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!
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.