Friday, March 18, 2011

My Girl Friday~

Santos is one of our translators. He’s only been working for us a few months, but I like his attitude and work ethic. He’s polite, helpful, and teachable. Mostly, he works in the pharmacy.

He’s been telling me about his pregnant wife, and eagerly awaiting the delivery. It’s his first.

He wasn’t sure if she’d deliver at the clinic or not. I encouraged him to do what he thought was best, and reminded him that we were here for them.

His wife, Mary, started labor last night and by early morning was looking very active. Santos insisted she come to deliver with us, even though she was resistant.

I didn’t do a vaginal exam right off, preferring to watch and wait. But by the time I needed to start doing prenatals, I couldn’t guess where she was anymore. She seemed to be in intense pain, but the contractions where short and sweet.

The exam showed her to be well effaced and roughly 8cm. Since I knew I could do a few prenatals as she dilated, I moved her to the laboring room. Fortunately, her mother arrived around then, and was happy to take over as main doula.

Even though her progress was steady, everyone seemed overly concerned about how long she was taking. I kept reassuring Santos, her mother and every other person within ear shot, that first moms take time to open properly. Give it time. They ignored me, shaking their heads in disapproval.

When it came time to push, I called Santos in the room to translate. He told me later, that his being there was breaking some cultural taboo, but the only other option was having a different male co-worker translate instead. It was the lesser of two evils, but it bothered him.

In spite my own reassurances, I was a bit perplexed at how narrow her pelvis felt, and how slow the progress was going. What if things didn’t go well? Sigh. I pushed aside my concerns and encouraged her to push when she had a contraction. Both she and the baby were doing great.  

When the head was visible for the first time, Santos looked at me quizzically and asked: “Will she open for the baby?” It took me a minute to figure out what he was asking, but when I did I had to laugh.

Here was a husband and father-in-the-making, watching a baby-sized head trying to knock its way through something the size of a quarter. No wonder he looked confused and .... skeptical!

I assured him, she’d open up. Unconvinced, he just stood there nervously fidgeting with the doppler and (probably) wishing he was anywhere but there!

Making him translate for me was asking a lot, now that I think of it. He had never assisted before in the birthroom. He was unfamiliar with the sights, sounds and procedures. But then again, it was either him or one of his buddies.

Once Mary got her on the birth stool, there was significant progress in her pushing. But... her pushes were so intense; she didn’t (or couldn't) stop for anything. I kept asking her to breathe every now and again, but she didn't seem to hear. 

After the head was born, out popped a blue-tinged rag doll, floppy and covered in brown goo.
                 ~ What? She was fine a minute ago. What happened?

The 'doll' blinked at me, but made no other sign of life. I wiped her clean, suctioned the gunk out of her mouth and nose, but nothing. Floppy stillness.

She wasn’t dead, but she sure wasn’t trying to live!
                 ~ C'mon baby breathe!

My internal alarm sounded, as I rubbed her spine raw. She made no signs of pain. Santos was asking me why his girl didn’t look right: “Why isn’t she crying?” Ignoring him, I called for help: “Margaret, my baby won’t breathe!” She was there in a flash.

Minutes rolled by like hours, as we cleared her airways and gave oxygen. Every now and again, she’d gasp.
              ~ What happened? Just a few minutes before, her heart was a steady rhythm.

Now as I listened to her heart race in her chest, I imagined formula-one cars roaring their engines. No. Jet planes. Her heart beat was 170, but she wasn’t breathing. Limp. Cold. Ashen. Gasping.

Once Santos understood something was wrong, he was useless as an interpreter. He couldn’t focus. How could he? His little girl lay like a stained dish rag. I had to call in my other translator.

I cut the cord so Margaret could work on her better. It took a full five minutes for her color to go from light-blue to dusky. It took another five minutes for her to gasp every now and again. By 15 minutes, her color and breathing stabilized somewhat, but she was glacial.

While Margaret resuscitated, I delivered the placenta and tried to get Mary and Santos to remain calm. Mary was uncooperative and didn’t listen to any of my instructions. Santos held back fear-stained tears, choking out a questioning, ‘Why won’t she cry?’ every now and again.

Long story very short, she started breathing and we got her temperature up. She improved, but then developed a fever a few hours later. I suspect she aspirated some of the meconium (brown goo), so we started her on treatment for MAS (meconium aspiration syndrome).

Please, please pray for them all. Pray for Mary as she is trying to get her baby girl to breastfeed. It’s not going well. Pray for Santos, he’s so worried. Pray for their baby to respond well to the medications, and figure out how to breastfeed.  Thanks.

They named her Friday. No joke. Pray for my girl Friday!

Update: March 20, 2011
So little Friday didn't want to breastfeed at all that first night. We expressed colostrum and gave it to her with a syringe, along with sugar water. Her fever came down with antibiotics, and the next day she was able to breastfeed well. We discharged them yesterday afternoon. Santos was tired but happy.
Thank you so so much for your prayers!
            ~ SW