A Very Different Birth.

A few months after arriving in South Sudan, a woman came in with antepartum bleeding. Her baby was dead, could I help her?

I hemmed and hawed, but eventually said I would try.

Her birth was the very hardest of my life --shaking me to my core --teaching me things I never wanted to learn.

I can still vividly remember sobbing hot tears into a staff member’s lap as she helplessly tried to understand my grief. She prayed. I thanked her, then walked back into the room where my helper quietly mopped up the pooled blood. 

Elizabeth had delivered. Finally.

But in that time, I somehow morphed into a different midwife --one that pulls babies out by their feet. I wasn’t sure I ever wanted to become such a midwife... but there was no going back.

Her birth changed me. 

Something else happened that morning. Something surprising. I came to love Elizabeth and her husband, Michael, with an intensity I find hard to explain. It rolls over me in waves, filling my lungs, making it hard to breathe.

So when I saw Elizabeth back in my prenatal line a few months ago I instantly recognized her. Love does not forget. Then I turned and saw Michael sitting beside her. He stood to shake my hand, bouncing as he proudly announced she was four months pregnant.

Could it be true? Was she really expecting another baby? Whoohooo!

She came faithfully to each prenatal visit with Michael always at her side. To date, he is the only husband who has come to every check-up.

Anyway. Long story short. Her due date drew near.

Then a few weeks back she started having contractions. Even though she was in early labor, I admitted her for observation, and watched her through the night. But her contractions stopped as suddenly as they started, and by morning they were ready to go home.

It was a false alarm. 

However, a week later she was back with more contractions. This time they were dilating her better, but barely. It was slow going.

Fortunately, it was a Sunday morning and the clinic was quiet. Since I was in no hurry, I watched, waited, and prayed; but her labor never progressed.
    --What was the hold up?

Eventually after waiting fourteen hours without any significant progress, it was time to take action. I started her on oxytocin, and she went from 4 cm to fully in about an hour.

As she labored, I listened in with the doppler. Each time the static warble found heart tones, she smiled. The steady toc-toc-toc of her baby’s heart, wrinkled her face in a toothy, contagious grin.

We were making new memories. Memories that didn’t involve silent wombs. Memories that were noisy with life --her baby’s life!

When it came time to push, Michael supported her from behind, and she got on her knees.

The pushing was slow for a G7 (or woman delivering her 7th child). Really slow.
     --Which explains a lot. 

As she grunted, pushed, and sweat, I silently prayed. 
    -- Lord, however you work this birth... please let the baby live.

I confess, the toc-toc-toc reassured me more than I let on.

Hard as I tried, I couldn’t shake the echo of that fateful morning from my thoughts. Here I was... in the very spot I pulled her last baby from her body.
    --Would this baby die, too?

Deep breath.

She continued to push, but the head would not descend. Finally, I had had enough of waiting, and I got out the vacuum. It took one tiny tug and another strong push, and she was born!

At the sound of her plaintive gasps, the room filled with laughter, and her parent’s eyes danced with joy.

She was alive!

It was a very different birth --one that ended in tears of joy rather than sorrow. Thank you Jesus! And thank you all for praying for her. He answered our prayers!

Elizabeth, Michael, and baby girl at 3 day check-up.

Placenta Previa?

Two days ago, Adhieu started having contractions in her sleep. She thought it was unusual since she was only 6 months along, but there was nothing she could do about it. She lived too far away to get immediate help. She’d have to wait until light.

But as the sun peeked up the next morning, the bleeding started. Lots and lots of bleeding. She bled heavily until noon.

She said her baby kicked like mad during that time, but then suddenly stopped.

That was a day ago.

She knew something was wrong, but it took time to get the family involved. Someone needed to bring her to town. She couldn’t go alone. Who would come?

Eventually it was decided her father would accompany her.

By the time she arrived, her clothes and legs were crusted in dirt-stained blood. A large flap of membranes hung from her introitus but she was no longer in labor.
    --Was this placenta previa?

(For those who don’t know, placenta previa is when the placenta presents first, causing painless bleeding. It can be life threatening for both mother and child, depending on the blood loss.)

There were no heart tones to be found. No movement. Nothing. Her baby was dead.
        --Could she have had an abruption?

(For those who don’t know, an abruption is when the placenta detaches from the uterine wall prematurely. This is very painful and presents with bright bleeding. An abruption can be complete or partial. It is almost always life threatening for the baby unless delivered quickly.)

