Friday, June 17, 2011

Birth by Flashlight.

Shortly before sunset, I got the tap at my door. James, one of our translators, had that look. The look of intense concentration that says ‘Come quick, I do not want to catch this baby by myself!’

Smiling, I gathered my stuff and hustled over. I found her by the clinic door in a lot of pain; the contractions were on top of one another. She could barely move two feet before the next one rushed her. Intense.

By the time I was able to check her in, I found out she’d been in labor for 24 hours. She told me her water broke at noon, and she immediately started pushing. (That was a full 7 hours before.) When the baby would not come, they decided to come for help. 

When I got around to doing a vaginal exam, she was 9 cm with an intact membrane. But because she had been pushing for so long at home, she no longer had the strength to do anything about it. She was exhausted.

I ruptured her membranes in hopes that it would bring her baby lower. It helped but not enough; she had nothing left to give.

As I stood there evaluating the situation, I wondered aloud to Sarah and prayed. What did THIS woman need most from me? I knew what I wanted for her. I wanted a peaceful, gentle birth where the midwife does nothing but keep the child from hitting the floor. I wanted that so very much. But we were past that point --way past.

What I saw was a desperately exhausted mother of soon-to-be six children in a lot of pain. Although her vitals were within limits, she was not doing well. Seven hours of ineffectual pushing at home, coupled with an hour’s walk across town, left her weary.

Do I act or let things develop on their own?

Finally, I threw out my ideals and started an IV. All she needed was a little push; I decided to augment her contractions and see if she could find that urge to push.

Two minutes after augmentation, the head was crowning.  She was big and beautiful... but blue. Or she seemed that way in the dim battery light. But within a few minutes her color pinked up nicely and we celebrated.

Aboung promptly breastfed her and fell asleep. Sigh. Thank you Lord!

Incidentally, she was my first flashlight birth. We are still working out the kinks in our electricity and had no other choice. Ha! I confess, I liked it. It was quiet, intimate and bug free.

However, please pray that our solar panels and battery packs get up and running soon. Thanks.

Supervising Delight.

This week has been quiet in terms of births. I am guessing the crazy lightening storms have had something to do with this. Who would risk rain, mud and lightening bolts just to deliver at the clinic?

However, one young girl came in labor yesterday morning. She was active but handling the contractions so well, I almost didn’t believe her when she said it was labor. Sarah took over her labor watch, and a few hours later she delivered.

What stands out to me most in her birth was her giddy delight once her baby was born. Seeing her lying on the floor crying, she asked to hold her child in her arms. Then she kissed her baby repeatedly and cooed.

She was thrilled. We all were.

Every time I mentioned how beautiful her baby was, she glowed. And as the family gathered around to bless her and welcome the newest member, the room filled with joy.

It was such a lovely birth. And Sarah did a fantastic job!

Way to go Mama! Way to go Midwife!

Thursday, June 16, 2011

Electric Darkness.

The dark rumbling started low, but screamed to a crescendo by the time it hit. Glowering clouds, pregnant with malice converged in a desperate clap of thunder, followed by a deluge of rain.

ping-ping-ping-pingpingpingpingpingping. The rain beat relentlessly on my roof.

Screaming in sideways, the wind knocked over metal drums and rolled them about with evident distain. Trees danced in dismay. Animals fled. I hid.

Craaackkk! The lightening struck out high above, weighing the air down with dread.

The storm chased what was left of the day away, leaving muddy drowned darkness in its place. Dancing with rage at each clap of thunder, it wailed on and on.

It was awesome to behold. Absolutely marvelous.

The pounding on my tin roof made thinking difficult. Mesmerized by its fury, I stood in my doorway and watched.

Soggy, raging darkness punctuated by brief flashes of lightening, it was hard not to be impressed. Plus, there was no time between the roar of thunder and the bolts of power that lashed out above. 

The storm was upon us.

Then suddenly as I watched from my doorway, one of those bolts struck land. KA-BOOM!! Even though it hit at quite a distance, I could see the individual sparks flicker and fly, then fade.

