What are your risk factors?
You may have heard it before; homebirth is a good option if you are “low-risk.” But how do we determine who qualifies as low-risk?
In Florida, midwives have a list of risk factors to consider with each client before being accepted into care. Assessment of risk factors is legally required for a homebirth.
Risk factors range from 1-3 points based on severity, with one being the lowest.
Anyone with a total score of 3 or higher will need an OB’s approval to continue midwifery care. If the OB approves, and the midwife agrees to continue care for the client given the assumed risks, the plan to continue with a homebirth may continue. If the risks are too high, the OB will advise the client towards the appropriate care.
Here is the form I use that is review risk status with clients considering midwifery care
You may not understand everything on the list, but your midwife will obtain a complete health history and perform routine tests during the pregnancy to determine if these risk factors apply to your care.
There may be other risk factors present that are not listed. For example, risks can include being pregnant with multiples, which licensed midwives cannot deliver. In these cases, it is at your midwife’s discretion to determine the next course of action. Possible actions range from no additional risk to advising care with a high-risk OB.
Can you use your home?
Now that you understand how risk is determined, what factors do you need to consider with your home?
The number one requirement is that your home must be within 30 minutes of a hospital with obstetric and neonatal intensive care services. If you live in the city or surrounding suburbs, this is very likely, but a midwife will discuss this with you if you are unsure.
Another requirement is that you have running water, electricity, and general cleanliness. Not a sterile environment, bacteria are a normal part of daily life, and the risk of infection is lower with homebirths. Additionally, you are not required to have a house with a yard and a white picket fence; homebirth occurs wherever you call home, be it an apartment, condo, bungalow, or trailer.
If your home is not close enough to a hospital, delivering at a birth center birth might be advised and offers a similar experience. If a birth center is not available, there may be other options for your situation -like delivering at the home of a family member closer to a hospital- so speak to a midwife. They may have a solution to help.
The next consideration is not a requirement but a good guideline. Consider who is in the home. Are you living with family or roommates? Are you comfortable delivering with them nearby? Are they comfortable with you delivering at home? Who in the home will support you during your labor? Just as important, who will care for you -and the house- after the birth? Bed rest is advised for the first two weeks or a minimum of the first 24 hours. Meaning you need to have someone who will oversee cooking, cleaning, and taking care of any other children in the house, preferably for the first two weeks following delivery.
This last consideration may feel like an obvious one: planning a homebirth will involve no pain medication. It is not because midwives want to deny you this service. There are risks associated with pain medications, so the use of pain medications requires additional and continual monitoring, making the hospital the safest place for these to be administered.
Can you afford a homebirth?
Most midwives offer a self-pay rate, and this often varies anywhere from $5,000 to $7,500. Every midwife has different options/services included in their price. Some midwives include blood work, ultrasounds, medications, etc., while others may only offer those for an additional charge. However, the cost should cover your prenatal visits for the entire pregnancy, the labor/delivery, and postpartum care. Full payment is typically required by 36 weeks of pregnancy, so plan accordingly.
What about insurance or Medicaid? This topic can be an entirely separate post of its own; the bottom line is to ask your midwife. Some do accept these, and some do not. Midwives often want to take them. Unfortunately, many insurance companies usually either do not cover midwives or only pay a fraction of the fee.
Are there midwives who serve your area?
How do you find a midwife for a homebirth? It depends on where you live. Some areas have many midwives or group practices of midwives. Other areas have none, simply put, most midwives are on Google.
If you live in an area with a few midwives to choose from, it is a good idea to interview your top choices and choose who you trust the most. A trusting relationship is crucial to your birth. A trusting relationship means that you will trust your midwife’s guidance during your care, but it also means that your midwife will trust you to follow her guidance, and your midwife is also going to trust you when you feel otherwise. For example, if a midwife advises the client to transfer to the hospital, the client should trust the midwife’s judgment and transfer. The midwife also needs to trust the client not to risk their safety and willingly transfer. A trusting relationship also means if a client feels something is not right and wants to transfer, the midwife should respect their desire to transfer and support them during the process.
Are you ready?
There are many steps taken to ensure that homebirth is a safe option here in Florida, but no matter what kind of birth you choose, it is essential to research all the options available to you and choose what works best for your family.
Being a parent means making choices that you feel are best for your child. For example, you will make choices about dietary needs, schooling options, extra activities, etc. Every choice you make will have risks and benefits; these choices start with birth. The tricky part of making these decisions is often related to someone disagreeing with you. Educate yourself on your options, surround yourself with a supportive network, hire care providers that have earned your trust (and fire them if they break it), and get ready for the journey of a lifetime!
After writing so much about birth, I guess it is time that I write about the birth I am now asked about the most, my own. There is a small handful of women who become midwives before giving birth, and I was one of them. So, naturally the immediate question from everyone was “Sooo, how do you feel about birth now?” The short answer, I feel that I have been truthful. I have spent years telling women that it is hard (no matter how you give birth), but that it is amazing, and that they can absolutely do it!
So as we near my little one's first birthday, I will give you the story of my pregnancy and birth:
I had experienced a miscarriage four years before, after recovery took longer than expected, my husband and I decided that we would wait until I went through midwifery school to try again. During those years I happily walked with so many others through their births while awaiting my turn. I really didn’t mind the waiting, school was easier without children as I was able to fully commit myself and did not have to experience the awful “mom guilt” for being gone so much. The rare occasions it did bother me, was when I wasn’t trusted by certain clients during my internship, simply because I had not had a child yet, all I have to say about that is “Would you trust a male OB? Yes? Do you realize that they have never given birth either? Okay point made.”
