Last week of 2011...

My silence this week has stemmed from a fierce desire to stay sane despite a post-Christmas birthing spree.

Apparently, a large number of babies were dead-set determined on being born in 2011. Three of the labors were teenagers.

The first was only 15 years old, but she was strong and resilient. She awed me with her determination and trusting spirit. Although her labor was painfully long, she rallied at the end and pushed with all her might. When her baby girl was finally born the whole room sighed in relief. She was amazing! 

Sweet baby born to, Elizabeth, the 15 year-old girl.

The next teenager was the exact opposite. She argued with me, ignored my advice, and fought me at almost every turn. Despite her attitude, her mother and I got along smashingly. We understood it was the pain talking, and found ways to laugh about it. When her baby boy was finally born, we laughed even harder at his enormous eyes! Apparently it’s a family trait. 

What big eyes you have!

However, the third teenager to deliver brought much sorrow. She had only been in labor for 2 hours by the time she got to us, but she was already fully dilated. There was no way to prevent the birth.

Since we weren’t sure how premature she was, we prepared for the worst but held on to hope.

After the birth, her baby needed some initial help breathing, but her APGAR scores were good. We were hopeful she’d do well despite her 1.2 kgs.

Long story short, we had to resuscitate her three separate times and start intravenous fluids. Although her color was good while on oxygen, she couldn’t maintain her own breathing without it. 

The preterm baby girl born this week. She lived only 5 hrs.

She quietly died 5 hours postpartum while we watched on and prayed.

Her young parents wept openly as I prayed for them. But by then, their family had gathered and was able to comfort them in their grief as well. They even comforted me. This might seem strange, but I’m grateful I had the opportunity to be a part of her life... if only for those few hours.

Thankfully the rest of the births were less complicated --but not by much.

This week I also had another severe hemorrhage. But fortunately I was on my guard after last week’s hemorrhage and I was able to control it much faster. Her birth was a blur to be honest as she arrived at 1 a.m. and delivered mid-REM cycle. 

It was almost a full day before anyone thought to tell me that she was one of our translator’s wives! Thinking back, I thought it was strange that he’d showed up at 1 am for no apparent reason, but in my foggy, sleep-deprived brain it never occurred to me that it was because she was carrying his child!

Yes... I really am that slow. But it would have been easier to believe if someone had bothered to tell me he got married! 

Peter Malok, his wife Akutet and baby girl.

So let me be the first to say (for anyone who has been to Tonj and reads this blog) that Peter Malok got married --there is still an issue with cows of course-- but he’s married, has a beautiful wife, and now a delightful daughter!

Let’s see... what else happened this week?

Oh, I also had to transport a woman for CPD (cephalo-pelvic disproportion) after an unsuccessful trial of labor. She arrived before dawn in a frantic state, saying she had been pushing for hours at home.

This was her 10th pregnancy --but only 4 were living. The rest died during delivery or shortly afterward. Fortunately, we had enough time to diagnose her situation and ready the ambulance for transport at first light. 

Transporting for the CPD.

I’m happy to say she got to Wau and was taken to surgery almost immediately. Both of them are doing well, I’m told.

There were a few other straight-forward births this week with happy moms and healthy babes. But the most memorable of them was Arop’s birth.

I’ll end with her story.

Arop lives 3 hour away by foot. But after her first three babies died during delivery at home, she decided to see if we could help for this next one.

She was faithful to come for prenatal care and we watched her closely, encouraging her to deliver with us no matter what.

She took our advice and started walking to the clinic once she was confident her labor began. She arrived fully and delivered a precious little boy 40 minutes later. Her birth was delightful and remarkably simple.

Afterward as I watched her breastfeed for the first time in her life, I was overcome with joy. She has carried 4 babies to term; she has labored 4 separate times; but this was the first time she’s ever heard her child cry. This was the first time she’s ever held one to her breast! 

Arop breastfeeding her baby. What a smile!

What a delightful way to end a year!

Happy New Year!

A Sudanese Christmas.

Christmas morning started slow and easy. There were no children to wake me at dawn; there were no presents to unwrap; there were no babies to be born, so I slept late.

By the time I got out of bed, the sun was high in the sky casting a thick oppressive heat on all below.

Out my window off on the distance several dozen well-dressed church-goers marched and sang Sudanese Christmas carols to a beating drum. They were quite literally marching off to church. As they paraded passed they picked up people on the way, telling them it was time to celebrate Jesus’ birth.

They marched slowly allowing time for children to tag along. A white flag bopped up and down as they passed.

Later I asked a Sudanese friend about it. He told me that this is the ECS church’s (Episcopal Church of Sudan) way of informing people it’s Christmas.

He explained that they start beating the drums on December 20th, (Yep, they sure did!) to get everyone ready. Then starting on the 23rd, they march and sing each morning announcing the coming celebration. How else would those in the villages have time to make it to town?

I loved this explanation --not only for the festiveness of it all-- but also for how culturally appropriate it is. There are few calenders around here --especially off in the village. So why not drums, songs, and dances?

Since Dr. Tom and I are the only staff/missionaries left on the compound over the holidays, we were also the only ones left to perform church. That means we were alone in singing off-key Christmas carols interspersed with scriptures. It was a short service but it blessed me nonetheless.