Within milli-seconds the blast of energy raced toward me like a wave and jolted my body. What a rush! The same wave that hit me, fried everything electric in sight. The lights blew with a snap.


All I could think at the time was, “Did I just get electrified?” Still bristling with electric juices, I stood there more in shock than actually shocked. “I did. I was after-shocked by lightening.”

I’ve heard of lightening striking a person. But this? It was wild! How many other people were slammed by this wave of energy?

Anyway. The storm raged on through the night, and I eventually fell asleep. When I woke, the land was battered and bruised; but it would recover. So would I.

Sadly, our electricity has not faired so well; we have been limping along ever since. Most days we run out of electricity shortly after dinner, and have spent our nights in various shades of night.

It’s not so bad really. It could be worse.

The hardest part so far has been not having the internet. It’s hard not keeping in touch with friends and family. Worse still, I’m not able to complete my college classes online. I hope my teachers give me some leniency when they find out the extenuating circumstances. Imagine the email I’ll have to write for that one. It makes ‘my dog ate my homework’ sound good.

“Oh. Sorry I couldn’t take my test this week, Professor. Lightening hit our town and knocked out all forms of communication for over a week.” Do you think they’ll believe me?

No (or honestly, very little) electricity makes me feel like a real missionary! Ha!

Thursday, June 9, 2011

A Community Affair.

Long labors here in Sudan often mean serious injury or death. Those most at risk are the first time moms. Knowing this crucial fact, I often try to convince women to come for help early in labor. Some might even accuse me of sounding like a broken record, but I don’t care.

I don’t care, because every once in a while someone listens; every once and a while, it makes a huge difference. One of those ‘whiles’ was this week.

Her name is Nyaruom, and if we were right on her dates, she was roughly 40-42 weeks pregnant. Her perfectly round face glowed in health, matching her perfectly round belly.

When I saw her on Sunday morning, she looked to be in early labor. Her contractions were moderate but irregular. Although painful, she seemed to handle them well. Initially, her mother wanted to take her home to deliver. But when I warned them to come back if her labor had trouble, she changed her mind. They would stay.

Smiling, I gave the labor to Sarah. It seemed like a good one to learn on. Plus, I had delivered a baby just a few hours earlier; I didn’t want to be greedy. Ha ha. And since it was Sunday afternoon it was a perfect time to teach.

Sarah jumped at the opportunity. She hadn’t delivered a baby in days, because each time there was an opportunity, she either got called too late (arrived after the baby was out) or the labor I gave her turned out to be super complicated.

Well, little did we know that this birth would be complicated, too!

I won’t try to write out all the details of that chaotic day and a half of labor watch, but I will try to give you some of the highlights.

Sunday mid-morning: Nyaruoum arrived in labor with an entourage. She decides to stay and deliver at the clinic. No vaginal exam done.

Sunday afternoon:
Her mother got antsy at the slow progress and asked me to do an exam. Vaginal exam: 2 cms, 60% effaced. I tell them they can go home if they like but to come back if the contractions get stronger and longer. But they choose to stay saying the house is too far away. 

Sunday night: Nyaroum is loud and uncooperative with each contraction. I plan to give her some pain meds and a sedative if she is not due to deliver soon so she won’t get exhausted. Her vaginal exam shows her to be 3 cms, 80%. She has progressed only 1 cm in about 9 hours, but refuses to let me give her any pain medicines.

Monday morning early: She slept on and off through the night (as did Sarah and I), all is normal. But her contractions were not going anywhere. I suggested we augment her labor. They jumped at the offer, chiding me for not doing it earlier. Immediately her contractions improve.

Monday noon: another labor arrives and delivers. Read her story here.

Monday early afternoon: With the oxytocin, Nyaroum is even louder and more uncooperative. I figured things are dilating, but her next vaginal exam showed her to have only progressed another centimeter. I decide to rupture her membranes and be more aggressive with the augmentation.

