Monday, December 19, 2011

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.

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.