Later that afternoon, I arranged to celebrate Christmas like a local. This entailed walking around from house to house, catching up on life and eating cookies. I invited Dr. Tom to join in on the fun.

I missed out on it last year, because I didn’t know I could do it. But this year I was determined to celebrate Sudanese style.

I arranged for my friend Mario to act as my guide. He knows the area well and happily took us to homes of babies I’ve delivered in the last few months.

Me holding Nyankiim, & her mom.

The first baby I saw was by accident, though. A woman stopped me on the street and handed me her toddler, saying “This is your baby. You delivered her. She is named “Daughter of the clinic” or Nyankiim in Dinka.

Holding her doe-eyed tot in my arms put a huge smile on my face. I thanked her for letting me hold her child, we slapped hands, and she walked off in the other direction. What a joy!

As we walked on, I asked Mario who we’d be visiting first.
-- He said, “We are going to see the baby with no knees.”
-- “What? The baby who has no knees?” I repeated, more than a little confused.
-- “Yes. He was born last week...” he added trying to clarify.
Guessing I asked, “Do you mean the baby with the clubbed feet?”
-- “Yes. Yes. The baby with no knees,” he insisted while indicating his own patellae.

When we got to her house, Akoot’s friends asked us inside while they went to get her.

Since the door was only 4 feet high, I had to bend completely in half to enter the tukel. Pink wall hangings covered the interior. Two plastic chairs and a bed with an intricately embroidered sheet made up the sitting room.

I sat on the bed, and Tom and Mario took the chairs.

Akoot breastfeeding & me.

Beads of sweat formed on my forehead, then gathered to stream down my face. Akoot was happy to receive us and came to sit next to me. As we talked, she proudly breastfed her son while her other children bounced around the room in excitement. One kept sneaking up to Tom to inspect his white-ness, then would run away in happy shrieks when seen.

Sweet laughter!

They served us fluffy sugar cookies as we talked about her son’s progress. I’m happy to say he’d doing well.

We didn’t stay long, however, as Mario wanted us to visit his sister.

Atong was a prenatal girl but ended up delivering elsewhere. Her labor started while visiting friends in Wau, and she delivered there.

Atong telling me about her birth.

As we sipped on orange Tang and enjoyed another round of cookies, she told us about the birth.
-- “You were right,” she started, “My boy came out with his legs first.”
Handing me her prenatal book, I read my notes. Her boy had been persistently breech each visit.
-- “Did you go to the hospital to deliver?” I asked, eager to know how it went.
-- “No. No. My friends helped me with the birth. He came out easily.”
-- “In your book it says this was your second breech,” I started then added, “It says your last breech baby didn’t breathe for a long time but is okay. Is that right?”
-- “Yes. But this baby breathed well right away,” she explained.
-- “Oh, good!” I said, bouncing his chubby body in my arms.

Tom & Mario at Atong's house.

Tom watched our interaction on from across the richly draped tukel, then teased, “The babies in Sudan... they come out feet first, hit the ground, and run off!”

He dramatically miming the various actions, causing those who understood English to burst out in fits of laughter. Even though she doesn’t speak any English, Atong chuckled hesitantly with us, knowing she should laugh but not why.

But once Mario translated she laughed very hard --genuinely amused at the idea.

It was a nice visit. I got to see what a middle-class Dinka family’s house might contain. Their wealth was obvious. On a nightstand, a black boom-box with a neat stack of cassette tapes picked up radio waves from Wau.

The DJ bounced from English to Dinka to Arabic with ease, as love ballads set to metal drums filled the air. Mario tried to translate one of these ballads for me. It was something about a woman doing a man some kind of wrong... and how very sad he was.

Kids watching us from the tukel door.

Behind the radio stood a rack with neatly folded wraps and skirts which served as a closet. To the left, dozens of drinking glasses stamped with fading Pepsi logos lined the shelves. Behind me tucked in the opposite corner, a black 1990‘s TV set with bunny-ears collected dust under a mess of bottles and trinkets.

Mario pointed it out and sadly stated, “It was working before... when we had a generator. But now it does not work. No power.” I nodded in understanding. Fuel prices are just too high for such a luxury.

What that television must represent to them though! It’s the first I’ve seen outside of our compound. Just owning one that works must be a powerful statement of wealth.

A baby I delivered 2 mo. ago.

Afterward we visited two other women and their families. Then Mario showed us his tukel and brought us home. It was a wonderful way to learn about my patients and build relationships. I’m so blessed to have gone.

I hope that all of your Christmases were as fun as mine! Merry Christmas... a bit late!

Updates: Triplets, Clubbing, Car Accident...

Car Accident:
Kuac, the boy run over by a truck, had to wait almost 24 hours in Wau before he got surgery. But he eventually got it. Thank you so much for praying!

His family is running out of money, though. Please pray they obtain the funds needed to get the rest of the surgery he might need. The man who hit him will be held liable, of course. It’s just an issue of liquid cash. The hospital charges for each item used (i.e. gauze, gloves, IV fluids). They have to pay up front.

Clubbing:
Baby Tong, the boy born with severe clubbing, is doing well. His parents brought him in for a check-up today. He’s breastfeeding well, and his joints are more limber.