Monday evening: A beautiful boy is born after some serious management (perineal stretching, vacuum, oxytocin) to the relief of everyone in the clinic! Sarah does a great job describing this labor in her blog. Read it here and enjoy.

In total, Nyaroum was in labor for 48 hrs -- 32 of which were at the clinic! Although not a record, it was certainly note-worthy.

Well done Nyaroum! And great job labor watching Sarah! If I had to be the solo midwife on this labor, I don’t think I would have made it. Thank you Jesus for babies that come out! Thank you for oxytocin! Thank you for vacuums!

Cultural side note: a labor is not just a family affair here; it’s a community affair. How do I know this? Well, after the birth, the strangest people kept congratulating me.    
        --Me? Why would they congratulate me?

The first one to congratulate me was Mario, one of our translators. The minute he got on shift, he already knew about her and was thrilled to see she’d delivered. He told me he was impressed and shook my hand vigorously. He was so impressed, in fact, that later that night he knocked on my door to ask me how I learned the skills necessary to make a baby come out like this one.

Confused at first by how much of a fuss he was making about it, I told him about my schooling, then went to sleep.

The next morning, two other translators (Santos and Peter) --who had listened to Nyaroum screaming the previous day-- were pleasantly surprised to learn she’d delivered. They shook my hand and one even slapped me on the back. Why were they so impressed? What was different about this birth that they were making such a big deal about it?          -- Hum....?

Then again. Not long after, the woman who cooks at the compound (Elizabeth) inquired what had happened. Did she know them? No. She had just heard her screaming all day and had to know. Was the baby born? When I told her that all went well, she praised God excitedly.
    -- Interesting.

As I thought about it, it occurred to me that very few people thought this baby was going to be born naturally. The community was watching with bated breath to see what would happen. Would the Kowaja know what to do? Would Nyaroum need a cesarean? This was a birth the whole community had been waiting for.

Her birth was hard. There is just no getting around it. It was challenging on so many levels. But I shudder to think what would have happened if she hadn’t come for help. I think she would have stayed in labor for 3 or 4 days easily before her family finally took her to Wau. I think she would have delivered a dead baby or a seriously compromised one, if she had delivered at all.

Such labors are a fact of life here. The whole community knows it only too well. But now... they  know there’s another way. That is why I’ve been congratulated.

Pray that this birth gets the community talking in a positive way, and other first-time moms come to deliver too. Thanks.

Wednesday, June 8, 2011

Whooping it up!

She arrived without knocking, barging into my prenatal visit with noise and confusion. Falling to a small, crumpled mass on the floor, she stared up at me pitifully but didn’t speak. She didn’t need to; she was in labor.

Her friend (who later I would learn was her midwife) rambled incessantly. Words! Incomprehensible words!

The noise of it all overlapped and drowned out my own confused questions. No one was listening, except the woman in labor on my floor, and the prenatal mama on my bed. They just looked at each other quietly and waited.

Why does this always happen on a Monday?

I asked her family to wait for me to finish my prenatal visit before they spewed out all their worries and demands. It was hard for them, but they complied.

Turning to my prenatal patient with an apologetic smile, I counseled her on how to take her vitamins, prayed for her and sent her on her way. She didn’t seem the least bit rattled by the intrusion. Frankly, neither was I. The only one struggling to keep up was my translator.

As the prenatal left, Ayen climbed on the bed explaining that her labor had started the night before. Her contractions were good and her vitals were normal, but she was having a hard time handling the pain -- a very hard time.

She was loud.

When I say loud. I mean LOUD.

When she hollered the whole clinic stopped to listen. It wasn’t a fearful high-pitched shriek but a gut wrenching wail of Wooop! Wooooop! WOOOOOPPPP!

Once the contractions stopped, she would quiet down and smile at me sheepishly. She had a crooked smile with a large gap between her front teeth, and even larger expressive eyes.         --Adorable.

