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.