Over the years helping others, I couldn’t help but envision and plan my next pregnancy. I knew that I really wanted a baby born in the month of May. This had become my obsession since the age of 16. I had a December birthday that was often overlooked, as a matter of fact it was so overlooked, that my family couldn’t even agree what day it was on. Additionally, I came from a large family, so there were birthdays every single month, except for a few, and one of those was May, so I had decided that I wanted a May baby.
Now as a midwife I try my best to help parents not become “set” on such expectations, because with pregnancy and birth, setting exact expectations, often leads to disappointments. But those who give advice, are often the worst at following it, so I had to take it a step farther. I decided to plan a “trip to conceive” and narrowed it down to one week in which I could get pregnant… two years in advance! If that wasn’t dumb enough, I made sure to pack the week full of endless flights and hiking mountains (because surely Floridians wouldn’t have to deal with altitude sickness), does anyone else see where this is going?
The long-awaited trip arrived at last! We spent a week on what felt like non-stop flights, dealt with altitude sickness, “slept” under the stars, in sub-freezing temperatures, in a tent, while sick, no we did not huddle together for warmth, our warm blooded bodies nearly froze to death while shivering in our iced over tent while we wore 10,000 layers (honestly I would have loved one more layer at the time, called a house!). We hiked, skied, played in snow, etc. (insert a bunch of magical romantic sounding stuff that was truly awesome, but also stressful and exhausting with many bumps along the way, that left very little chance of actually conceiving a bump).
We were so happy to return to our beautiful Florida weather, and by beautiful, I mean we returned just days before a huge hurricane was about to impact us, and days later, as we huddle together underneath our stairs waiting for it to pass, I cried. The pregnancy tests were all coming back negative. The whole trip, all of my hopes for a May baby, four years of waiting while taking care of everyone else, and I missed my chance. I didn’t care about the storm raging outside our windows, as a matter of fact it represented how I was feeling inside, angry. Angry for getting my hopes up, angry for doing exactly what I advise others not to do, set themselves up for disappointments.
The hurricane passed, and we were relieved to have had very minimal damage to our newly built home. I felt better after my cry the night before, and decided that I was going to hold my head high and have a positive outlook on the day. As a matter of fact, it was almost too positive. I cleaned and cooked so much my husband thought that the sudden change in emotions must have meant that I had finally had a positive test and was just waiting to give him the news, so the lack of news for the entire day confused him, but I assured him I was truly at peace with not being pregnant. That was until I decided to take one more test.
A past client had donated one “fancy” type test to the birth center I was at. She said she couldn’t remember if it was a pregnancy test, or an ovulation test, and it wasn’t labeled, so the midwife gave it to me in the months prior, which is why I hadn’t used it, but thought “Hey, I guess I’ll at least find out what kind of test it is”. Turns out, to my absolute surprise, that it was a pregnancy test, and it was positive!
Only ten months of pregnancy ahead....
The practice of waterbirth has always been, to me, the equivalent of a mother choosing which position she desired to labor in. I had not realized until I became a student midwife that not only was there additional benefits to choosing it, but that there is also some opposition against it. Naturally, as a student, I was intrigued to learn what the known benefits and risks are, and why is there opposition against choosing waterbirth.
I started my research by reading the American congress of obstetricians and gynecologists (ACOG) committee opinion on what they referred to as “Immersion in Water During Labor and Delivery” aka waterbirth. Of course, I read it with my water birth experience in mind, so I was finding it very interesting that the complications ACOG was referring to occurring more during waterbirths, I had yet to experience. Although their evidence was very slim, they explained their findings in a way that suggested care providers avoid waterbirth. Still, even ACOG had to admit that “There are insufficient data on which to draw conclusions regarding the relative benefits and risks of immersion in water during the second stage of labor and delivery.” Still they continue with “Therefore, until such data are available, it is the recommendation… that birth occur on land, not in water.” So, their stance is, we cannot prove it is unsafe, but let’s not do it anyways since we didn’t see great benefits in our hospital trials.
The unfortunate part, to me, about ACOG’s statement was that it would turn care providers away from offering waterbirth, and women away from choosing it. Speaking from personal experience as a doula, I had so many clients go on hospital tours in which they would be shown the bath tub and told that the hospital offered waterbirth, yet time and time again when it would come down to it, clients would have to beg the nurses to allow them into the tub, where if they were allowed, it was only for a limited amount of time and they were always told that birthing in the tub was not allowed. So, I know that even though clinical trials were done in hospitals to determine the risks and benefits of waterbirth, the hospital setting also carries a very different mindset on waterbirth which makes it difficult to accept, and therefore the care during waterbirths is different as well.
A prime example of the care affecting the outcome is how ACOG referred to an increased chance of Umbilical cord avulsion (cord “snapping” or cord rupture) as the newborn is lifted or maneuvered out of the water. I see this as an increased chance in the hospital trials because the care providers are so focused on bringing the neonate out of the water quickly following the birth, that they do not take into full consideration the possibility of a short cord. I know this feeling myself, because as a beginning student, I too use to rush to bringing the neonate up immediately after the birth, which in most cases was fine, but sometimes if the neonate was tangled in its own cord I would struggle with bringing them up and then trying to unravel them without letting them become re-submerged. Thankfully my preceptor taught me patience with this and how to unravel the neonate from their cord while still submerged. Once I discovered this and became comfortable with the practice, I desired for more mothers to choose waterbirth and I found managing tangled cords was a breeze in comparison to delivering on land.