After several recommendations, I researched Arthrogryposis, a rare congenital condition that displays these symptoms. No one is sure how this condition develops. Nevertheless, I believe he has it.

If he has it, there is a 50/50 risk he’ll die within the first year of life (assuming he has one type of the condition). But it’s equally possible he’ll live a long, albeit disabled, life. There is no way of knowing for sure how severe it will turn out to be.

Please pray for his family to know how to care for him properly and that he’d one day have use of his hands and feet. If you are interested in learning more about this condition, I recommend this website. 

Triplets:
The triplets are alive! Can I get a hallelujah?

Yar, their mother, came in because Ngor has a cold and needed medicine. I took the opportunity to check them all out. Each has gained weight since I saw them last, but they are not growing as would be expected for their ages.

Yar told me they eat only twice a day. She gives them cow's milk, even though she still has breast milk. Once again, I did a long teaching on what should be done to help them gain weight. But I don’t think she listened. She’s hard to read. I’m not sure what to think.

Anyway... please keep praying for them. Their names are Ngor, Chan and Adit. Thanks.

Preterm:
Since I haven’t seen our preterm baby for a check-up this week, I’m starting to think she may have died. She was just so small.

However, I reserve the right to be wrong. Perhaps she’s doing so well that her mom doesn’t think it’s necessary to come back for a check-up. Perhaps.

Pray as the Lord leads. Thanks.

Blood Loss.

They aren't smiling... but they were happy. At least I think they were...

Apiu is one of my prenatal girls. Although she lives far away, she decided to move to town her last month of pregnancy. She explained that she had had 3 days of heavy bleeding after her last child and was worried it would happen again.

So when her labor started yesterday morning, she slowly made her way to us. She arrived quite active and delivered two hours later on her knees.

Her precious girl looks just like her. Same sparkling eyes. Same playful mouth.

Although she had some initial bleeding postpartum, I controlled it with fundal massage and oxytocin.

But just when I thought it was over, she started bleeding again. Clots. Heavy clots. 

So I decided on intravenous oxytocin to keep things firm and had her breastfeed. This improved things dramatically and I figured we were through the roughest patch.

Once stabilized, I moved her to the postpartum room to rest. She’d only lost about 600 cc by this point and she wasn’t dizzy.

But during her recovery (roughly 2 1/5 hrs postpartum), she started bleeding again. Heavy, thick clots.

I got there to find her lying on the floor COVERED in blood. Several large blood clots lay beside her. And she was dizzy. Too dizzy to even sit.

In all my time here in Sudan, this is the first case quite like this. She’d lost at least another 600-800 cc by this point.

Something was keeping her uterus from clamping down on itself, leaving me with few options. There was just one thing left to do -a manual exploration.

(For those who don’t know, this procedure requires me reaching inside the woman’s uterus with my gloved hand and systematically removing anything remaining inside, i.e. placental parts, sequestered clots, etc.)

I hate doing this, but I couldn’t let her bleed to death either. So I readied the room, started more IV fluids, then reached inside her body.

Her screams brought looky-loos (of course), but it couldn’t be helped. She needed to stop bleeding. This was the only way left to do it.

I quickly removed several large clots, then massaged her uterus shut.

Painful? Yes. Anyone who has ever had this procedure knows it’s crazy painful. Some say it’s worse than giving birth.

Effective? Yes. It stopped her bleeding almost immediately.

It took me some time to convince Apiu that I didn’t hate her... and that I wasn’t an evil person determined to cause her endless pain. But I’m not sure she believed me.

“I didn’t want to hurt you, Apiu. I just didn’t want you to bleed to death, either. Can you understand that?” I asked pleadingly.

She just stared at me with hardened eyes. So I continued.

“If I had let you continue to bleed, you would have needed a blood transfusion,” I explained. “This was the only way I know how to help you stay alive...”

More hardened stares coupled with whimpers, but then a slight nod of her head.

Once the pain subsided and the bleeding finally stopped, I think she forgave me. But I’m not sure. She looked at me with fear-tinged suspicion the rest of the night.

But did I care? Not really... I did what I did to save her life. She might not get that now, but I do.

We kept Apiu overnight for observation, but by morning she was strong enough to be discharged. Please pray she regains her strength quickly. Thanks.

Afterward, all I could think of were my midwifery teachers in the Philippines who taught me this procedure. If they could see me now...

To all my teachers at Newlife School of Midwifery: I love you and thank you from the bottom of my heart! This women is well because of the countless hours you spent teaching me. I love and appreciate you ladies so much!

Lord, bless the faithful midwives who worked so hard to teach me these skills. Bless them for their dedication and patience. Help them remember when they are tired and frustrated that their service is quite literally saving lives half way around the world! May they never forget that. Amen.

Car Accident.

Kuac is in bad shape.

About an hour ago, his ten year old body was struck by a speeding truck, then dragged 40 feet before stopping.

His chin and lower teeth are all but missing; his chest is rubbed three layers raw; and yet he's conscious.

There is a hole from his left molars through his cheek, ending at a stub that used to be an ear.

And both ankles are broken.

Although he's only ten... and in a lot of pain... he still took the time to thank us for saving his life. I mean, come on!