She wasn’t surprised when I told her baby was dead. And she didn’t cry, either. Instead she looked unblinkingly off in the distance, hardening her jaw. Resolved.

A quick speculum exam revealed a 2-inch chunck of placenta plugging up her cervix like a cork. Thick membranes dangled down the canal, but the bleeding had stopped. She was 2 cm dilated and had no contractions.

Ideally, she would have gone to Wau for a c-section, but I intuitively knew this was NOT an option.

Had you asked me how I knew this, I would have been hard pressed to give you an answer. And yet when Tom asked me to send them anyway, I gawffed, “That’s not going to happen. They don’t have the means.”

He insisted on it though, expounding on the potential danger of her bleeding to death if it was a previa, etc.
-- “If contractions start, her cervix can open and she can hemorrhage... maternal mortality.... too dangerous... must transport....” He lectured pedantically. He wanted us to warn them of the risk of her dying. Just in case.

I listened to his words --I even agreed with them-- but I knew they’d never go.

Her clothes were too worn. Her body was too lean. And neither of them wore shoes. Plus her only companion was a frail father with clouded pupils and trembling hands.

But the biggest clue was the fact it took her a day and a half to get to us.

No one with any sort of means waits a day and a half to seek treatment with this much blood loss. No one. 

I respected Tom’s wishes though and talked to them about transporting. The discussion was disheartening short.

Conclusion: They had no money. His goats were back in Thiet. It would take time to arrange their sale --perhaps two days.

I listened and nodded, then induced her.

I had peace about this induction. Her bleeding was almost nil, and she was a multigravida. If the medicines worked... she’d deliver quickly and this would all be over.

Then no goats would need to be sold.

By God’s grace, the induction was effective and she delivered 2 hours later with very minimal bleeding.

Her baby weighed just 800 grams, but he was perfectly formed. Tiny ears. Delicate fingers. Two thin eyebrows neatly knit atop unseeing eyes.

He never opened his eyes to this world... but I believe he’s seeing something much more beautiful now!

Please pray for Adhieu as she grieves this loss. It was not her first. Pray that it is her last. Thanks.

Chubbiest of All the Land.

Amouk arrived in the morning with a fountain of gushing amniotic fluid each contraction; it pooled on the floor -- a puddle but not quite a lake.

Splish-Splash

Expecting her 7th child, she looked like she was carrying twins by the way her belly hung. It was a mountain beside her lake.

When I checked her, she was 4 cms dilated with abysmally short contractions. But with a G7, you can never guess how quickly labor might go. So I admitted her and watched.

She spent the morning trying to augment her contractions with nipple stimulation and walking. And I knocked off prenatal after prenatal from the line. There were at least 35 prenatals to see.

Each time I checked her baby’s heart tones, she would comment on the fact there might be two inside. What did I think?

I told her that I honestly didn’t know. I felt and heard only one baby, but she was the size of two babies... maybe even three!

We’d laugh each time and she’d go back to waddling around the clinic. I’d go back to my prenatal ladies.

When the very last prenatal was seen, I brought her back in for another vaginal exam. It had been hours (8 hours to be precise), and she was looking no closer to delivering. What was wrong?

Her second vaginal exam showed her to have made no progress whatsoever. She was still 4 cm and 50% effaced.

Hum...

But by this time, her helper had changed. It was no longer her mother but a young lady named Martha. When Martha saw me she laughed excitedly and asked if I remembered her. When I said I didn’t and that I was sorry, she laughed again.

“But you delivered my baby last year! I’m Martha,” she exclaimed, “I named my son Stephen after you!”

And together we slapped hands in excitement and caught up on how my namesake had been doing. Martha was Amouk‘s niece and had no doubt encouraged her aunt to deliver with me.

So back to my story. When I told Amouk that she was not progressing and that I wanted to augment her labor with an IV drip, her only concern was whether or not she’d get home before dark.

Hum...

It was about 4 pm already and it gets dark around 7:30 pm. Would she deliver before dark? I couldn’t say. But we induced/augmented anyway.

However once the oxytocin was running, her contractions kicked up a notch. In fact, just 30 minutes later she was asking to push.

Not sure if she was exaggerating things or actually ready, I did another vaginal exam. Not only had she dilated to 9 cms, but his head had dropped 2 stations. It was a go!