Although ACOG was willing to take a step forward to consider the benefits of water birth, their research provided was quickly analyzed by the American Association of Birth Centers (AABC) and Evidence Based Birth. AABC not only analyzed the ACOG trial, but also collected their own data on waterbirth in the birth center environment. AABC’s data demonstrated that “Water birth, with careful selection criteria and experienced providers, does not negatively affect mothers or newborns…. The claim that water birth is dangerous for mothers and babies is not based on prospective population data with skilled birth attendants, but on negative outcome case reports or individual case outcomes reported in a large surveillance study from another country.” Furthermore, Evidence Based Birth went on to prove that ACOG’s evidence was not very accurate “The literature review in the opinion statement was outdated and did not reflect current evidence. Out of 29 references, only six were from the past nine years (2005 or later).” (Evidence Based Birth)
With all the research taken into consideration and including my own experience, I fully plan on keeping waterbirth as part of my practice and I will continue to consider it safe for low risk mom’s and babies. Still, I do believe that having a protocol in place is best to decrease the chances of unnecessary interventions and emergencies. So, I have created my own protocols based on experience.
Non-reassuring fetal heart tones:
Updated to state that I went on to have a beautiful & safe waterbirth of my own in May of 2018.
What I once thought would go on forever, ended almost as suddenly as this very second, or so it felt. Now: Each day gives reality the weight needed to sink deeper and deeper into my heart, and it manages to find places so dark I nearly lose myself in it many times. To sit down and think about one's life is a challenge, to think about the lives you have changed is greater yet, but to sit down and realize the lives that have changed yours, well that, for me, has been life changing.
Each day was so different, yet looking back they all blur themselves together, as if it were all just a dream. You wake up to find the people that were in the dream are nowhere around, and those who are now around you seem only to be happy that you are awake. But in those fine moments of awakening, you can't help but wonder, “Was I really dreaming? Or was my dreaming really real!?”
It was our last day in the hospital, and I was assigned to the admissions ward. Work was hit and miss with the admissions ward, some days you never sat down, other days it seemed sitting was all there was to be done, but this day was different, it was like one of those sweltering summer days that begs to differ the very existence of snow ever falling on the same land. The thought of having nothing to do on this day laid only in the minds of those who could not think.
Multiple women on beds, many on the floor, and more were coming in. The few doctors there looked like octopuses, in my mind, as they were moving so fast I could hardly count the amount of hands they actually had. Young student nurses ran around busy as ever but always seemed to have the “deer in the headlights” look about them as they had almost no supervision and nearly everything they were doing, they were doing for the first time. We stepped into the middle of it all. Those of us, who were not taking orders from the doctors, were giving orders to the student nurses.
With just a few moments to asset each situation I managed to work my way towards the examination room. I pulled the green stained curtains back just enough to get in and asset any situations inside. Two metals beds, one empty, the other with a mother lying alone. I first saw her eyes, they were dark and distant. She stared at the wall continuously as if I hadn't even entered. I followed her eyes down, her sari modestly covered her chest, but her legs were open and bare for the world to see. And there, just next to me, a site I had seen too many times before. A baby, a little girl, tiny, limp, macerated. Lying in her mother’s fluids, and alongside her a placenta as black as death itself.
I'm sure the mother was waiting for me to slap her around and sweep the baby away just to get her out of the room to make way for the multitude of women in waiting. But no, I ran to her side and grabbed up her hands in mine. We didn't share the same language, but I spoke anyways. I prayed. She had no idea what I was saying, no idea who I even was, we were strangers in every way, yet after just a few words, she clang to me. She gripped my hands tighter and tighter with every word, and then she cried. She didn't dare let me go, even as I checked her vitals. And I was with her as we watched a cleaning lady put on one glove, and toss the baby into a cardboard box as if it were meat to go out to the trash. I ran my fingers through her hair, gave her a kiss on the forehead and then with one last prayer I pried her fingers from me, and walked away. Back to my duties, for I had only been there twenty minutes.
I pried my fingers from the grieving mother I was with because another mother was being placed on the empty metal bed next to her. Normally I wouldn't leave one women for another so quickly, most of all one who just lost her baby, but this new mother was seizing and I was needed to help hold her down. She was so young; her baby bump was very elongated and easy to hide behind a sari, which was surprising for her small figure. As I held her down her skin felt to me hotter than the temperature of the day, which was exactly the case. Her seizure was being caused by a fever of 106.2 F. As she was held down by my instructor Rachel and I, we called to the doctors for some medications to bring down the fever, but the doctors ignored our calls in the misted of the chaos. After the mothers seizure ended, Rachel left me and another student, Lindsay, to care for the mom as she went to get the needed medications herself. The mother was unconscious at this time, so I left as well to gather up some cleaning rags and a hand washing bowl. I rinsed out the bowl and rags as best as could before filling it with new water. I rushed back to the moms side where Lindsay and I started placing the few rags over the mom as best we could. It was at this time that we noticed the moms belly was tightening, and then relaxing… she was in labor.
Rachel returned and administered the medications as we let her know that the mother was in labor. So she slipped on a glove and checked the mother for dilation, she was a full 10cm! I immediately checked for the baby’s heartbeat. After a quick palpation and some moving around of the pinard, I heard the sweetest sound, the song to midwives ears; a strong heartbeat! As I lightly nodded my head to the beat while watching the seconds of my watch tick, my excitement changed. The baby’s heart rate was pushing 176 BPM. If this baby was going to have any chance it needed to come out now! But with an unconscious mother, no amount of fundal pressure was going to get the baby out soon enough.