But as her contractions started up again, so did the WHOOOOPS! Periodically, she would slap her leg forcefully, making even more noise. I couldn’t help but wonder if those outside listening, thought I was beating her!

Her vaginal exam showed me she was fully, and had probably been fully for quite some time, but she wouldn’t push. She just whooped, slapped and clapped incessantly. My efforts to get her to push were fruitless. She just couldn’t figure out how, or... wouldn’t.

But one thing she did really well, was make noise!

After an hour of refusing to push, an artificial rupture of membranes (AROM), and a number of positional changes, I decided to augment. Perhaps she just needed a little nudge.

Once the IV was in and the oxytocin was flowing, she got serious. Within 5 minutes the whoops had completely disappeared and she was pushing! She arched her back and out came mister Benjamin Button (as we termed him for the day).

He looked a hundred years old! His wrinkles had wrinkles on them! And when he got ready to wail in protest to our teasing, he scrunched up his face like a dried prune, twisted his lips and wailed just like his mother!         --What a hoot!

How could someone so new look so old?

Ayen laughed heartily after the birth and thanked me for helping her do it. When I told her that she was the first woman I have ever seen physically beat herself during labor, she just smiled sheepishly and shrugged.        

Her friend/midwife confessed that she too had never seen a woman react in such a way, and was sure something was wrong; that’s why she brought her in.

Even now as I think back on her birth, I have to laugh. She was truly unforgettable. 

Whatever works, I guess. Right?

Saturday, June 4, 2011

Paper People.

A shadow of a waif that once was a woman, she wore her dress like a tent. It hung awkwardly on knobby shoulder, attached to rail thin arms. And in those arms, a tiny stick version of a child peaked out at me.

Six months ago, Amon started coughing and couldn’t stop. It got so bad, she explained, that blood came out at times. Each coughing fit shook her slender frame; Wet, deep hacks that bent her in half.         --Tuberculosis.

As I lifted the blanket and touched her baby’s skin, my hand burned with fever. Skin-and-bones set on fire, he weighed just 1.9 kg (4.2 lbs).          --Lord...?

But that was just half the problem. She also reported her uterus was coming out?     --What?

Tom and Benedict took the baby and started an NG tube (naso-gastric tube) to give the child some food and medicine, and Sarah and I took Amon to another room. I had to see for myself what she meant by her ‘uterus coming out’.

Was it prolapsed or inverted? No... it couldn’t be inverted. She’d be in shock... or dead. Right?

She moved with speed but obvious pain. Once on the bed I was able to see the full extent of the protrusion; a third of her uterus was visible. White with a fibrous brown-red patch near one end, it left no doubt; it had prolapsed.        

-- Amon, I need to understand. How long has your uterus been out like this?
-- It happens each time I deliver. It comes out after the baby, I go to the hospital, and the doctor puts it back in.
-- And the coughing?
-- Oh, it’s been six months.
-- And the fever?
-- Since the birth.
-- When was that, exactly?
-- Last month.
-- Last month? Why are you just coming now then?
-- My husband was caring for the cattle. I couldn’t come without him.

Her husband sat in silence as we moved between the rooms starting IVs and taking vitals. He looked like a normal person, thin but strong. But his wife and child looked like paper people --edges torn and wrinkled.

I guess I could have attempted to re-position her uterus. But I’m not ready to do that mentally. I’m not ready to cause her the pain. She’s sick but stable. They are able to make it to Wau; and I’m okay sending them there.

Please pray for them both. Pray for Amon’s tuberculosis and prolapsed uterus. Pray for their son, Dhuony. He’s getting food now, pray that he would survive this month of wasting fevers and pain. 

Post Script: As I finished this post, Tom knocked on my door to tell me the baby had died and they wanted to take Amon home. Her husband explained that he’d bring Amon back tomorrow for the procedure, but tonight she must attend the funeral.

How could I argue? She had waited a month; what was one night going to change? So I prayed for them, then watched them walk out with their precious paper child.

