A “train wreck” is what the midwives call being “slammed busy”. We had 9 moms in labor over the course of 24 hours. This is a lot for a 6 bed clinic. We had moms laying out all over the place either in labor, having a baby or postpartum resting.
On my shift that day, there was a continuity birth ( a student that has followed through with all of a patient’s prenatals and has agreed to come at any hour, for her birth). This mom was measuring small for how for along she was, and the person handling the birth decided to do the birth anyway. As it all ended up, the birth was a tight fit, even though the mom was normal sized. That seems to happen a lot around here. We knew that the baby was going to be small and were preparing for infant resuscitation. Pushing seemed to take forever, and the baby’s heart beat did not have a lot of variability. Finally, the baby was born and it was very small. (just under 5 lbs.) It really had a hard time getting going. We suctioned, rubbed baby down, oxygen and finally it was starting to pink up after 15 minutes. The baby seemed to be really struggling to get air in. His little tiny nostrils were flaring and his shoulders heaved with effort. Things did get better for him after a while, but we transported the little one, with his mom to the hospital because of the question of whether he was early or just plain small for dates. There was some question whether we should have even tried the birth, because the baby was so small. But I think he will be alright.
The next birth was a mom who pushed with great effort, after a fairly normal labor pattern. The head was visible about 3 cm and then kasploosh! The baby was out, sitting in the intern’s hands. As the baby was coming out suddenly, I looked in shock at the mom’s bottom. It had made a new hole in the mom’s bottom! Not the vagina, but a hole next to it off to the side. I felt sick to my stomach. What a mess. I had NEVER seen anything like it, nor had the midwives here either. The baby was doing really well, and the mom stable after a while. We had to transport her to be sewn up, as between the new hole to the side and the hamburger mess inside, it was more than we had time or skill for. The mother’s tissue was brittle, like paper if seems and did not have much give to it. I went home and slept for 3 hours. Her little sister kept the baby at the clinic and several of the students and interns that were nursing their own babies kept his little tummy full.
Even though I had just gotten off working a 16+ hour shift, I asked Joyce to call me back to see the next birth. I planned to see the birth and then zip up back to the house for the continuation of my rest. Little did I know that I would end up staying another 12 hours. When I came down to the clinic, Joyce had woken me up from a sound nap. I couldn’t even remember how to turn my ringing text phone off or how to retrieve a message. All I read on the text was BIRTH. So I crawled out of the air con room, no veil on, my hair long and up in a barrett, still in my scrubs from the day/night shift before. (I had just collapsed in the bed for a nap before I showered.)
Anyway, I walked into the clinic and looked at the busy chaos with some humor.. It had been fairly quiet the last few days and some people were complaining at how boring it was. Now, as it ended up, they were a little short handed for the amount of patieints, so I stayed and charted a birth. Then the moms just kept coming in. Labor! The guard would shout from the door way. Labor! He yelled again. Labor! This was getting ridiculous. 9 labors… I worked hard all night and had a great time. I did end up transporting to the hospital 3 woman. They were not my births, but because I don’t mind going to the hospital, I was happy to go. At one point in the evening, I was in the middle room charting for Julia, who has catching, with a labor also on each side of me. I would chart one, chart the other and go to the other side to view the birth. There is just a curtain separating each cubicle, so this was entirely possible. We only have two birth carts, so as soon as a baby was born in the one area I was charting, we needed suction for the baby about to be born in the next bed. I quickly cleaned the machine and got it ready for the birth next door.
I did not actually catch any baby that evening, as I was not officially on shift. Some of the girls are protective of their births on their shifts. I can certainly honor that. If I had a baby that was supposed to my labor and someone who wasn’t even on shift waltzed in and took it, I might be sad too. As I have seen it, it is always the luck of the draw on whether you get births or not on your shift. Some shifts you get none, some you might even get two. The paperwork is quite lengthy for each birth and the responsibilities for postpartum care are pretty big too, as moms usually stay a minimum of 6 hours afterwards.
Two of the births were 3 minutes apart. I was just having a great time, charting for two and observing one at the same time.
The last one of the evening for me, was actually my patient from the previous night shift. She came in at 2:00 am in light labor. She was quiet and labored literally all day and all evening, finally getting to 9 cm by 9:00 pm. She as very tiny. About the size of Mercy Grace, and thin. I wondered how in the world is that baby going to come out… I did an IE and felt that she was small, yet I had hope that her body would open and her bones spread.
Carmen worked with her (she was also supposed to be off shift) and Krys came in just to say hi and ended up working with us. This little girl was crying, sobbing with the contractions. It must have hurt her very much. She had been so brave all day and now, after being up all night and all day, she was literally exhausted. It came time for her to push and she worked and worked and strained and strained. All positions we could think of and then some new ones! Her little bottom was so small and although the baby small, it wasn’t tiny. By 9:00pm, with hair of baby barely visible, the baby’s head was just too small to fit past her tail bone. It was sort of strange. This mom’s tail bone would not give an inch. Most times, they break, or at least bend in response to the baby coming through. This baby’s head was not coming down with the normal, chin tucked, presentation, but straight on with both sutures felt. The baby was small… but mom was too small even for her baby. So, after an incredible effort, we transported. This was my third transport that evening and the Dr.at the Davao Hospital threw her hands up in the air! What are you doing here tonight again?! She was laughingly, joking at me. It had been a wild night for her too, with 33 births, ours being number 34. So we got our little mom up on the exam table and they could hardly hear the baby’s heart beat. It was very slow. They got her ready for a c-section immediately.
Carmen and I were very quiet on the way home in the ambulance. We were both exhausted beyond words. I crawled into bed and realized that I had neglected to get pictures of the births that evening, and by morning, the moms would be gone. So I crawled out of bed, threw a dress on over my nightgown, and took my camera down to the clinic. Julia was kind enough to snap pictures for me, as I zombied on the couch for a few minutes. I then sleep-walked back to my house, found my bed and promptly feel asleep until 7:00 am.
It is 8:00 am. I am here at clinic now, doing initial histories until 12:00 pm. There are a lot of moms here (60). I went home, ate a bowl of leftover oatmeal, peanut butter and milk for lunch and went for a nap.
I feel asleep for a nap and woke up with 5 minutes to spare to get back to the clinic for my shift endorsement. Whew! I almost overslept. The clinic is quiet now, except for one mom who had her baby at 1:04 pm, so I think I will continue my nap. I am on next when a mom comes in. I am sure that the guard will awaken me with a shout of “LABOR!” soon.