I let her push a few times but she wasn’t making progress so I asked her to hold off pushing until she was fully dilated.

Another 30 minutes later she started pushing with earnest. Although fully, her baby’s head wasn’t coming.

She pushed and pushed. The head molded and molded. I could see it crinkling up inside; but it would not come.

Hum...

After 40 minutes of this, I tried the vacuum. And even then... he wouldn’t come. No doubt we were dealing with a bigger baby than normal.

However, with time his head started to crown and he eventually emerged.

Roughly the size of a mac truck, he squealed and complained as I wiped him down. Rolls of stocky legs and chubby arms, he flayed his arms in excitement.

He was HUGE!

If I hadn’t watched him come out, I would have sworn he was a 3-month old! And would you believe it, he is officially the biggest baby I have ever delivered!

10.3 lbs (or 4.7 kg) of kissable cuteness!

Twins he was not, but he could have been!

Afterward, Amouk laughed in relief while her mother --eyes greyed with age and cateracts-- took my hands and lifted them to the heavens --this is how the midwife is honored in this culture-- and together we praised God for His goodness in giving us a healthy baby!

Inchelich Nalich! Praise God! Inchelich Yesu! Thank you Jesus!

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.

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.

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?

Helpless.

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.

AROM to the Rescue!

Crhisma is one of my prenatal girls. Expecting her second little one, she came as soon as her contractions got strong. They had started earlier that morning, giving her plenty of time to beat me to the clinic. Her contractions were strong and frequent, giving the impression it was time to push. But after trying to push a few times, I didn’t see progress, so I chose to do an exam. She was 5 cm but in a G2 (second time mom) that could mean anything.

She labored beautifully, choosing to alternate between walking and resting for several hours. The contractions stayed remarkably strong and regular, so I expected progress when I checked her again later that day (by her request). However, she had regressed to 4 cm and her cervix had become somewhat swollen. Even after, six hours of regular, painful contractions, there was no progress. I was confused.

Her cervix showed signs of softening (very good sign), so I chose to rupture her membranes to see if that might move things along. A warm bath of vernix stained waters gushed out in a wave,  surprising me a little. I wasn’t excited about the intense pain she would experience from this point on, but I, also, didn’t want her to get exhausted.

She chose to stand and walk furiously with each contraction, which fortunately kicked up a notch. She is the first woman I have ever seen actually walk DURING the height of a contraction. Normally, they walk between them and pause with the pain -- but not her. It was unique and powerful.

I prayed things would progress, as the possibility of transporting her weighed on my mind. As I watched the sun settle in the west, I wondered if this wasn’t a case of CPD. If so, could I get her to Wau in time? I prayed for wisdom and then sat back and watched her walk.

Remarkably, only 30 minutes after rupturing her membranes, she started pushing. I didn’t stop her. Instead, I set up the room in anticipation. So what if she was only 4 cm a few minutes ago. If she needed to push, perhaps it was time.

She pushed on her knees with my translator at her back. She pushed well-- focused and determined. She pushed joyfully and even laughed when she saw her precious boy emerge! Crhisma was thrilled with the birth, which is all that mattered to me.

Afterward, while holding her boy to her breast she smiled sweetly and told me in her limited English, “You give name. Christian name. You!” She was honoring me with the joy of giving her son an English (aka: Christian) name.

The friends in the room were surprised by this honor, and so was I. They smiled at me expectantly while I thought. Images of strength and beauty flooded my mind and the only name I could think of was Samson. So I told her, I wanted him to be called Samson. Would she mind? She shook her head and smiled. No, that would do fine!

The problem was (and this is a problem I keep forgetting when handing out names), Samson is difficult for Dinka speakers to say. The “S” sound comes out like a “F”. So, as she said his name, it sounded more like “Fanfon”! It was adorable.

She and her friends, happily whispered his name over and over to themselves in practice. Eventually, they mastered it and kissed him each time they said it. Sigh. It was so fun!

I really do love my job! How could I not, when you have little ‘Fanfons’ populating the world?

Magson Menace!

This is Magson. It is an herbal oil that women put on their bellies here. I'm not entirely sure why they think it's necessary but it is very common. It's a major problem.

It causes a woman to have contractions and often to go into pre-term labor.
One young lady went into false labor at 34 weeks and found herself admitted into the emergency room.
During prenatals this morning 5 out of the 8 women I talked to have been using Magson regularly!