This kid is strong. Remarkably strong.

His family is gathering money for an immediate transport; the police are filling out accidents report forms; and the looky-loos have all come to gawk.

Now that his ankles are braced and his wounds are cleaned, we watch his tiny chest bounce up and down as he breathes, waiting for his transport to Wau.

Like I said... he's in bad shape.

But by God's grace he'll live. Please pray that he does. Thanks.

Clubbed Breech.

Sunday was a blissful day of rest. After church I napped and read. It was nice not to have any labors to watch or babies to catch for a few hours.

However just before dusk drew an orange cloak across the sky, Tom told me about a woman with premature rupture of membranes who had just arrived. He’d checked on her, but she wasn’t having any contractions yet. What did I want him to do?

Since I was making dinner (and didn’t want to check her myself) we discussed her case briefly and decided to let her go home to labor. She didn’t live far.

Two hours later she was back.

Since Tom was the one who saw her originally he offered to take care of things again. But as I stood there hesitating on whether or not to go help. God pushed me to go.

I changed out of my pajamas, slipped on my shoes, and wandered over.

Akoot was in obvious pain.

As she lay on the bed writhing, she explained the contractions came fast and hard once she got home.

I measured her belly and counted heart tones. She looked small for a term pregnancy. Could she be preterm?

-- “How many months pregnant are you, Akoot?” I asked calmly.
-- “I’m eight.”
-- “Does that include your first month?” I asked knowing that most women don’t count it here.
-- “No. I’m nine months if you count the first month.”
-- “Okay... but your belly is small,” I pointed out between contractions. “Are you sure you’re really nine months?”

(For those midwives out there. She was measuring only 27 cm. And her baby’s heart rate was erratic --lots of variability but within normal range.)

I was about to do a vaginal exam... but quickly realized I didn’t have time. Thick membranes bulged between her legs, revealing a vernix stained fluid beneath.

Birth was imminent.

Instead I called Tom in to assist. If this baby was preterm, I wanted his help to resuscitate.

Tom took a seat in the corner while I told Akoot my concerns.
-- “Akoot, it looks like your baby is coming soon. But I think he might be too small...” She listened carefully to each word.
-- I continued, “If he is very small he might have a hard time breathing. Do you understand?”

I always hesitate in times like these. How much do I explain beforehand? Will telling the mother my doubts cause more fear than necessary? Should I refrain?

In the end, I usually always tell them. Hard truths take time to seep in. But mostly, it’s what I’d want. I’d want to know of problems earlier rather than later.

-- She listened, nodded that she understood, then explained, “I’ve been sick for one month. Very sick.”
-- “What have you been sick with?”
-- “Bloody diarrhea. Chest pain. Fatigue.”
-- “One month?” I asked again, “Why did you wait so long to come for help?”

Flipping through her prenatal book I saw various entries of where she’d sought treatments for various complaints. She’d been treated for a number of ailments, the latest being dysentery. But she’d only had that for 4 days.

In fact, Tom gave her very effective drugs for it earlier in the day.

Pushing her sicknesses aside, I turned my focus to her baby. Whatever the reason, he’d be born very soon.

Looking back at the bulging membranes, I was disturbed to note they had turned from white to black. Not good. Could this be blood?

No time to worry about that. Everything was set up for the birth, so I encouraged Akoot to push.

At first I thought the membrane-covered object was his head... but I was wrong.

Admittedly, I was surprised to see a tiny butt emerge instead. He was coming out breech. And he was in the caul (aka: born in the membrane sac).

When I broke open the membranes, I realized that what I had confused for blood was actually meconium, and I wiped it away.

This breech birth was different however. His legs were jammed tightly against his face, and I couldn’t release them.
    -- Strange. 

Akoot continued to push and I called over the wall for Tom to come help.

Something was holding up the delivery of the legs though. So I reached up to draw then out. They wouldn’t budge.

So I pulled harder.

Eventually they came free but then hung awkwardly to the left of his body. Stiff as boards.

Both arms were tucked up close to his head. So, I reached in to release the right one first. It came on the first try. But the left arm wouldn’t bend.
         -- Strange.

I ended up having to deliver his head before his left arm.
        -- Very strange.

Once he was born it became clear he was not preterm. But there were other problems to consider.

His feet were severely clubbed and his knees were locked in straight line. His hips were unbending causing his feet to fall naturally at his chin. When I tried to move them his back arched in pain.

Later we realized his fingers were formed but clenched in boxing fists, impossible to open.

Seeing the confusion on our faces, Akoot tried to understand what was wrong.
-- “Is my baby alive?” she asked eagerly.
-- “Yes. Yes. Your baby is breathing well. And the good news is he is not preterm,” I started.

She nodded and searched my face.
-- I continued, “But there are some unusual things about his legs and hands. You will understand more later. Please don’t worry... I’ll explain it after the placenta is out.”
-- “His legs are bad?” she asked.
-- “Don’t worry. Your baby is doing well. You’ll understand more later.”
 She nodded gravely then delivered her placenta.

This is the first time I’ve delivered a baby with clubbing. I wasn’t sure what to say.