It’s hard for me to understand the nuances of life here. I confess, obligations and protocol surprise me almost daily. Was it truly impossible for her to come without her husband? Did she really have no other choice? I don’t know. I just don’t know.

Please pray she comes back in the morning. Now that there is little chance she’ll go to Wau, I’m ready to try and re-insert her uterus. Pray that it goes well and she’s able to seek treatment for her TB soon. Thanks. 

Friday, June 3, 2011

A Son to Hold.

Aluel is a G5 who has been coming for prenatals for months. When I first saw her, I learned her last two children both died at birth or immediately afterward. She couldn’t explain what caused it since her labors were not long or excessively difficult; the babies just died.

Personally, when I see consecutive term stillbirths, I think syphilis. So I treated her for it, prayed and monitored her carefully.

She came for check-ups faithfully and assured me she’d deliver with us. So when she arrived yesterday around noon, I was thrilled but admittedly worried, too.

What if he died? What if he wouldn’t come out? What if... ?

--Lord, give me the strength not to carry the fear of these last few days into this birth. Help me to trust You deeper than ever before and rest in Your goodness. Amen.

That settled, I turned my attention back to Aluel.

Her contractions were short and a bit sporadic, but it was definitely labor. Since she lived close by, I asked her if she preferred to labor at the clinic or at home. She told me she’d go home for a few hours until it was time, so I prayed for her and sent her on her way.

Four hours later she returned looking active but had no urge to push.

She walked a bit, and seemed relaxed, but her helper tended to hover. When Aluel needed to push, her helper, Achol, kept repeating: “You know her last two babies died at birth.”

“Yes, I know,” I reassured, “but this baby is doing fine.” 

Satisfied that at least I knew, she let it go; and Aluel started to relax.

A half an hour later, Aluel called me in, saying she had to push. I wasn’t sure if she was fully or not (since I hadn’t done a vaginal exam), but she was giving me all the signs that it was close.

She pushed on her knees, while I encouraged her softly.

Hesitant and cautious, she seemed to fight her body -- undoubtably fighting the memories of her past births.

Each time I saw her tense up, I grabbed my doppler and let her listen to the melodic toc-toc-toc.
-- “Do you hear that, Aluel. That’s a happy baby. He is doing fine. Keep pushing with your body.”

She nodded that she heard, then turned inside herself with determination. A few minutes later, he was born.

The first cry he made as he slid into my hands brought relieved laughter to the room.    
           -- He was alive!

But Aluel didn’t say a word, nor did she try to touch him. She just watched me wipe him clean, and smiled.    
--What a tender smile that was!

When all was said and done, she thanked me for the good work I did in keeping her baby alive. Smiling, I reminded her that it was her good work that helped this baby live, as well. She came for prenatals; she took her medicines; she delivered at the clinic.

And now... she had a son to hold.

Thank you Jesus! May she have ten more just like this one, and may they all grow up to glorify Your name! Amen.

Update: Helpless

(If you haven't read the previous story yet, read it here first.)

After insisting Biyana go to Wau, her family took her home. At the time, I worried they might let her die, but the following morning, I learned she caught the first bus to Wau!    
    --Hope.  Blessed hope!

Later on, I heard through the grapevine that she had made it through surgery, but the baby had died. This didn’t come as a surprise as his precious hand looked swollen when she had left.

However, this afternoon, the story changed again. I got news that the baby lived!

Yep, you read that right! Biyana is alive (Woohoo!), and her son is in her arms! (Hallelujah!) Please pray for them both to recover quickly. And pray that her fistula is somehow fixed! Thanks.

However, I’m not sure what has happened to Abuol. Her husband kept trying to find a private vehicle to take her to Wau, but failed. By mid-morning, I got tired of his dilly-dallying and told him to get her on a bus -- and fast!

Then I explained she was developing a fever and her baby was showing signs of dying. Only then did he seem to take me seriously. I think he hadn’t fully grasped the urgency before then. 

(Midwife note: The baby’s heart rate had no baseline. It was 112, 152, 124, 140, 112, 156, etc. I’m thinking a possible sinusoidal pattern.)

