Tuesday, March 1, 2011

Hardly Simple. Simply Hard.

Sunday night Mary came in with solid contractions, but they started two hours before. She seemed like she was handling them well, so I didn’t do a vaginal exam. If she was early, I’d have to send her home. I didn’t want to send her home. But it wasn’t my call; it was Margaret’s, as she works nights.

Knowing she wouldn’t deliver right away, I handed her over to Margaret early. Margaret did the vaginal exam, and she was only 2 centimeters. However, Mary categorically refused to go home, so, Margaret labored with her all night. I’m told she was vocal and uncooperative, making it tough for anyone to sleep.

At 7 am (when I’m back on shift), another labor came in looking active and they called me to help. Mary and Margaret were in a battle of the wits. Mary was fully but unprepared (I think mentally) to push. Margaret was fed up with her screaming and stubborn antics (or so I’m told), and kept insisting she push-push-push.

I wanted to take over, but the new labor was very active. I was torn. Where to go? Who to help first?

The new labor’s name was Yom and this was her third baby. She didn’t want an exam, and I didn’t want to do one. So I opted to monitor her while stepping back and forth between each birth.

Mary kept screaming and calling for God to just let her die; Yom silently squatted on the floor and rocked a bit with each contraction. The difference was dramatic and perhaps even more marked by their proximity.

Yom’s membranes ruptured spontaneously a few minutes after admission, and she needed to push almost immediately. She pushed, and I scurried to set up the room while her husband watched from a chair in the corner. He is the first husband I’ve seen ‘support’ his wife in labor in AGES! I was happy to have him there.

She pushed silently and a gorgeous, vernix laced baby boy bounced into the world. His whiteness concerned the father, but I assured him that the ‘white stuff’ comes off. He laughed when I promised him he didn’t have a kowaja but a Sudanese!

When Mary, in the next room, heard Yom had delivered within minutes, she got mad... and motivated. Margaret tells me she started pushing properly, all of the sudden.

Once Yom was breastfeeding and her bleeding was controlled, I went to help with Mary’s birth. Margaret was using our newly donated vacuum extractors (Thank you Ann-Jule!!!), but was having little success. Fortunately, Mary was close and so we stopped with the vacuum extractor and taught her how to push a bit better.

A couple serious pushes later and her boy slipped on to the scene. Mary’s mother sat exhausted but pleased in the corner of the room. What a relief!

Margaret gathered her things and stumbled off to bed, and I took over. Mary, had a slow recovery and after the placenta was born continued to bleed like mad.

I rubbed her fundus and massaged out clots repeatedly, but her uterus just wouldn’t firm up. Was it incarcerated clots? Were membranes or placental parts retained? I didn’t want to do an internal manual exploration at all, but I couldn’t see any other option. 

Needless to say, she was uncooperative (a theme for her birth I guess, but understandably so... ). But the instant I finished, her bleeding stopped, as if I’d turned off a faucet.

They recovered together, most of the morning, and were discharged later that day. Yom, skipped off with her husband as if she were off to the fair, but Mary was another story.
Mary and Margaret after the birth.
She was sullen and sore, perhaps even disappointed in herself, or us. I’m not sure. It was a hard birth for her. Before she left, I told her that her birth was tough - there was no doubt about it! She nodded slowly in response. I added that sometimes births are easy, and that just because this one was hard, it doesn’t mean the next one will be, too.

She softened when I said that and nodded some more. She believed me. Pray for her. May God bless her with a speedy recovery, and the next time may she have an easier go at it all!

Side note: Mary’s birth was my 200th catch. Yep. I’m one of those geeks that keeps track. Ha ha. I’ve attended a total of 358 births, the last 70 were here in Sudan. What a blessing to be a midwife!