I asked her about possible teratogens that may have caused this and she mentioned a fight she had with a family member at 6 months pregnant.
-- “No. That is not the cause. This does not happen at 6 months,” I told her. “This happens before 3 months.”
-- “Oh... well, at 3 months I got injected (vaccinated) by the traveling medical people...”
-- “Do you know what they injected you with?” I asked.
-- “No. They did not tell me.”

Could vaccinations have caused this? I don’t know. I suspect not.

I also asked her if any of her other babies came out breech, and she gawfed.
-- “Ehh..? My baby came out breech?” She asked incredulously.
-- “Yes,” I laughed, “He was born breech. Have any of the others come out this way?”
Shaking her head in disbelief, she looked to her friend for confirmation. They discussed it rapidly in Dinka.

Turning to my translator, I asked him what they were saying.
-- “She says no baby has come out butt first like this. First time.”

She was obviously surprised --almost even more surprised by the birthing position than the clubbing.
-- “Why is she so surprised?” I asked him.

They discussed it with fierce animation, interspersed with laughter, then he turned to me and said, “She says that in the village if her baby had come out with the butt like this they would have forced him back inside and given her lots of alcohol to drink...”
-- “What? .... I mean why?” I stumbled over my questions but smiled at the thought.
-- “They say babies die when born like this one. She is amazed her baby is alive...” he explained.

Only then did it all make sense. Yes. With all the troubles this breech gave me, I think he could very well have died if he wasn’t born at the clinic. He was not an easy birth. And he needed a bit of resuscitation right at the beginning.

When I told Akoot this she nodded enthusiastically, then looked down at her child in wonder.

Over the next day or so, Tom and I helped Akoot understand his problems, start physical therapy, and establish breastfeeding. It was essential to me that Akoot bond as well as she could with him.  

He took some time to breastfeed properly but I am happy to report they are both doing well and were discharged this morning.



Tom decided to put casts on his legs to turn his feet outward. Seeing such a tiny tot with casts like this is new to me. It makes me smile.

Please pray for them. I think he might have signs of down’s syndrome as well. Thanks.

Preterm Prayer Project.

This precious baby girl was born last week. Her mother brought her by for a check up a few days back and I discovered she has lost a lot of weight since birth.

Right now she's only 1.1 kg.

Her mom assures me that she is eating well. And her vitals are good.

Please pray for her. Pray that she would not only live... but thrive!

Thanks.

The Fantastic Five!

 (Warning: long but fun stories... grab a cup of coffee and get comfortable. It’s gonna take awhile.)       

I arrived in Sudan after a long but uneventful flight to find Margaret elbow deep in a twin birth. Her wry smile couldn’t hide the frazzled look underneath.

-- “Have you been busy, Margaret?” I asked already sure of the answer.
-- “Yes, it’s been crazy. I’ve delivered 6 babies in the last week. Two sets of twins, two preterm and oh... by the way, the first set of twins were preterm and both died.”

She went on to explain some of the strange cases that had filled her days then asked, “Where are all these women coming from?”

I smiled knowingly. I knew Christmas would be a busy time. It’s simple math.

Just count back 9 months and you’ll see what I mean. 

November, October.... skip a few.... July, June... keep going... May and April, then March!

March was a big month for South Sudan. Men journeyed here from far and wide to vote on the referendum. Every vote counted. A country’s future was at stake!

But while they were here... they made sure they did their part to populate this great country!  

Thus the birthing surge.

So when I got the call the following morning that a woman was in labor, I smiled and marched over to the clinic. I walked in to find a huge smile on a very familiar face! 

Rebecca used to work for us as a translator but quit shortly after getting pregnant. She has a happy laugh and playful spirit, and now she was in labor!  

Rebecca and her son.

Although she was still very early, she insisted on staying at the clinic. I didn’t argue. If she was happy to labor here, I was happy to have her.

But morning melted into afternoon which faded into dusk, before her contractions picked up any speed. But by nightfall her labor was well under way. And by 1 a.m. she was fully.

But pushing wasn’t going well. She had pushed for an hour with very slow progress.

-- “You need to push harder than that, Rebecca, if you want your baby to come out,” I urged.
-- “I’m pushing... but I’m afraid,” she finally confessed.
-- “What makes you afraid?” I asked.
-- “I’m too small down there. My baby won’t come out,” she stated flatly. 
-- “... but you’ve seen how this works. You know your body can open, don’t you?
-- “Yes. I know. I’ve seen it. But... I’m too small,” she argued, “I’m just too small.” 
-- “You are not too small, my dear. Just push and you will see. Just push harder,” I pleaded.

Another hour went by.

As the minutes ticked past, I worried. How long should I let this go on before I get tough with her? Was the vacuum in order?

I chased away each worry with the facts. The baby was doing well. She was still strong. There was progress.

Even though it was slower than I liked, nevertheless, there was progress.

It’s moments like these that I wouldn’t mind having a midwife of my own.... You know, someone to remind me to be patient. Someone to speak encouraging words in my ear. “Don’t push her until she’s ready. Trust the process. Know when NOT to interfere...”

So I prayed about it and God assured me things would be fine. So I sat on my hands and waited.

Then all of the sudden, her pushing changed and she gave it her all; within minutes her boy was in my hands!

After the birth, Rebecca fell asleep as soon as she could with her boy snuggled close to her chest.

