Today I reported for clinic at 6:00 am, very groggy and sort of hoping that I could have a chance to wake up a few hours before any labors came in. My wish was granted… for a little while.
I went in to assist another midwife, that had taken this mom over in endorsements, from another midwife who was heading to bed. This particular mom was in a lot of pain. She cried out and moaned all night, since she had been admitted in the wee hours of the morning. I think that the fear…tension…pain cycle is so true. Blatant examples this are seen here all the time. I wish so much that I spoke the language so I could work with some of the moms, helping them to understand that what their bodies are doing is natural and it’s O.K.
This mom finally was fully dilated and started pushing, sort of… She cried out with each push and was having a hard time focusing down below. She would throw her head back and lift her bottom off the bed and scoot, trying to get away from the pain. She pushed for 1 hour, and then 45 minutes… then her baby started getting worn out. Heart tones started taking a nose dive after contractions… late decels meaning that her baby was not getting enough oxygen. We put oxygen on the mom and listened for a few more minutes. Carmen started an IV. I called out the heart tones every 6 minutes as I counted them with the doppler. 90…..100….80….70…80……70….65…..70…. Yikes normal is 110 – 160.
We could see the baby’s head, but we were a long way from getting that baby out. We decided to transport, because the birth would be safer in the hospital where they had better resuscitation equipment… (well not really, but the rules say we needed to transport). It was better that way anyway, because I don’t like dead babies and we just could not tell whether this one was stuck or not, as it was coming so slowly through the pelvis.
They flew off in the little blue ambulance after getting her loaded up out of the wheel chair. She delivered after being in the hospital not very long… The baby is safe.
My second birth of the day was right after 2:00pm endorsements. The midwife on shift had gotten her settled and thought that she might go pretty quick. She handed me the file and said like… quick! I mean right now!…So I jumped up and grabbed a birth cart, oxygen and yanked on gloves… (sound familiar). And she was pushing. 3 pushes and the baby was out. I again worked really hard at getting the baby’s head to stretch the perineum slowly, but the baby came so fast… number 5 for her. That he just sort of slid out onto the bed.
A little boy. He seemed very healthy and pinked up right away. This family is Muslim and just the birth mother-in-law was there to help her. At least the dad was not there this time to whisper in his baby’s ear before his little one hears anything else, “Allah is God, and there is no other…” The Muslim dads all do that…
The mom speaks almost no English and really doesn’t talk much at all. It is so strange not to be in communication with the birth moms I am helping. It makes the situation seem kind of “not real”, but they are very real…. There is lots of blood with this one to prove it. This mom bled about 600 cc which is not too bad. Still, my heart was with her as she kept throwing big clots and trickle bled, even though I was really squeezing the uterus firm every couple minutes. I gave her some pitocin. Finally, about a half hour, she slowed way down and she is fine now.
I, with baby in one arm and her clean clothes in the other, we slowly made our way to the bathroom.. It amazes me that she is not dizzy. She even balanced on one foot to get dressed in the soaking wet bathroom.
The bathroom has big white, tile flooring and a huge bucket with a scooper that is used for flushing the toilet and washing off. We slosh the toilet off, too with it.
After getting her settled back in bed and resting, I did the baby exam. I heat the big tea kettle on the gas stove and get the green plastic baby bath out the back door, where it is hanging from the last use. I fill the baby bath with a little hot water from the now steaming kettle and some cooler water from the sink facet. I touch the water with my elbow… Yes, I hate scalding babies…. My hands are pretty numb to heat after all the years of mothering and washing. I adore very hot baths…. (Ahhh a hot bath… I have not had one in a very, very, long time.) But babies do not.
I carefully carry in the warm water bath and place it on the bed beside the mom. I then ask for the bar of soap that they generally have brought. I unwrap the baby and lower them in the water, carefully swishing them off, getting rid of the blood and mec. Most of them holler and are not happy with me. If I hold one arm pinned to their body as I wash, sometimes I can get a quiet one. I soap the head, wash it off and rinse off the rest of them and turning them on their backs as I am taking them out of the tub, do a quick exam for any anomalies. We do find some occasionally.
After the bath is done, I wrap up baby and whisper in his ear that he probably won’t like this next part, and I am terribly sorry, but it is the rules… and I will try to be as quick as possible. Next I run out to the fridge and get the vitamin K shot and draw up the HepB syringe. Then I get a cotton ball with alcohol saturated and steel myself for the most unpleasant task of this whole thing. We have to record which leg we inject what, and what time and the date, after we footprint them with ink on the newborn exam form. They don’t like being messed with on their feet… but the 2 needle pricks are worse. After my dastardly deed is done, I wrap them up and give them back to mama to nurse. Sigh… sorry little one….
The paperwork in the clinic is just a reflection of this paperwork-happy-country itself. There are literally reams of paper work and everyone seems to think it makes things more official. So, the birth certificate paperwork is 5 pages long and sometimes 6 if the family is Muslim. The birth record form itself is 5 pages, each having a special purpose and part of labor. They document EVERYTHING here. Papers to get into the clinic, a paper to get out (to show the guard). Paper that proves you are married or a tax schedule that shows you are a household with your housekeeper. Anyway… you get the idea.
Tonight the Pinoy midwives are all singing in the kitchen with much gusto and laughing. They are singing Philoppino Christian praise songs and using a small congo drum, spoons on the counter, a guitar and their voices. I wish I could tape it and put it on the web so you could hear it.
My birth mom just wandered by to the CR (comfort room) again, so I am going to see if she needs anything. Her husband (yes the Muslims are all married). He left to go get something down the road. They just told me that they wanted to change their baby’s name…. so I’ve gotta go!