Rachel grabbed the attention of one of the doctors and upon explaining the situation asked the doctor to please bring the forceps and deliver the baby. The doctor looked at all of us trying so hard to help this one woman and said to us “Look, this is a waste of your time. This girl is 17 and no one in her family knows she is even pregnant. She lives alone with her father as her mother passed away many years ago. Her father will beat her if she returns home with a baby. She is better off if the baby dies.”
We didn’t become upset with the doctor because we knew too well how this was normal for their culture, but we also were not going to let the culture be the reason why the baby lost its life. So we didn’t give up. Rachel asked every doctor there, she even asked to perform the forceps delivery herself. Meanwhile she continued to find medications as needed, and I continued to refresh the water and rags as much as possible as Lindsay stayed by to help among helping as many other women as possible.
One hour went by... Her temperature had dropped to 105.4 F and the fetal heart rate was 172 BPM.
Another hour... Temp was now 104.8 F, fetal HR was 168 BPM
Another hour... Temp: 104.2 F, FHR: 132, Mother was still unconscious.
After three full hours we had not left her side. There was so much work to be done that Rachel convinced the first doctor we asked that if she would just deliver the baby that we would move on to help with other things. So the doctor agreed to help us. After all, if the baby was still alive after this long there may be a better chance of survival than she had originally assumed.
In preparation of this forced delivery we all gathered around and positioned ourselves so that we could hold the mother in place, pull back her legs and apply fundal pressure all on the doctor’s command. Before beginning, the doctor reached inside the mother to manually break the bag of waters. As the bag of waters broke the doctor yanked back her hand and started shaking it as if she had just touched a hot stove. The yank of her hand was followed by a think yellow fluid that steamed as it spilled onto the metal bed; meconium. FRH: 122… and dropping fast. Through a mass amount of teamwork the mother was pushed and pulled until the doctor was able to bring out a beautiful baby girl with a head full of dark dreamy Indian hair. I took one look at her and called her Jina.
The name Jina had two meanings. In Tanzania Jina meant "Name", and in India I leaned from one of the nurses that it meant "Loved". If anyone deserved to be loved and given a name, it was this little girl.
We cleaned her and suctioned her as best we could, but her heart rate was now only 96 and her limp body refused to breath. Rachel and I immediately began CPR as we prayed over and over for the life of Jina. Her heat rate continued to drop as her unconscious mother was being stitched up. After five minutes of CPR Jina’s heart was now beating at only 60 BMP. By 10 minutes, only 30 BMP.
At that moment the cleaning lady came in and motioned for us to give her the baby. As Rachel handed her Jina she explained that the baby was still alive and that it needed to be taken to the NICU; which in this case was a long walk up three stories and on the other side of the hospital. The cleaning lady bobbled her head and giggled at us -as they often did because she most likely didn’t understand a word we said but found our American ways funny-. She walked out of the ward with Jina held up over her shoulder in one hand and a bucket of cleaning supplies in the other. I never saw either of them again.
The mother was cleaned up and left alone as we went on about finishing up our work for the afternoon. In just a short while the workload slowed and it was time for everyone in our group to leave. As our last day at the hospital; we never saw the mother regain consciousness, and although presumed dead, I never saw Jina again.
I couldn’t imagine what it would be like for the young mother to wake up. One moment hiding a pregnancy, the next moment waking up in pain, without so much as one look at her baby. Whether she wanted the baby or not, I knew there would be no support for her. No one to tell her what happened, and no one to tell her how beautiful Jina was.
Had Jina survived and the mother been conscious, and still not wanted her, I would have certainly adopted her. I often dream of what my life would like today if I had a beautiful little girl from India.
The story of Jina doesn’t stay with me because it was tragic; it stays with me because it reminds me every day of what God has created me to do, to love those who may not understand love and to fight for those who cannot fight.
Nireekshana means Enduring Hope
Nireekshana clinic. It's an HIV and AID's clinic run by a wonderful couple who truly have God's heart for their own people, and many others. Simply put, the group of retired doctors and volunteers spend each day giving hope to some of the thousands of people that walk through their doors each month. They listen to their stories, counsel them, provide the medications needed and lavish God's love on them so that the people can live better, longer lives and continue caring for their families. And if they’re not in the clinic, they are going out into the communities.
The clinic is located just a mile or two away and has worked with BAS many times before. So as we are here again we were invited to come and do some teachings. We gladly did, many times. The second time we went they had gathered a whole group of children from the community, about one hundred in all. We joined the clinic staff in morning devotions and then lead all the children in worship. Girls sat on one side, boy's on the other, small children in the front, teens in the back, and they all raised their hands in praise.
Soon after worship is was our turn. We taught them all about keeping clean and the huge importance of washing ours hands regularly. We preformed dramas, used props and sang our little hearts out along with hand motions and all the kids joined in. As the morning faded into noon the older boys and girls were split up and the younger children sent to color. Emily and I followed the younger ones. After tracing and coloring our hands and many smaller ones, we helped each child wash their hands and served them a lunch of rice, curry, and boiled eggs. Once the children were served, we enjoyed helping ourselves to the same.
