Saturday, March 26, 2011

A day apart!

Today a woman was brought in by ambulance, sirens wailing and lights flashing. I was already at the clinic, and watched it approach from my window. As I peeked out in interest, I heard them say something about a woman in labor, but all I could see were her feet sticking out the ambulance door.

If she was coming by ambulance, it must be pretty serious. Right? Since I wasn’t sure how long it’d take them to get her through our narrow halls, I started setting up the room.

I barely had time to pull out my instruments when a VERY pregnant woman wobbled in, a bit off-balance. She walked timidly, like her feet couldn’t be trusted. I figured she was just lopsided with such a BIG belly, but there was some swelling in her legs as well.

Gingerly she lay on the bed. Everything she did was slow and steady. My translator was still outside, so I instructed her in my limited Dinka to lift up her dress so I could check on her baby.

Just then, my translator interrupted me:
-- “Wait. Here’s the baby!”
-- “What baby?” I asked stupidly, while pointing at her belly. “Do you mean this belly?”
-- “No. She gave birth yesterday. Here’s the baby,” he insisted, handing me a pea-sized person wrapped in an endless stream of clothes.

It took me a minute to find her face. She was tiny! I sent someone to get Margaret; this was going to be a doozie. What was I looking at if not a baby?

Aluong, my very-pregnant mama lay awkwardly on the bed, and slowly explained she gave birth yesterday afternoon, but the placenta wouldn’t come out. Huh? This belly was just her placenta? I wasn’t buying it.

So, I sent for her family. I needed to hear this story from every perspective. In my head, she obviously had twins. The question was... was the second one still alive.

When her mother came in, she explained the baby was born yesterday afternoon, but hadn’t nursed yet. They clamped and cut the umbilical cord, but it was sucked back into her body. (I could see no cord handing from her vagina.)

-- “Did you tie the cord on two sides and then cut in the middle?” I asked. I still didn’t have time to check heart tones. But if they had let the cord bleed, this baby might be dead.
-- “No. We tied it just once,” the mom explained, looking a bit confused I’d ask such a strange question.
-- “Aluong, can you feel a baby moving inside?”
-- “Yes.”
-- “Good.”
-- “But the placenta won’t come out,” her mother insisted.

I had to laugh. In my head the most important thing was delivering this next baby, not the placenta. But in her mind, she was more vexed the placenta hadn’t come out.

Margaret arrived just then, and I caught her up to speed. She took over checking on the pea-sized person. Since she hadn’t nursed in almost 24 hours, Margaret got her some sugar water and checked her vitals.

Her fundal height was 39 cm, the baby was cephalic (head down), and in a good position. I found heart tones easily, then started counting contractions. Whoever was inside was happy-- so was I!  There was no excessive bleeding, so I did a vaginal exam.

The membranes were bulging, and as I pressed deeper, I could feel the head. Everything was looking great. She would deliver very soon.

We got everything set up for the birth, made sure the other baby was doing well, and then I ruptured the membranes. I had to do it twice. The first time I got a slightly bloody fluid. The second time, the waters were clear and fresh. They gushed out in one salty wave, making the room jump back a bit.

The head settled into the pelvis nicely, and she instantly needed to push. Heart tones were solid, so we just sat back, and watched this little patch of miracle peak out at us intermittantly. Three solid pushes and she was out! 

Her chubby cheeks cried astonished whoops of wonder as a tidal wave of salty waters burst behind her, and trickled to the floor in rivulets. She lay on the bed like some beach beauty, announcing her arrival. We laughed!

Her size and the fact Aluong’s belly drooped anti-climatically reassured me that there were only twins, and not triplets. (Yes, I had my doubts.)

After the cord was cut and the placenta was born, we discussed her obstetrical history a bit more in detail. She explained this was her second pregnancy. Her first was born dead at 8 months. She claimed she got in a fight and her baby died.

As for this pregnancy, her first baby was born almost a full day before her second. Their weights weren’t too different, but their appearances were striking. The first was thin, frail and weighed only 2.3 kg (5lbs). The second would have made sumo wrestlers jealous in her chunky folds and lusciousness, but she only weighed 3kg (6.6lbs).

Nevertheless, they were a delight to behold!

I taught Aluong how to breastfeed them both, since this was her first time; she was a natural. Both babies sucked vigorously, and they were all discharged a few hours ago.

There you have it... another almost twins story! Ha ha!

Oh, for those who like to know about such details, let me tell you about the placenta! It was super cool. They were two separate placentas (completely unattached). Both had remarkably short cords (less than 10 inches), but they appeared healthy. There were a few blood clots trapped between the amnion and chorion, and the smaller placenta (for baby number 1) looked as if it had partially detached (abruption?), since it had an extensive black clot over one edge.

Also, the membranes of the first (smaller) placenta had two areas where they had ruptured. The placentas were ONLY connected by these membranes. I’m thinking they may have shared the chorion? What do you all think? Check out these pictures. You can decide for yourself.

All I know is, had they shared a placenta, the second baby would not have survived after they cut the first’s cord. I’m thinking fraternal twins. What do y’all think? I think I can rule out twin-to-twin transfusion as an explanation of the size discrepancy. Right? Perhaps the blob on the smaller placenta caused her to get less of the oxygen and nutrients.

So praise God with me that both girls lived! They are beautiful!

Twins, born a day apart, used to be things I only read about in books! Is this really my life? I have to say, I love it. I really do! It’s hard at times, but I really do love all this craziness.

What a grand adventure He has laid before me!

Thank you for following me around in these adventures! Thank you for encouraging me so persistently, and praying so diligently! You help me in so many unspeakable ways! Thank you!