But when he did, he moved. He took the medicines and walked her gingerly out of the clinic to the bus station. But she didn’t get far, before she fell to the ground.

Too weak to walk, we drove her to the bus in our vehicle. But I warned Aboul not to show that she was sick, or else the bus drivers might charge her too much for her seat. Then I turned to Lucus (her husband), cautioning him to get her the surgery at all costs. He nodded blankly, promising to send word as soon as he could.

I cannot stop thinking of her. I don’t know how she is or what has happened. I promise to give an update if I do. Please pray for them both. Thanks.

Wednesday, June 1, 2011


Last night just as I prepared to put the cap on the end of a good day (happy prenatals, beautiful breech birth, etc.) in walked a labor, then another... and then two others followed.

What? Four labors all at the same time?

The first to come in was a G2 in early labor. She lived close by and opted to go home and labor until she became active. I told Sarah that she should catch this one (since it should be simple) and I’d supervise. The woman’s name was Victoria.

Then Adeng showed up. Adeng was a G1 (first time mom) who had been here earlier in the day for a prenatal. I had diagnosed her with STDs and warned her not to go into labor until the medicines were finished. She nodded in comprehension, forgetting that women don’t get to choose when they start labor. However, once she got home, the contractions started.

Now, she was back on my prenatal bed --in labor with STDs.

As I counted contractions, there was no denying the fact that labor was on its way. The progress was slow and steady, but she was good about moving around. Her family watched her like a hawk, hovering around her as she walked. This was her first, so the pressure to have her get the childbirth confession was strong; they wanted to be in the room all the time.

Then Aboul showed up.

She announced her arrival by throwing herself on the clinic porch with melodramatic flair. The crowds that had gathered laughed at her, but she ignored them and lay there silently until addressed.

When I got around to her, she explained that her water had been leaking continually for over 3 days. She had no contractions but was haunted by a constant lower abdominal pain that had compelled her to come for help.

Honestly, the continually leaking water worried me, so I checked her out. Her chart indicated that she’s been here only once before. At that time, I couldn’t tell if she was carrying twins or a very large term baby. Either way, it/they were breech.

When I checked her this time, she was already 2-3 cm dilated with ruptured membranes. The tiny buttock presenting, made me think she was carrying twins. But if that were the case, one of the babies was dead. I could find only one heartbeat.

I was still trying to figure out what to do with her, when Biyana came in.

Biyana as many of you may recall was here a few weeks ago with a vesico-vaginal fistula at 5 months pregnant. At that time, I had tried to assess it but it was too painful, so I referred her to Wau. (Read her story here.)

But yesterday, when she came back, it wasn’t about her fistula; she was bleeding.

My heart started to sag with the strain.

When I examined her, some bleeding was visible, but she wasn’t in labor. I tried to do a speculum exam, but she hit the roof in pain. Calling for Tom, we decided she was having an inevitable premature birth, and decided to sedate her.

Once the drugs took effect, I was able to place the speculum with ease. What I saw though... took my breath away.

A pool of dark red blood obscured it at first, but then it moved! Five white fingers flexed and twitched in unison. I was looking at a hand!          -- Sh#*!

Both Tom and Sarah bent low to inspect it for themselves. Could it be true? Her baby’s hand had prolapsed!

Because of the pain she experienced with the digital and speculum exams, I worried how she’d handle a vaginal delivery in the first place. Now we had no choice; she was dilating.

We observed her for some time, but eventually induced her. Her husband kept insisting there was no money to take her to Wau, and that it would be better to make the child come out.

However, the oxytocin did nothing but cause her uterus to form a tight, painless ball. I couldn’t do digital exams to monitor progress; she wouldn’t allow it. This went on for several confusing hours. 

In that time, Sarah caught Victoria’s baby. It was a fun birth. But I'll let her write about it on her blog. I'm sure she will soon.
Victoria and her little girl.

