Tuesday, March 29, 2011

Is it one of us?

Abak, the midwife, her wounded bird friend.
Abak came in pushing. She was pushing so hard, the translator on duty ran to call me, and breathlessly announced, I should hurry. I grabbed my stuff and ran. I didn’t want to miss it.

But when I got there, not only was she NOT pushing, but she seemed calm and collected. I had to laugh.

Nevertheless, this was her 4th child. It was sure to be soon. Heck, I could see a little patch of membranes ready to burst as she pushed. That’s always a good sign, right?     -- Not always.

Smiling, I went through the regular check-in scenario and set up the room.

In her mid-thirties, Abak was small and slender. She’d come a number of times for prenatals, and I was looking forward to her birth.

Between pushes, I learned that her labor had started the night before. No water or blood had come out, and all was great.         -- or was it?

As she pushed first in the supine position, then kneeling, then on the birth stool... I began to suspect there was a problem. Why was it taking so long?

Only then did I think to ask: “Have you been pushing like this at home?”
-- “Yes, the baby won’t come.”
-- “When did you start pushing?”
-- “After the water broke.” That didn’t make sense since, I could see the membranes bulging and she had just told me the water hadn’t come out yet.
-- “When was that exactly?”
-- “Last night around 8 pm.”
-- “Oh...”

Mind you, it’s 3 pm on a Sunday afternoon.

Since her story was all jumbled with mis-information and assumptions, I asked her to start again.  She explained her labor actually started on Saturday morning. When her water ‘broke’ that night, she attempted to deliver alone and began pushing.

She had delivered all her other babies without assistance, and assumed this one would be the same. However, it had been 7 years since her last birth; perhaps she had forgotten how.

As she finished explaining, I started counting backwards. It was almost four pm now, and if she’d been pushing since dark the night before... the sun sets around 7pm... that means roughly 18 to 20 hours of ineffective pushing... humm... not good.

“Poor thing! Why didn’t she come earlier?” I thought to myself. I didn’t bother asking her though; I already knew the answer. It would be someone ‘important’ in her family that had insisted she stay home. I’d heard it before.

Honestly, I didn’t know if I should be more impressed or horrified. Eighteen hours! That’s a record in my book!

Only then, did I do a vaginal exam. I wanted to rule out a compound presentation or some kind of cephalopelvic disproportion (aka: baby too big for the pelvis). I, also, wanted to rupture the bulging membranes. Perhaps that would speed things along.

Her pelvis felt more than adequate, and I could see no major reason for the delay. The fetal head did appear to be somewhat military in presentation and a bit posterior. With her permission, I attempted to flex the fetal head and ‘dial’ it to a better position.

She pushed well, but even still, there was little progress. Obviously worried, the young girl assisting her, couldn’t sit still. She moved about like a wounded bird. I was glad when she left the room.

Humm...  What to do? What to do? Lord, what is needed most right now for this baby to make its way into the world? Do I need to move her in a better position? Do I need to manually assist? How do I get this baby out?

As I prayed, my translator kept looking at me funny. I’ve been praying out loud over my patients for so long, I’ve forgotten how strange it must seem to those less familiar with my ways. Once he figured out I wasn't talking him but God, he just smiled and watched from a distance.

Doesn’t everyone talk to God during deliveries? It can’t be just me!

Anyway... back to my story.

The brother-in-law kept poking his head in the room, monitoring the progress. I couldn’t blame him. Eighteen hours of pushing! I’d be worried too. I think coming for my help was a last ditch effort on their part. It was as if they were saying, “Why not see what the Kowaja can do?” Perhaps not.

But they did seem a bit hopeless.

At one point, Abak said: “If I die, Sudan will not fall into the sea.” My translator explained it was the Dinka way of saying, ‘my life is small in the grand scheme of things, just let me die’.

I told her that today was NOT her day to die, and reminded her to stay strong. Her baby was doing great, and despite the encroaching exhaustion, her vitals were stable.

Finally, after an hour of putting her in every position imaginable, I got out the vacuum extractor. I told her what it was, and how it worked. She nodded, “Okay, I’m ready.”

Once in place, she pushed and I pulled. I barely had to tug, when the head crowned and rest of her baby’s wrinkled body followed.

What? So easily? It surprised us all, at how quickly it worked.

Abak couldn’t stop laughing in relief, and although tired, she sat up and grinned at this tiny trouble maker. She continued to laugh in disbelief as I laid her on her chest. 

This wrinkled, no-neck self, howled her hellos as I rubbed her clean. If the gestational dates were correct, this little one was a bit over-cooked, arriving past her alloted 42 weeks.

Meconium stained vernix covered most her body. That coupled with the fact, her feet were peeling and her nails long, indicated someone forgot to set the timer on the oven. She wasn’t the prettiest baby in the world (just then!), but she was the most celebrated!

At her first cry, the brother-in-law again poked his head in the room. Relieved beyond words, he asked, “Is it one of us or one of you?”

My translator explained that this is how Dinkas ask if it’s a boy or a girl.

“It’s one of us! It’s one of us!” (Since it was girls saying it, it meant it was a ‘girl’.)

He smiled and immediately went to share the good news.

Meanwhile, Abak continued to laugh between periodic naps. She almost slept through the placenta delivery. Calling her tired, may have been an understatement.

My translator said, at one point, she mumbled to herself: “This is why I told them to let me come.”

I couldn’t help but smile.

Yes. It was a good day. A very good day.

They named her Lat, which means ‘Sunday’. Perhaps she’ll get a better name later on, but this way they can keep track of her age... at least for the first couple months. Ha!

Thank God for vacuum extractors!

Rejoice with me that baby Lat was born after such a long labor, but please pray for the fever she developed right afterward. We treated her with medicines and discharged her the next morning. At that time, she was breastfeeding well but colicky. Pray it passes quickly. Thanks!