drop in BP and a very high pulse showed that she was going into early shock. Again I couldn't leave her and no one could help. She was tired but seemed to be doing rather well for such a long labor. So I managed to take care of what I could and that included getting everything cleaned up and her dressed.
As I was helping her dress on the bed she insisted on standing to finish dressing. As she stood up I noticed some blood on her back that I had missed and quickly reached for some cotton to clean it off, but quickly wasn't quick enough. As I went to wipe her off she started to fall forward, toward a nurse still trying to put a cannula into another women, she was fainting! I reached forward and grabbed her but her nose had already hit the metal bed frame. None the less she was caught before the damage was made worse. I laid her on her back on the dirty floor and we tapped her face to wake her as her legs were raised to encourage blood flow to her head. Before we could even bring her to waking up another student commented that her nose looked broken! Upon waking up another nurse started to ask her questions and we found out that she had not eaten in three days. Prolonged labor, borderline PPH and no food in three days! The case of this poor mother just never seemed to end.
I really didn't want to leave her, but still no one else could help. I ran and grabbed my bottle of water and brought it back for Halima. After getting her to drink a bit I cleaned her bed and got it ready to put her back. She fainted twice more as we lifted her up to the bed, but she was up none the less. In the following moments many of us tried to get a cannula in her so that she could be re-hydrated, but none were successful. So I went out to the local canteen and bought two big bottles of water and I was given two different brands. Once I got back to Halima I said “Moja mimi moja wewe.” (One for me one for you) and I let her pick which brand she liked more. I then went and got Ishmael who was sleeping soundly with his fist in his mouth and brought him to lay next to his mother. We sat next to each other as we ooooo'd and aahhhhh'd over her son and drank our bottles of water.
An hour, lots of paper work, check ups and water drinking later it was time to go. Halima was feeling and looking much stronger and she had also had a bit of food. I helped her carry Ishmael and all her belongings over to the postnatal ward. Her poor nose was still purple as could be but she didn't seem to pay any mind to it. In our parting ways I jokingly scolded her with my broken Swahili about needing to drink more water and eat more food. “Wewe maji sana chakula sana! Sawa!?” Once she got over laughing at my broken Swahili, she happily agreed to do so. “Sawa.” She said still chuckling.
Later that evening I was left wondering about the day. Wondering about how it was so great to be able to help, but at the same time I sometimes felt like I didn't know enough to help. I want over the steps of PPH management when I arrived home and realized the different steps I had missed that could of prevented some of the blood loss. I was a bit disappointed in myself for not remembering them.
During my wondering's I passed a man selling paintings, I stopped to take a look out of politeness and we struck up a conversation as he spoke English rather well.
When I told him I worked at Temeke hospital he immediately replied “Oh, you deliver babies there!” Sightly taken back by how he knew that I said, “Yes, why yes we do.” “Yes I know you do!” he said. “I have a friend who was a patient there. She went there to have her baby and when I saw her after she delivered she told me about a flood of white people that came into the ward. She said she didn't know who the people were or where they came from but all of them were kind and loving and what surprised her most was that they took really good care of her and never once asked for a bribe!”
After leaving the conversation I couldn't help but thank God for his consistent encouragement. I may not always remember every step or do everything right, but Halima didn't know that, and even if she did I'm sure she wouldn't hold it against me. At the end of the day both her and Ishmael were well alive, well cared for and very well loved!
4 Days of Life, Love and Loss
January 25 2011 – Tuesday in the labor ward
CPR baby # 1. APGAR 0-8
I initially started this blog while working overseas to keep my supporters updated, then I did it a time as a required assignment during my midwifery school, but now I write but because I want to. So now I share my current journeys, in hopes that others can learn from them, or at the least have a good laugh.