Equally tired, I tried to follow her example. But sleep evaded me for several more hours. By 5 am I finally dozed off.

Two hours later there was a loud knock at my door.
-- “Ma’m Akuac. There is a woman in labor.”
-- “Is she pushing?” I asked scratching the sleep from my eyes. (I always ask this so I know how fast to get dressed.)
-- “No, but her contractions are very fast...” he explained.
-- “Okay. I’ll be there in a minute.”

I arrived to find her squatting in the middle of the room.... pushing.

Glancing quickly at her book, I learned her name.
-- “Yar, do you need to push?” I asked.
-- “Yes. Yes. Baby is coming...” Her hurried voice was all I needed to hear. 

I signaled for my translator to get the room ready for the birth while I did a quick vaginal exam. Sure enough, not only was she was fully, she was at a +3 station.

Yar and her daughter.

She paused long enough for me to get a pad under her butt. Then her mother came in to help hold her shoulders down while she pushed in a semi-squat.

This is a typical birthing position for the women here. It provides counter pressure for them to push against.

And boy did she push!

She pushed so hard that when her baby finally crossed the finish line, it stormed the judges, stole the gold medallion, and ran off with it!

Honestly had I turned away for a second, her baby would have hit the ground hard enough to bruise.
        -- Impressive!

Once she was cleaned up and ready to transfer to the postpartum room, my translator informed me there was another labor waiting outside.

She’d been there awhile in fact. Over an hour.

I invited her inside with an apologetic smile, and she smiled back. Her name was Mary and she was expecting her 7th baby. 

She was calm and relaxed, so it came as a surprise that she was already 9 cm dilated. But since she wasn’t quite ready to push, I asked her to walk a bit. She happily complied.

Meanwhile another woman showed up in labor.

I asked Tom to check her in because I was feeling spread a little too thin. He screened her but found her to be having braxton-hicks contractions and sent her home.

A few minutes later, Mary started getting grunty and waddled back into the clinic. She tried to urinate in the chamber pot (aka: big wooded bucket with a toilet seat), but got nothing.

Then she started pushing while still on the pot.

All of a sudden her eyes flew wide and I instantly knew it was time. The problem was... my translator was off getting tea.

I tried to get her to a better position --as the chamber pot isn’t ideal for maneuvering-- but she couldn’t move. So instead I reached low and steadied her baby’s head as it eased out. Her little girl was born with one push!

Having no where else to place the tot, I slip her into her mother’s waiting arms and we laughed.                        --Priceless.

When my translator arrived with the tea a few minutes later. He couldn’t believe he’d missed the birth. He was only gone a few minutes!

Apologizing nervously, he kept asking what I needed and what he should do.

He’s new to the whole birth scene and had never seen a woman give birth on the toilet before. It was my first toilet birth as well.
           --I confess. I liked the easy clean up!

Mary got off the toilet to deliver her placenta, then sat down on the floor to breastfeed. As I was charting and monitoring her blood loss, one of the compound workers interrupted to say another labor was on her way.

Apparently this woman’s family had called for the ambulance. They had just gone to pick her up and I could hear the sirens wailing off in the distance. So we scrambled to set up the next room for her birth.

Mary smiled knowingly as I excused myself to go help.

Mary with her daughter.

The next labor stepped out of the ambulance gingerly. She moaned non-stop as we walked her to the birth room, peppering her with questions.

How long had she been in labor? Had the water come out? Had she been pushing at home? How many babies did she have.... oh, and by the way... what was her name?

-- “Akuch. My name is Akuch,” she whispered between contractions.
-- “Okay. How long have you been pushing?
-- “Five hours.”
-- “You’ve been pushing for 5 hours at home?” I repeated incredulously.
-- “Yes,” she moaned. Another contraction hit.

We soon learned that she was expecting her 5th child, had been in labor since dawn but started  pushing from the very first contraction. She couldn’t explain why. No water had come out.

All her vitals were normal except she was in obvious distress. Was it fear?

After assessing her and finding her dilated to only 5 cm, I reassured her all was fine. With time I  convinced her to walk around a bit, strictly forbidding her to push.

She promised she wouldn’t and wandered off with her sister. 

By this time Mary --the previous birth-- had moved to the postpartum room and we cleaned up the main birth room.

I was about to go rest as well when one of the translators rushed in to tell me Akuch was pushing outside.

He’s the excitable kind but rarely wrong, so I went to check on her.

I found Akuch surrounded by three family members, all trying to hold her upright as she strained to push her baby out.

-- “Akuch, please stop. You are not ready to give birth,” I argued.
She trembled and grunted in response.

My translator informed me her water broke, and I looked down to see a  steady flow of fluid running down her leg. As another contraction rolled across her body, she fell to her knees and pushed like mad.

-- “Akuch. Don’t push. Don’t push...” But my words were white noise in her transitional state.

After her contraction faded, I picked her up out of the dirt and walked her back to the clinic.
         --Could she really be fully after only 15 minutes?

Akuch and her daughter.

She lay down on the bed for me to get a better look...  and lo and behold the head was visible! We had just enough time to put an under pad beneath her before her little girl was born.