Tummy's now full we parted with the small children and joined our other teammates huddled into a small office room. We were going over our teachings about changes that happen in a girl’s body as we waited for the group to come. Before the girls could come in, the head madam came in. We gave her an outline of what we would be teaching and she was very happy, than she added “But I would also like you to talk about sex. You know, talk about how it is a gift from God. And also talk about abuse, when sex isn't good.” “You want us to tell them about sex? Isn't that something they learn from their moms or at school or something?” “Nope, they don't often find out until they are married off, and then it is quite shocking.” Everyone in our group was quick to set our eyes on our two married team members, Jenny and Louise “Well okay than, I guess we will teach them.”
Within just a few minutes the room filled to the brim with young girls from 12-18 years. We taught about physical changes, periods and yes we even taught them all about sex. Each wide eyed girl paused to let their jaws drop a bit as they were eating their small bowls of ice cream when Louise explained what sex was. During the teaching Emily shared what the bible said about how they were knitted together in their mother’s womb by God, how each one was created in his image and he made each one to be different. She shared about Jesus loving them so much that he gave his life on the cross as a bride price for them, and then rose again just to be able to be with them and love them. When she finished speaking she asked if any of the girls wanted a relationship with Him.... Ten girls raised their hands!
We prayed with them and introduced them to adults and other girls that would be able to answer more questions, then continued on with our teachings.
When we were all finished we asked the girls if they had any questions... they said nothing... We asked if had had learned anything..... silence.... “Anything? Did you learn anything new at all today?....” One small girl mumbled in a small voice to the translator, the translator looked at us with a beaming smile and repeated what the girl said. “It was all new!”
Ugh... my eyes slowly opened as my body awakened to the sound of the church bells just outside of our third story window. I glanced at my watch, 6:00am. Every morning without fail the loud bells rang in my ears. I rolled over and placed my pillow over my head in attempt to drown them out... 7:30am, I forced my eyes back open only to wish I could close them a little longer. I looked over at my bible that was covered in dust, I laughed to myself thinking about how some might see that and say I was a “bad Christian” not reading my bible, but really all the dust had settled on it overnight as it rolled in our bare windows from the flat roof top. “Not right now” I thought as I drifted back off for just 10 more minutes of sleep.
Once up I gobbled down some breakfast over our team meeting/morning announcements. It was decided that we would all spend some time reading God's word together rather than worship in song this morning we stared reading in Isaiah... “You will run and not grow weary; you will walk and not grow faint...” One girl read. “Oh God...” I thought to myself, “My run has turned into a walk and I feel as if I am growing faint, but I can't stop yet. Please give me strength for today so I may care for your children as you would.”
An hour later I found myself in the familiar feeling of my shapeless light blue uniform, gum drop boots and gold striped pants peeking out between the two articles keeping my knees covered. “Well girls today is only a half day so we will be leaving at 12:30pm.” Rachel, our staff, said after we finished praying over the day amongst other student nurses in the room. We let out an exhausted cheer and filled our pockets will all things needed.
As soon as I stepped into the left side of the labor ward I went straight to sorting out what was going on in the misted of what most would consider utter madness, well pretty much because that is what it often was. I started by stopping by each mothers bed side, stroking their hair and smiling at them. I would encourage them and ask some questions, it didn't matter that I could not speak their language with words, I had learned to let my actions speak for me. “Kaitlin! A mother over here needs her blood drawn, will you come take it?” Hmmm one of my favorite things to do, how could I say no, so I went right away.
We crossed the bustling hall to the right side of the labor ward where it was often far less busy. Many laboring women where in there but only one was near delivering and next to her stood an audience of student nurses, one of whom would be delivering her baby. The student nurse stood by the mother, average height and rather boney she held her sterile gloved hands together tightly in anticipation of the next coming moments. As I walked by she stopped me “Excuse me ma'am, could you please help me help this mom bear down?” This kind of question would have surprised me at the start of the week as the student nurses often were more in the way than of any help, but as students ourselves we had taken them under our wings knowing if there was going to be any change in the healthcare system, it would come through them. I instructed a student standing by on how to help and let them know I would be there to assist once I finished my task at hand. It was amazing to see that now by the end of the week the nursing students ate up every chance to learn from us and often asked us to help conduct them through their deliveries.
As I returned from handing the blood over to the doctors I took my place next to the mother and started to help her, student nurses joined in right next to me by fanning the mother and giving her water between contractions. As I helped the mother I also instructed the student conducting the delivery. “Okay good, now guard her perineum with your other hand, yup just like that...... okay the head is out now, check for the cord around the neck. Cord? Yes, okay now....” Once the baby was out and whisked away to the newborn room I taught the students how to check for tearing, once we confirmed it was a 1st degree tear I had a line of students asking me to teach them how to suture too.
I left the students to make sure the mother was cleaned up and prepared for suturing as I went away and confirmed with my staff that I could teach them. Once I returned I found the mother cleaned up and ready to be sutured, but no students were anywhere to be seen! I let the mother know I would be back and made my way out of the ward to find where the students had disappeared to. On my way out I noticed an older women sitting on the floor with her very pregnant daughter lying next to her. “You okay?” I asked the daughter as I stroked her arm, she bobbled her head and said “Scan.” as she pointed to the ultrasound machine. I noticed there were no doctors around and she was waiting to be checked. Her mother next to her started to ask me something but having no way of being able to understand her I just assured her that a doctor would come soon to take care of them and with that I was out the door.