Adeng also progressed but not as quickly as her family wanted, so they opted to take her home. They promised to bring her back once it was time to deliver, then whisked her away.     --Sigh. I didn’t argue.

And Aboul... well Aboul slept the night at the clinic. We didn’t want her to go home, but we didn’t want to induce labor either. She needs a cesarean not induction. After loading her with antibiotics, she slept and promised to call her husband in the morning.

By 10 pm, we stopped trying to induce Biyana because it wasn’t working. Her baby was still doing famously --his little heart ticked like a drum-- but there were no signs that she was dilating. So we agreed to try again in the morning. 

Exhausted, both Sarah and I wrapped up the clinic. Aboul was sleeping, Biyana and her husband were well, and Adeng had gone home to labor. Victoria was recovering with her baby girl at her breast. So, we bid them all good night and went to sleep.

By sun up, Victoria was discharged, Aboul was rested, and Biyana reported no more pain or contractions.

But what would be our plan of attack?

I consulted with Tom, and we decided on watchful waiting. I’d focus on the prenatals accumulating out front, and deal with Aboul and Biyana later in the day.

By noon, I had finished with the prenatals, and I decided to try and induce Biyana again. But after several hours of oxytocin, nothing happened. The problem was, I couldn’t tell if she was dilating.

What happens if she cannot dilate? What then?

Finally, I bit the bullet and did a vaginal exam. It caused her tremendous pain, but I was finally able to get some answers.

She was still only 2-3 cm (no progress despite induction). Also, her baby’s entire right arm was prolapsed into her vaginal vault.

Yes. You read that right. A prolapsed arm that wiggled.

Despite my better judgment, I tried to replace the arm back through the cervix, but Biyana screamed and writhed in pain. Unable to watch her suffer anymore, I stopped.

What more could be done? We were out of options, so I informed her husband she HAD to go to Wau.

The baby was transverse. The cervix was not dilating. She needed surgery. She also needed her fistula fixed. Only after I explained the situation in detail for the third time, did he move. I repeated over and over again. “Your wife will die without surgery.” “She needs a cesarean or she will not live.” “Take her to Wau if you want her to live.”

Could I have been more clear?

I don’t mean to insinuate that he was calloused or dull. He is a husband that cares and is moved with love and compassion. He wanted to take her to Wau, but he kept insisting there was no money.

The look he gave me as he asked me to try again, will haunt me for the rest of my life. 

I can no longer muster hope.        

Finally accepting to go to Wau, her husband asked me to write an official referral for the doctors there. But as I was writing up the referral, my translator came running to get me.

“Come quick. The hand is coming out of her vagina,” he sputtered. 
“I know,” I spoke slowly, “There is nothing I can do. Tell them to go to Wau.”
“No. You don’t understand, Akuac, the HAND is out!” he insisted.
Frustrated and spent, I raised my voice, “No,” I hissed, “You are not listening. I have told them, there is nothing I can do. The baby is not coming out. It is only the hand. Go tell them they must find a way to get to Wau quickly.”

Turning back to the paperwork, I knew I had spoken too harsh, and I instantly felt bad. What did they want of me? Can I turn this child? Can I make him come out? Can I heal her wounds? Can I stop this pain?

I’m helpless -- heartbroken and helpless.

I have no ambulance (the government of Southern Sudan won’t give us the clearance papers). But even if I did, there is NO fuel in Sudan. Something has interrupted the fuel imports and the gas stations are empty.

How Biyana’s husband is going to find a bus, afford the exorbitant price for the seats..... and then afford the TWO surgeries she’ll need, I cannot begin to imagine. 

I knew in coming here, I’d see such things. I knew I’d experience these kinds of obstacles, but I didn’t know it would hurt so much. Overwhelmed and hopeless, I’m ready to run away. I’m ready to hide.

Lord, hide me in the shadow of Your wings! Hide me Lord from the pain and suffering I see. My heart can’t take any more.

My heart is not used to such suffering and pain. It’s leaking dry. Soon it will be a hollow heart-shaped shadow. What will I have to offer anyone then?