As I wiped her baby off, several family members smiled at us through the screened window; a few more peaked past the sheet we use as a door.
           --Wow! ... I mean wozers! I mean gosh-golly-gee...

Four babies before lunch. Now that’s a record!

Tom kindly offered to take over any other births that might come in so I could get some shut eye, but naps don’t come easily to me these days. I tried and tried to sleep but I couldn’t.

By 2 pm I headed back to the clinic only to find another big-bellied mamacita pacing the grounds. Her name was Agum.

-- “Tom, do we have another labor,” I asked not wanting to know the answer.
-- “Yep, but she’s only 3 cm dilated. Don’t ya worry ‘bout her,” he quipped, “I got her covered.”

Covered? I didn’t doubt him for a second, but he looked pretty busy. He kept bouncing back and forth between a very sick man with malaria (who incidentally bit him in the butt while he inserted an IV) and another patient with massive road-rash from a recent motor accident.

Since I was more or less rested by this point, I assured him I’d look after Agum.

As the sun dipped low on the horizon, Agum got a bit more active. Her contractions were regular but unimpressively short. Was she progressing? I couldn’t tell.

Nevertheless, a few hours later she was sweating profusely.
    --Could she be in transition?

Not wanting to do a vaginal exam, I waited and watched. Her contractions were still very short.

At one point, I left to grab a cup of coffee; my lack of sleep was starting to take its toll. When I returned, I crossed a friend of hers in the hall. She motioned frantically for me to go inside but didn’t say a word.

Agum holding her son.

I entered to find Agum lying on her side, soaked from the waist down. Her water had broken.

Knowing the drill, I readied the room and checked for progress. I was considering doing a vaginal exam, but didn’t need to. The head was visible.

She pushed with her next contraction and out slid a very handsome boy with a very happy cry.
        --Woohoo!

After dinner, I didn’t linger long. Tom promised to look out for any labors or births in the night --Bless his heart!-- and I hit my bed like a rock.

There was in fact another labor that night... but Tom delivered her. I’m told she gave birth around 2 am. I was called to come if I wanted to, but I declined. I had nothing left to prove.

Five babies in one day! That’s a record for this midwife.

I wonder how many babies will be born this month...

Please pray for strong hands and deep sleep... when we can get it! Thanks.

Labor of Love ~ Nov & Dec 2011

Labor of Love Newsletter Nov & Dec 2011

Swiss Delights.

My first stop in Switzerland landed me in a stone railway station with arching windows and dozens of suitcases marching about like ants.

My train arrived two hours earlier than expected, and I wasn’t sure how to reach my friend. But since I was no longer in Europe (Switzerland opted out of the European Community years ago), I had to exchange some money and find a phone.

But once again I was in Swiss-German territory. Who would understand me?

If I had paid better attention in geography class, I would have known I could speak French to the locals but I didn’t. Instead I blabbered away in English.

Bea and Me in Basel.

It wasn’t until much later that I learned that Basel --Switzerland’s third largest city-- marks the spot where France, Germany, and Switzerland meet. As a result its locals are quite fluent in all three languages.

With time I found a phone, called my friend, and arranged where to meet. My dear friend and fellow Newlife graduate, Bèa, met me at the tram station with warm hugs; we dropped off my bags and immediately headed into the city center.

Basel has a beauty and tranquility that is hard to describe; its rich past bleeds through picturesque views of the Rhine; its worn, cobblestone steps hint at an antiquity full of lore.

We only had a few hours to catch up, so we set out at it with gusto. Bèa and I laughed and reminisced over pasta and pizza, then I sent her off to work while I tumbled into bed. She works nights.

The next morning, I climbed back aboard a train for Zurich where another Newlife graduate, Medea, met me with her 9-month-old belly. She’s due any day!

Meda and Andre near Zurich.

Together we laughed, took pictures, crocheted, and ate our way through her house. I kept hoping she’d deliver while I was there... but it didn’t happen.

Our time together was blissfully restful though, and I’ve come to realize that weary travelers and term preggos need about the same number of naps each day!        --I love naps!

The following day after visiting another amazing Christmas market in Zurich, I caught the last train of my trip.

Now I sit at my sister’s house in Geneva, sipping on my forth cup of coffee and listening to the house wake up on this sleepy Sunday morning.

An fun handmade Advent calender.

I love my sister and her family so much. What a blessing to come to a home where hugs are meted out liberally, and the conversation bounces from French to English in the blink of an eye.

Their home is laughter and joy, warmth and love. Thank you Jesus for giving me such a wonderful family and so many extraordinary friends! I’m blessed... so very blessed.

Next stop... Kenya.

I fly out in the morning. Please pray for traveling mercies. Thanks.

Hamburg.

I arrived in Hamburg as the sun was westering low on the horizon introducing me to a cold I’d long forgotten after my years in the tropics.

The sun set around 4 pm casting a pale gray over the city like a thread-bare shawl, allowing the unfamiliar chill to soak into my bones. But despite the frigid air, I was greeted with warm hugs and laughter as my friend, Stefanie, welcomed me to the city of her youth.

Stefanie and I first met over ten years ago when we both lived in Spain. We’ve kept in touch over the years, seeing each other as time and distance permits. Reconnecting with her after all this time was like stepping back in time.