I found a group of nurses enjoying their lunch in the changing room and wanted to scold them about leaving the mother alone, but then again all the students looked the same to me and I wasn't sure who to scold. So I grabbed my water and left to return to the mother still waiting to be sutured. As I re-entered the right side of the ward I saw the mother still sitting there with her daughter as I had left them and again she started to ask me something bobbling her head speaking almost in a whisper. Her daughter was resting next to her and like a good mother she was calmly sitting with her just waiting until she would be checked. You didn't have to speak the language to be able to tell that much. So again I assured her that the doctor would come soon. But before I could turn and continue my duty the mother took the courtesy of lifting her daughters dress, I guess soon wasn't going to be soon enough for the doctor to come, the baby's head had already crowned, and I was the only one in the room who could do anything about it. So much for stereotyping people, I thought everyone would find a baby's head coming out to be rather urgent, guess not.
I called for my staff but she was unable to hear me from her crowded side of the ward. A student turned the corner and I noticed her jaw drop at the sight of me delivering a baby on the floor in the door way. “Get me a birth kit!” I instructed her... she didn't move.. “A BIRTH KIT!” I shouted. She turned and ran to grab it hoping not to miss any of the action, and she must of spread the word along the way because she returned with the birth kit, and the whole group of students that had previously disappeared. By now everything that needed to be done was well drilled into my head as I didn't even give a second thought before I had my gloves on and the mothers dress all the way up. After some struggle in communicating I managed to get the mother to set behind her daughter and help her.
I was glad to see Beth come in along behind them as she is one of my team mates and she knew our protocol. She helped me with crowd control by giving farther instructions to the students and I was able to fully focus on the coming baby. The mother and her pushing daughter seemed to be more focused on me than the baby as they hung on to my every word trying to understand and obey my every command. Without a single noise from the daughter her son slid out. He was a bit blue and not too keen on crying, but after some back rubbing, feet flicking and nose sucking he let us know that this wasn't his idea of a great birthday party, and we agreed.
As soon as he was taken away I took a chance to stand and relive my back, as I did so I noticed the warmth I felt on my knees was not the floor but rather a large puddle of amniotic fluid, and what parts of my uniform were not soaked in her fluid were soaked in my own sweat that had been pouring out of me since the sun had risen, really I could not make out where my fluids stopped and hers stared. But not to worry now, I knelt back down into her fluids and delivered the placenta.
-Now at this hospital it is protocol that ALL primi's (First time moms) have an episiotomy done when delivering, and not just any episiotomy rather a 4cm (almost 2 inch) episiotomy. But when we are in charge of a delivery we avoid it as best as possible as it is more often than not unnecessary, but getting any of the doctors to understand that was not very easy. - So by now all the action had attracted the attention of one of the doctors who now stood near. “You need too suture for episiotomy?” She asked. “No Ma'am, I did not give her an episiotomy.” “But is she not a primi! What degree is her tear!?” She looked at me almost scared to hear my answer. “Yes she is a primi... but there is no degree of tear. She is perfectly intact.” The doctor stood in wonder for just a second as every student nurse stood by with gaping mouths. “Well I guess you will not suture than.” With that she left to continue her work, but the students still stood with their mouths gaping a little longer. Had they just witnessed a miracle?!
The cleaning ladies would not let me care for P. Rajini any longer there, so we had to move her to a bed next to a still laboring mother. I cleaned her up as best possible and had just started to take a second set of vitals when I heard Beth speaking, and she sounded worried. I looked up at her just pulling her head from her fetal scope pressed against a mothers protruding belly. “The fetal heart rate is very slow, and dropping. This baby needs to be delivered right now!”
Beth began to get everything ready as I ran to get our staff Rachel. We soon returned. “She is fully dilated, but I know her perineum will not stretch enough and certainly not soon enough. We will have to do an episiotomy.” But I had just looked, there no scissors, no cotton, no bulb suctions well not much of anything to work with really. So Rachel left to find some in the sterilization room and returned successful.
With every contraction we encouraged the mother to push, but her tries were not getting the baby's slowing heart beat out any faster. She was very tired and didn't understand how to push. Beth prepped her with lignocaine and on the next contraction picked up the blunt scissors and began the episiotomy. It started small, but the baby's head would still not come, she cut a bit more, but still no head, the mother just could not push the baby out.
I poured water from my bottle into the mother’s mouth between every contraction and pleaded for Jesus to give her the strength enough for just a few strong pushes. Rachel cupped the mothers sweating face in her hands and looked right into her eyes. “Mama your baby could die very soon if it doesn't come, please mama you need to push.” As soon as Rachel let go of her face her head landed with a thump back onto my shoulder as I held my arm behind her. I realized then that God had given her strength, it was us.
Rachel grabbed the Doppler again.... Heart beat slowing and fading. “This baby has to come right now.” We gave each other a quick glance, Beth standing with her hands guarding the mothers perineum, Me standing behind the mother helping her sit up and Rachel standing the in middle at the mothers side, nothing had to be said, we knew what had to be done next. As for the mother we reverted to the one thing that makes us feel more useful when we couldn't communicate and no one is around to translate.... We started to speak to her in Swahili.
I pushed the mother into an almost upright position and held her rag doll body up as I crawled onto the bed and emptied my over filled pockets that hinder my ability to sit. I wrapped my arms under hers holding her as if I was a lifeguard rescuing someone from behind. I pushed against her back with my chest and stood on my knees. I pressed my sweating face against hers I started to pray quietly by her ear as the next contraction rolled in. “Nooko, nooko, nooko, nooko...” we all started telling the mother together. As I held the mom up and Beth waited for the baby's head to come down Rachel got onto the bed as well and pressed her hands to the mother’s fundus with all of her might and body weight.
