Tuesday, May 10, 2011

Heart-shaped perfection.

A heart-shaped face perched atop elegant shoulders, drooped slightly in despair as she explained; there was bleeding. It started at noon. It was getting worse.

At first I didn’t know what to think, but then I saw it --Dark red stains and clots. Oddly, there were no contractions.

Painless vaginal bleeding tends to indicate placenta previa (when the placenta grows over the cervix causing bleeding during labor). There was just one thing... she wasn’t term.

Her brown taut belly only measured 25 cms, and the child palpated to be about 6 months along.

Questions raced through my head.   
--Previa? Stillbirth? Preterm? SGA baby? What?

Checking for heart tones, I was surprised by a steady thuk-thuk-thuk-thuk that echoed throughout the room.       
--Her child was alive and remarkably NOT in distress, but for how long?

Her name was Abuk.

Studying her chart, I learned that she had come to see me once several months ago, and then again came last month to be treated for STDs. She said the medicine she got hadn’t helped. She still had many of the symptoms.

While calling for a consult, I set up for a speculum exam. I needed to know exactly what I was dealing with. I would be able to see the if the placenta was in the way... or if she was even in labor.

Dennis arrived quickly, and we stopped to discuss her case at length.

Even though her LMP put her at 22 weeks GA (or 5 months), she was obviously more; her fundal height clearly indicated more like 6 months. But if she was having a simple preterm birth, why was there so much blood loss? Why the clots?

This had to be something more. Right?

Since night had already fallen, we could no longer safely refer them to Wau. And even if we could, what would Wau do for them?     --Nothing. Not at 6 months.

Dennis went to talk to her husband while I did the speculum exam.

Once past the obvious bleeding, I was able to clearly see her cervix. She was almost completely effaced and was well passed 4 cm dilated. Tinged blue, the bag of waters glistened under the flashlight’s yellow glare.         --She’d deliver soon.

Abuk listened carefully as I outlined the options:
“One, you could go to Wau right now, since your contractions were so far apart, but getting there at night is tricky. Two, we could admit you to our clinic, make you comfortable, and wait for your child to be born. Or three, we could induce you... but induction is painful... and well, it is hard on the child, too.
Piercing black eyes flashed from me to the floor, to her hands, to her blood, as I spoke.

“Think about it, talk to your husband, and I’ll be back in a few min...” I barely had the words out when she interrupted: “Just help me stay alive.” Only then did it occur to me she thought she was dying.

“Abuk, I promise you. You are doing fine. No matter which choice you make, you will not die. Please, don’t be worried.”
Nodding at my words, she sat there studying my face. Could I be trusted?

“Please... talk to your husband. Decide together what is best.”
“No. I don’t need to. Why wait? My child is going to die no matter what. I want to be induced.”

As the truth of her logic settled in my heart, my tongue went numb. I had no more words.

“Still, think about it a bit more.”
Nodding, she curled in a small ball on the bed and rested, and I called for her husband to join her.

“Abuk, can I invite my friend to come pray with you?” I asked.
“Yes. I would like that.” Her face softening a bit at the thought.

Suzy, my director and prayer warrior, came to pray with them while I discussed her case with the rest of the staff. We all agreed. There was no stopping this birth. There were no drugs we could give. It was inevitable.

I would induce.

While preparing the room, my heart sagged with questions.

Why the hurry? Why not let the child come naturally? Was I doing more harm than good? Was I killing this child? Was I saving her life?

Understanding never fully came, but her baby did.

An hour later, a beautiful little girl was born. She had the same heart-shaped face of her mother. Beautiful.

Weighing just 900 grams, she never tried to breathe.

After examining her perfection, I wrapped her in a blanket and asked the father: “Do you want to hold her?” He didn’t hear at first, so I asked again.

I had to ask several times before he lifted his head from the table. The day’s events were too much for him; they weighed him low.

“Why don’t you hold her. She is so beautiful,” I said gesturing towards the beauty.
“Yes. I want to hold her,” he said softly, and took her in his arms.

He unwrapped her, once or twice, for a closer look, and then tenderly balanced her tiny frame on his knees.

“Will you name her?”
“Yes. She will be named after my mother,” he said hesitantly, then later added, “No. I can’t name her that. I can’t name her now that she’s dead...”

Abuk returned to a fetal position on the bed -- too tired to cry.

Six months of hopes. Wrapped in a blanket. Breathless but perfect.

Suzy and Sabet came together afterward, and we all prayed again before taking them home. It was a sad birth, but one showered in prayers.

Please continue to pray for them as the Lord leads. Thanks.