Oh, Lord. I’m tired. Please help me hope again. Please do a miracle for Biyana.

Pray.  Pray as He leads you.               --I’m out of words.

P.S. Some of you might be wondering... but what of Aboul. Well, she is waiting for her husband to come. She’s stable. Her water is still ruptured, but so far no infection has set in, and her labor has still not begun. We are waiting. She, too, needs to go to Wau. She needs a cesarean. Pray she can get it.

And what about Adeng?  Well, I suspect her family had her deliver at home. She never returned.

Breech: Fearing the Curse.

Two week ago, Wecnyin and her family arrived in early labor with a breech child. Even though her dates said she was only 8 months pregnant, she measured more, so I prepared for a breech delivery.

However, after awhile I wasn’t convinced she was really in labor. Her contractions were very short, and she hadn’t had anything to drink for days. Since dehydration can cause Braxton-Hicks contractions, I hydrated her and watched. My chief concern, however, was her reported ruptured membranes. I saw no evidence of it, but I couldn’t rule it out either. So I admitted her for observation.

At the time, she was only 2 cm dilated. After several hours of no significant progress, I tried to send her home, but she refused. She kept insisting that her home was too far away, and that it was getting dark. I tried to convince her all would be okay for the night, but she looked panicked at the thought.         -- Strange.

After digging deeper, her family finally explained that her first child was born breech and died shortly after the birth. The head was trapped for well over an hour.        -- Oh.

Even though her labor had stopped, I let her family convince me she needed to be augmented. They weren’t going to go home, so I obliged. Fortunately, the augmentation/induction failed, but by then it was too late for them to go home. So, they stayed the night.

The next morning, her labor had completely stopped. It was clear she hadn’t had any water come out, so I told them to go home, drink water, and come back when labor started. The great news was that in the night, her baby seemed to have turned cephalic (head down).    

I expected to see her a few days later for a check-up, but she never came. I reasoned that she must have delivered at home. But I was wrong.

A full two weeks later, she arrived yesterday morning for a prenatal; she was in labor. The contractions were strong and close together, making feeling the position of the baby difficult. Was she still breech? I couldn’t tell.

When I did a vaginal exam, I was happy to see her fully dilated, but the baby was not engaged. All I could feel were taut membranes bulging powerfully each contraction. After some preparation, I opted to do an artificial rupture of membranes (AROM) to see what would come down.

Sarah monitored the fetal heart tones continually to search for any signs of cord compression, and within minutes, the butt was engaged and making its way through her pelvis. Knowing how frightened she’d be to hear her child was breech, I explicitly kept it from her.

She pushed well, and the blue-tinged buttock moved lower with each contraction. Since she was on her hands and knees, it made assisting her very easy.
A few minutes later, the legs dropped, the arms emerged, and then the head followed in sweet succession. She was perfect --small but lovely in every way!

When Wecnyin realized she was born breech she looked grief stricken. While the rest of the room broke out in smiles and cheers, she remained silent. Why? Her little girl cried sporadically a tiny whelp of confusion and surprise, making the rest of us rejoice. But still, Wecnyin sulked.

So, I asked her why.
-- You seem sad to me Wecnyin. Don’t you know that your baby is doing well.
-- But she came out breech. Now she will die.
-- What do you mean? She is healthy. There is no reason to think she will die.
-- Well my first baby died after being born breech.... so this one will too. Something is wrong with me that my babies come out this way. I’m cursed.
-- Oh...

It took me a few minutes to explain to her the whys and hows that caused her first baby to die, but eventually she understood. Once reassured, she started to bond with her girl and a few minutes later found her smile.

It was such a simple and calm birth. What an honor!

Please pray for Wecnyin and her family to trust God for this child’s life and learn to rest in Him. Thanks. And praise God with me that this birth went so well.

(Loud shout out to MTw and her midwife friend in Switzerland, who taught me this new breech delivering technique. It worked like a charm! Thanks girls!)