After three contractions with us pushing for the mother the baby's head appeared. Cord wrapped around his neck was clamped and cut as hospital protocol and with that the rest of his limp body slid out. We prayed as he was rubbed, suctioned and flicked... nothing... “Heartbeat?” I asked. Beth moved her two fingers to his small chest... “Yes!” He was rubbed, suctioned and flick some more, his eyes opened, and his small lips followed as they parted to let his cry past his lips.
We all let out the breath we had been holding. “Mama your baby is going to be ok!” We showed her the sex and after confirming with us that she did indeed have a son I laid her back down on the bed and took the metal pan from Beth that held the small boy's slippery body. I walked quickly down the hall to the newborn room, on my way I told the madams the name of the mother and they turned to jot it down in a book that is the size of the book of life. There was a lineup of babies. “This one needs oxygen!” I stated and so the other metal pans with babies were quickly moved to make room. He was weighted and I shouted the weight to the madams still jotting information down in the book of life.
I removed him from the cold metal pan and wrapped him in a blanket that was soaked from the blood, vernix and meconium of other babies. I grabbed the oxygen tube and turned it on, holding it close to his nose I noticed the student nurses standing with the baby next to me were just playing with the baby and not taking it from the metal pan. I grabbed the baby's pink tag from its wrist and saw that it had been born twenty minutes before. “Why do you still have this baby in this pan!? Go to its mother's family and get it a blanket now! Can you not see its hands and feet are already blue!?” “But it has no family here.” said one nurse said without moving. I Looked back at the baby's tag and pronounced the mothers name and allowed the students to correct me. I handed the oxygen tube to another nurse and left the room.
At the end of the hall I pulled the curtain aside to expose the crowed of women waiting. As soon as I said the mothers name I immediately caught the attention of three women. “I need a blanket!” I told them... they didn't move, but then again I didn't expect them too. I acted out a cold baby and tugged on the fabric of their clothing until they understood. They left quickly to retrieve one for me.
As I waited, a whole crowd of women fought for my attention asking me about their daughters, did they have their baby yet? Was it a boy or a girl? I didn't have to understand the language to know what they were saying... but then again I delivered a baby on the floor last time I thought that. “Only English.” I said and that was enough for many of them to lose hope in asking me more questions. Then I was grabbed and pushed out of the door way by a doctor in a rush. “Don't talk to these women!” She scolded me “You cannot tell them anything so get out of here!” I knew full well that it was illegal to tell the family members anything here and more than anything you NEVER, Never, never speak about the sex of the baby to them. I tried telling the doctor I knew that and I was only waiting for a blanket but she just pushed me back farther and said again “Don't talk to them!” And then she pushed past me and entered the labor ward behind me. Just then the three women returned to me with a towel and I walked away with it ignoring all questions they had.
I arrived back at the newborn room and wrapped the little girl in a blanket before handing her to the student who looked rather ashamed for lying to me about the baby's family not being there, really she just had not asked. The student buried her eyes into the baby's just waiting to be scolded as her instructor would of done, but I was not her instructor really I was only a student myself who was blessed to have grace in my mistakes. “Hold her close and keep her warm.” I said with a smile and turned back to continue giving oxygen to the baby boy.
After taking multiple sets of vitals, expelling clots, assisting with suturing, fanning women with glove packs, answering student’s questions, taking pictures of hand written documents for the paper work that would follow later and doing full baby checks it was then time to go. We changed out of our uniforms, pried students off of us, and went out to the street to argue with each rickshaw driver till we find one would not overcharge us for being white women. Once home I found myself dragging up the stairs just to plop down in a plastic chair and hold tightly to a box of juice. It was just after 3:00pm.
“So much for leaving at 12:30 today huh?” I mumbled to a fellow student plopped in the chair next to me. “Yea so much for that.” feeling every part of my body groan as I stood up, “Well breakfast was eight hours ago, who wants to get some lunch?”
Beth and I soon found ourselves sitting in a restaurant surrounded by only men. We ate the fried yellow rice and orange colored chicken as fast as our right hands could before slumping in the hard bench to let our food digest for just a minute before leaving. Both of us were exhausted. We chatted about the stress of the day, the demand of work and counted down the days till we had real beds and good food again. But then again we walked away from work knowing we made a difference. It was days like this that put us on the edge of our seats and made life an adventure. I smiled, “It's been a wonderful day to whine.”
1. To cease or fail to remember; be unable to recall.
After months of excitement, adrenaline and living out an anything but ordinary life, you almost forget that the things you go through on a day to day base are not considered normal. Things like having buffalo milk with your breakfast, bartering for your every need or finding it so romantic when you meet a couple who married out of love instead of being arranged.
You almost forget that ants and mice don't actually belong in the hospital, roaches and mosquitoes in the bathroom, or cat sized rats in the kitchen. And too think that there was once a time when the world wide web was right at your fingertips, you could look up a recipe and be whipping it up in your kitchen within just a few minutes, or the local store would always have everything you needed at a fixed price, seems just out of this world.
You almost forget that in some places in the world people wait at cross walks, find it rude to eat with their hands or actually walk outside wearing shorts and tank tops without feeling completely naked. You forget that some people can actually control the temperature of the air in their home, flush toilet paper (if they even use it) or put their clothes in machines for washing and drying.
