It is now 3 days until I fly out of Davao City to Manila and head out across the ocean towards home. On my Thursday, I am spending the night in Manila and my plane leaves at 8:15 in the morning for Portland, OR. I am so much looking forward to being home. Words cannot express what my stay here has done for my ability… my thoughts about catching babies and about myself and my limitations. And yet I am so very, very anxious to be home and settle into being wife / mommy again. Nothing like a little time away to help me reflect and decide what I want to do differently for the better!
Much of my afternoons lately are spent doing postpartum exams and newborn exams. I am the last intern to leave and so I get all of the postpartum and newborn exams everyone left behind. So that is good… but sometimes I have them lined up pretty deep waiting for me.
The clinic was pretty busy… yet I am so tired (always am) Yawn….so I decide to take a quick nap on the bed below, just taking a “short nap” before some of my mom’s were due in for postpartums. 1 hour later, I awoke with a start to find 4 pairs of dancing, laughing eyes holding babies looking at me. All my postnatal moms had decided to show up at once and there I was snoozing away for over 20 minutes with them sitting within 3 feet of me, quietly waiting for Punta midwife to wake up! I am sure I had sleeping lines on my face and probaly had my mouth hanging open or drool or something. They are always so polite…
I only have 3 more shifts left, and I need 3 more births for the 17 complete handles required for my Associaiton of Texas Midwifery school I am going through. 3 more additional will be at home with Joyce, as they need to be continuity births from 15 weeks on until birth and then 6 weeks afterward. I have way over the 40 I need for Montana. And way over the amount of prenatals and postnatals and newborn exams for everyboby, which I am very thankful for. So, whether I get the 3 in the next few days, is not a terrible big deal to me, as Joyce and I have more births this year yet too.
Last night I had night shift. I was pretty tired and so I went to sleep on the bed above… see my pillow! This is where I hang out a lot when things are slow. Suddenly the guard calls “Labor!” Up I jumped! A mom had just come in the gate, after getting out of a Taxi, by the road and could hardly walk. Her bana was trying to support her as she walked. I had my clinic shoes on, so I didn’t go out and help support, but somehow she made it to the doorway. We then hustled her over to a bed… ( I am still walking in my sleep). Sure enough, she wanted to push. The baby’s head was visible. Once again, I yanked on gloves, wheeled the birth cart over, and someone else got oxygen and pitocin. We did get heart tones and they were very low. I stimulated the baby’s head and urged her to push harder. But not too fast… we don’t want to rip. 8 minutes later, from the time she entered the door to the center, she was born. As the baby’s head was crowning, the cord appeared on top, so I looped it over the head to the side, out of the way. So it turned out that she had a nuchal cord that was between her head and the canal and had slowed the oxygen down getting to her. She was very dusky and slow to start…. I always hate that…( I was awake now!) Anyway, after a few resuscitaiton breaths with oxygen and blow by for awhile, she perked up good enough. She was also a big baby. It was big baby night..
The baby before that same evening, had really stuck shoulders. It was the typical slow to progress labor that these bigger babies that are having a hard time descending into the pelvis have. It took her forever to get from 4 – 7 and then another forever to get to 7 – 10. The head was asynclintic too, sort of chin tucked way down and off to the side. The head came out dark blue and then retracted in a bit against the perineum. Uh oh… We tired briefly to get baby out and realized that the shoulder was pinned under the pubic bone. Elizabeth held onto the baby’s head, as I quickly brought mom’s knees way up to her chest and had someone hold them there. Mom stopped pushing, then I did supra pubic presssue, while Elizabeth pulled down. Then the shoulder slipped under the pubic bone and swoosh, she was out. Non-responsive. White with very blue head, I stimulated the baby and we grabbed resuscitation equipment and gave baby a few good breaths. Finally with a little cry she started to pink up and respond. Thank you Lord! She was only stuck for about 2 minutes, but it always seems forever while we are trying to get a baby out like that and breathing on her own. Time almost stands still. We used blow by oxygen for about 1/2 hour. Baby had chest retractions and nasal flaring for a while. But perked up after nursing and thankfully we didn’t have to transport. She was actually a stong baby and withstood all this in good stride.
I think that I will write a book called “The Birth of a Midwife” but maybe someone already has… Anyway, that is how I feel. I affectionately call my stay at Mercy Maternity, Midwife Bootcamp. It fits. I am exhasted and being pushed harder than I ever have been in some ways. I have grown in confidence. I can go home now and feel a bit more prepared to be of good use to Joyce. I am expecting to have a bit of a hard time with jet -lag and so your prayers will be much appreciated as I integrate back into home life and a heavy schedule.