The day I arrived, Stefanie still had a few hours to work; so I walked around the city. Once she got off, she drove me back to her place where I met her husband for the first time and got a better look at her pregnant belly.

She lives on a beautiful suburban street, but one that is still marked with war relics. Tucked between the off-white apartment buildings and mini-vans, sits a WWII bomb shelter. Gray and solid, it blends into all the other buildings on the street except for one thing --it’s windowless.

A square rock. A symbol of refuge. A fortress too strong to destroy.

Apparently dozens of such buildings dot the city. They were built to withstand direct bombs; they were built to last. Today, they serve no purpose... but are too expensive to dismantle.

A symbol of an era. An unmarked tombstone of the realities of war. 

Each time I passed it, images of frightened children and trembling mothers flashed through my mind.  What was it like to run for its shelter as the sirens wailed? Did its walls shake as they slept through the bombs?  What did they wake to find the next morning?

But my mind did not stray too long on such thoughts. Seventy years have effectively hid the scars of war beneath towering trees and neatly trimmed gardens.

Stefanie took the day off to show me around town, so we toured the city on bikes.

As we sped along the Upper Alster’s shores, Hamburg’s beauty unfolded before us. The skyline of boat sails and church spires spread from East to West.

Taking it in while dodging joggers and mutts dressed in tiny coats, proved to be challenging but totally worth it. The twenty-minute ride downtown was one of the most picturesque of my entire trip. We crossed canals, weaved through parks, and meandered along river shores.

When we reached the city center we wandered through various Christmas markets and caught up on the details of life. But by 3:30 pm the sun was already starting to fade; we had to head home or risk colder degrees.

Later that night Stefanie had a swimming class, so she suggested I join her but go to the thermal bath part. I happily agreed forgetting that nothing in the building would be in English.

It was challenging not having my translator with me. Which bathroom was female? Was this the woman’s changing locker or the men’s? I hesitated, chose a door, held my breath, and entered. I sighed audibly to learn I’d guessed right and put on my swimsuit.

I had to ask a handful of people before I found an English speaker who could tell me where the steam baths were. But when I did, I happily flipped-flopped my way toward them and sat down.

Once inside I was surprised to learn they add special aromas to them --chamomile and camphor. As I breathed in their essences I could feel my body relaxing on a cellular level. 

Afterward I returned to the pool for the jet streams which massaged my back. Then I saw a door with ‘Sauna’ written clearly next to it. It was the only word I understood, so I pushed open the door and entered. Suddenly 120 degrees of heat engulfed me, drawing me in like a hug. I breathed in shallow gasps and lay down, remembering Sudan.

A few minutes later two naked men entered and sat down.

I sat up in surprise and asked in English (the only language I could muster):
--“Is this the men’s sauna?”
The men hesitated in this foreign tongue, exchanged glances, but eventually answered me.
--“No. This is mixed sauna,” one stuttered in a stilted accent.
--“Really?” I asked trying to hide my shock, “Men and women share the saunas here?”
--“Yes.” More hesitant glances.
--“Oh,” I said flushing in confusion and lay back down.

But my mind could no longer relax; it raced round and round.
--Am I allowed to wear my bathing suit in here? I’m not about to strip naked... so why did I care? Were these guys as uncomfortable as I was...? What’s the big deal? It’s only naked men...

As a third naked man entered I closed my eyes tighter and concentrated on my breathing.
--What made white naked men any different than black naked men that I might see in Sudan?

But I couldn’t relax anymore; my skin was red as much from the blushing as the heat. So I decided to head back to the pool and leave the mixed saunas to the Germans.

Later when I shared my culture shock with my friend she laughed and reminded me that “this is Germany. People don’t worry about being naked here.”    

I laughed with her.
    --Yes. Clearly they don’t care at all!

Next on the agenda... Switzerland!

Winterzauber Wonders!

With the crisp zing of winter come holiday traditions and flavors --and in Germany that means glühwein, poffertjes, and kartoffelpuffer. I was delighted to discover these treats for the first time at various Christkindmärkte (aka: Christmas Markets).

Glühwein and Feuerzangenbowle are both different kinds of spiced wine. The glühwein can be served with an extra shot of liquor --Amaretto, Calvados, or the like -- but it is lovely without it.

The Feuerzangenbowle, I’m told, has a stronger flavor since it’s made by pouring the heated wine through a funnel of crystallized sugar, infusing it with a slightly burnt sugar flavor.


 
Poffertjes are silver-dollar shaped potato pancakes topped with melted butter and copious amounts of powered sugar. Be careful though eating this dessert in the wind! If not you’ll look frosted yourself!


 
Kartoffelpuffer or what some call Reibekuchen, are deep-fried potato hash. Recipes differ somewhat. Some are made by mixing grated potatoes in batter and others are just potatoes hammered flat and cooked to a crisp. Either way, they are served with slightly sweetened apple sauce.



My favorite winterfest treat though had to be the cheese filled sausage, käsekrainer. It had to be folded in half to fit the bun! It’s sweet yet spicy flavor burst out in every bite! (I didn't get a picture of the sausage... I ate it too fast. Ha!)

Whether deep-fried, dusted in sugar, or oozing cheese, it’s delicious! Germans certainly know how to celebrate Christmas!