You almost forget that churches actually have an ending time, babies can have blond hair and raw vegetables are safe to eat. That beds come in more sizes then single and in softer densities than rocks, and that it is not normal for men that you have never met to be hollering out marriage proposals to you from the streets.
You almost forget that people have their things in closets and drawers rather than a suitcase under their bed, and that there are fancy kitten calendars when you are marking off the days on one you drew out yourself. You almost forget that photo printing comes in more resolutions then just grainy, daily power outages aren't part of everyone’s schedules and work is something you actually get paid to do.
You almost forget that women are valued, abuse is not part of a normal conversation, families are excited to have baby girls and mothers can choose things about their labors like where they want it , who they want to be there, or if they actually want drugs or not.
You almost forget that some things use to be considered common since like keeping babies warm, or your hands clean. That doctors don't normally beat their patients, dead babies aren't always left out in the open and that you should be able to walk past the bathrooms without holding your breath. That anyone could ever understand your language, clean water was always available and waking up in a pool of sweat was not part of your daily routine.
But even when my memory fails to remind me about what life on this earth use to be, I realize there is one thing I have not forgotten and now find it impossible to ever forget, this is that God, my almighty and loving father, is here just as much as everywhere else, He is here. He loves everyone in this place; He loves to bring life in every corner of his earth. And he wants everyone to know his unfailing love and that He created all of them out of His image!
When you hear the first cry of a newborn, it is impossible to forget. When you see the change of heart in a doctor, it is impossible to forget. When a woman is valued by a man, it is impossible to forget. That life on this earth is a gift and God is calling all of us to gather children for his coming kingdom.
We leave India in just 39 days now, and Tanzania has already past. My time here will end soon and my heart is being torn in so many ways. I could make the choice to stay, but God is calling me home as I have promised I would do so. But no amount of words will ever be able to explain everything that has happened on this journey, no amount of pictures will ever be able to show what I have seen, no amount of understanding will ever be able to understand the life and death that I have held in my hands and although I have family I have never met, I also have a new family that you may never meet. So as I step off the plane home, may culture shock greet me well.
1. an exciting or very unusual experience.
We have now been in India two weeks today, and that means two full weeks of twist turns and plenty of adventure!
Things I love:
Things you live with:
This month started by sending our team into a sprint for the Tanzania finish line as we will be leaving for India on March 20th. But before we started packing up or saying good-bye, we set out for one last big African adventure! Our team split into three groups and set out in different directions, one stayed on base, one went to Kenya and one went to Zanzibar. I was with team Zanzibar!
After a little boat ride across the sea we arrived to meet some lovely new faces of a missionary couple, Ron and Carol. After a crazy list of events we were finally meeting these amazing people who were now able to connect us with a group of TBA's (Traditional Birth Attendants). After a nice chat over the first slice of pizza I have had since leaving America, we went back to our rooms located in the building that was the world’s last open slave market. Too tired to bother showering in the hotels shared bathroom we turned on the fan and crashed underneath our holy mosquito nets onto the lumpy pillows and fell fast asleep.
We started the next morning bright and early. The hotel served us one egg and two pieces of toast along with some fresh mango juice and then we piled into a van with closed windows and no AC, and after a few short pit stops we were on our way! For the next while we passed by the sights of the ocean, forbidden islands and then into the jungle where the road was lined with thatched huts and endless trees of every kind. We arrived at a small school where we found a group of beautiful women waiting for us.
There were almost forty women who came, many walked, some cam on bikes, but most of them traveled for many miles to come, but all seemed to be just as excited to be there as we were. We gathered in a classroom that consisted of nothing more than tables, chairs, a chalkboard, and bars on the windows. They were all provided with some paper and a pen for taking notes, but most were illiterate. Before we started our teachings, we wanted to know how much they already knew, so each women took a turn standing up and stated their name along with their age (if they knew it) and how long they had been a midwife along with where they were trained. Out of 38 women maybe only five had had some kind of training at a clinic, but most had learned from their mothers, grandmothers or just on their own. They ranged from 20 years old to 80+ and from one year of experience to over forty. After hearing this we wished that we could sit down and let them teach us!
We only had the day and a lot to teach, so we got started right away. We taught on the changes in pregnancy, ten danger signs in pregnancy, how to deliver the placenta and stop bleeding and what changes after the baby is born. We used water balloons, coloring pages, cut outs we made and videos on our computers. We acted a lot and taught as much as we could in the little Swahili we knew although we thankfully had a wonderful translator. We took a brake to pray after the first teaching as every woman there was Muslim, and later stopped to enjoy a lunch of beef and rice with them as we all sat on rocks in the shade together. At we sat there enjoying the company of these women Beth summed up just what we were feeling, “Ladies I believe we are living among legends right now.”
When we got back to teaching in the afternoon it was obvious that no amount of our acting could fight the sleepiness the class was beginning to feel after a good lunch and the heat of the sun. So as soon as someone was caught dozing the whole group was summed to stand up, and then someone would start a song and they would all follow out in singing and dancing!
The day was certainly one to never forget, but everyday ends someday and so after they each reported to the missionary couple we were with, they were restocked with new birth kits consisting of two pieces of string, a razor blade, a plastic mat, a pair of gloves and a little sheet of pictures showing them how to use everything and dispose of it properly.
After an evening of more adventures and laughter, we headed back to bed and prepared to leave for Tanzania again in the morning thus bringing us to the end of our time teaching in Zanzibar!
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
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.