Friday, September 16, 2011

Head Strong!

Aleu arrived on foot but in obvious pain; her friends had to hold her upright. Sweating and shaking with each contraction I wasn’t sure if she was in labor or having convulsions from malaria. Either way, it looked urgent.

But since I was mid-prenatal I let Margaret take care of her. I’d check on her when I could.

Five minutes later, I prayed for my prenatal and pointed her toward the pharmacy. I could hear excited voices in the next cubicle (achem... I mean room), and I decided it offer my help.

I walked in to find a very pregnant girl on her back frantically trying to push. Eyes jumping in confusion, her face was a mask of fear and pain. I stayed back and watched.

It seemed that Margaret was trying to do a vaginal exam. She did so despite Aleu's pushing and called over her shoulder at me: “She’s fully. Are you ready to take her?” 

Not wanting to seem too eager, I nodded and smiled. Touching Aleu on the arm, I assured her everything was alright but that I needed her to come with me.

“Can you stop pushing for a minute and move to the other room?” I asked quietly.
She nodded and slowly sat up. At the sound of my Dinka she seemed to melt. A good sign.

Once I got her into my room, I had her start pushing. She complied but couldn’t figure out how. After a few fruitless contractions, it finally dawned on me that she may have been doing this already at home.
-- “Has she been pushing at home?” I asked the room.
-- “Yes,” my translator explained softly. Apparently this was explained before I took over.

Duh, of course she’d been pushing at home. She showed all the signs. Frightened. Exhausted. Caput on the baby’s head. Vaginal swelling.

Only then did I take a step back and ask a few extra questions. How long? When did the water break? Was there any blood? How many babies has she had?

Normally I have all this information before pushing, but this was Aleu’s first time to our clinic. She hadn’t received any antenatal care at all.

But the story she told was not new. It’s one I’ve heard over and over again. Aleu’s first child died during delivery after 3 days of pushing. This was her second child.

She went into labor the previous evening, her water broke around 2 am, and she’d been pushing ever since. That was 11 hours earlier.

Knowing this information, I did my own vaginal exam and reassessed her pelvic outlet. Her ischial spines were prominent leaving less room for the baby’s head to maneuver. It’d be a tight squeeze.

No longer willing to dilly-dally, I got out the vacuum. It’s my go-to tool every time ‘one of these’ labors comes in --labors where the damage is already done --labors where the baby is still alive but the mother is exhausted.

But even with the vacuum and her pushing with all her might the head wouldn’t budge. In the States she would have been a very good candidate for a cesarean. I’ve rarely seen such a small outlet. 

Nevertheless, we persisted and prayed. The vacuum popped off a number of times but we kept putting it back on, each time hoping that the baby would come the next push.

Finally, frustrated that we were getting nowhere and fast, I placed the vacuum once again. I was determined to pull harder than the previous times. I put my back into it.

Yes, it was foolish. Yes, a cesarean would have been a better choice. You’ll get no argument here.    
-- I will say this however. I prayed. I prayed hard. And I pulled.

Would you know it? It worked!

The head slid lower and Aleu’s eyes widened in surprise. She could feel the difference and was eager to push once again. The next contraction the head was almost crowning.

The following one, he was born!

He had massive molding on his skull, plenty of caput (or swelling) and one large scrape from the vacuum. But he was alive!

I was horrified to learn the vacuum caused him damage but I seemed to be the only one to feel that way. Everyone else was amazed and thrilled he’d come out alive! So I dropped it and rejoiced with them.

Thank you Jesus for vacuums! Thank you Jesus for babies that come out! Thank you Jesus for everyday miracles!         
             -- I’ve seen my fair share!