Five Boys! Six Girls!

I’ve delivered 11 babies in the last 10 days. It felt busy, but it didn’t occur to me that I had been that busy until I counted. I can’t help but smile though, as I read their stories and remember.

My Valentine’s day baby --a boy-- was born during staff devotions. I remember how quiet the clinic was for a change since everyone was in the meeting. What a delightful birth!

The next day, Ajer delivered in a grand total of 45 minutes! Both she and her son had fevers and required lots of care, but they recovered in time.

Later that night Adut also delivered in record breaking time, then walked home an hour later!

The following morning Amour arrived looking active. Even though she had never come for prenatals and lived in Juba, her family insisted she deliver with us since I had delivered her sister’s baby a few months ago.

They also explained that Amour’s first baby had died during the delivery because the TBA had “strangled the baby” on the way out. They did not want that to happen again. Why a TBA might do such a thing... I cannot say. But I was glad when she delivered without any complications a little while later.

The next birth was a few days later. Although only six months along, Adhar went into labor after contracting a viral infection. Her contractions had kept her awake the night before, but she did not think it was labor since “her months were not finished”.

Only when her water broke bringing forth more blood than amniotic fluid, did she come for help. But by then, there was little we could do. Her precious boy lived only a few minutes. He was just too small.

Later that night, Anhiem came in fully dilated with twins. My helper and I had just enough time to set up the room, when her little girl was born. The first twin weighed only 1.5 kg (or 3.3 lbs) and was small even for her gestational age (SGA) of 34 weeks.

However, her second twin did not want to come. Five minutes turned into ten, and the twin seemed no closer to coming. The heart tones were in the right position for the breech presentation, and when I reached in to check, I felt a knee.

Or so I thought.

After 15 minutes of pushing, we could no longer find heart tones and I called for back up. Margaret came and agreed that the baby must be dead.... but how? Why?

She redid the vaginal exam and pulled out and arm.

An arm!

Then it all made sense. The baby was not breech but transverse. The leg was an arm. There must have been some kind of cord compression... or prolapse. And the baby died.

We ended up transporting her to Wau for a cesarean, and she got her surgery the following morning. My heart is broken over this loss. Honestly, I can’t stop thinking about it.

The next morning, another boy was born just before church! His mom arrived fully and pushed him out within minutes.

However the following birth was not so lucky.

Nyankiir arrived at 9 cm but stayed there for 4 1/2 hours. The head descended but much slower than seemed normal for a G7 (aka woman expecting her 7th child). Since four of her previous babies died during the birth, I confess I got a bit nervous. What if she needed a cesarean? What if this baby was too big for her pelvis?

So we prayed, encouraged, did exercises, and then prayed some more. Eventually her girl made her debut though; she was born with both a nuchal hand and a tight nuchal cord. What an honor to be a part of her birth! (Kerri also wrote about her birth on her blog.)

What else? What else... ?       Okay. Right.

So last night I was called again by the guard to come quickly. I arrived to find Veronica sweating large beads of sweat, and the look she gave me meant business.

Remarkably she was able to hold off pushing until the room was readied. But then two minutes later her girl was born!

The laughter in the room when her friends arrived was priceless. Their happy chatter and excitement filled the room with joy, making the night feel like day. She too ended up walking home within an hour of so of birth. Remarkable.

Then today there were two more births. Atong delivered at noon after laboring all night at home. Her baby was small but healthy. And just as I was getting ready to transfer her to the observation room, Rebecca arrived.

I was surprised to learn that Rebecca wanted to deliver with us even though she’d never delivered any of her babies at a clinic... nor had she ever come for prenatal care. I didn’t have much time to question her about it though... as she started pushing almost as soon as she arrived.

Her little girl was born 5 minutes later!

Please pray for these moms and babies. Pray for health! Pray for salvation! Pray for healing! And ... pray for me. I think we are heading back into another busy season. Thanks.

Hearing Him in the Darkness

(Guest Writer: Bubba Hoelzer )

Every day I read My Utmost for His Highest.  It is one of my favorite devotionals and today’s devotion spoke to my heart:

Sometimes God puts us through the experience and discipline of darkness to teach us to hear and obey Him. Song birds are taught to sing in the dark, and God puts us into “the shadow of His hand” until we learn to hear Him (Isaiah 49:2).

“Whatever I tell you in the dark. . .”  — pay attention when God puts you into darkness, and keep your mouth closed while you are there.

Are you in the dark right now in your circumstances, or in your life with God? If so, then remain quiet. If you open your mouth in the dark, you will speak while in the wrong mood— darkness is the time to listen.

Don’t talk to other people about it; don’t read books to find out the reason for the darkness; just listen and obey. If you talk to other people, you cannot hear what God is saying. When you are in the dark, listen, and God will give you a very precious message for someone else once you are back in the light.

Yes Lord, when you bring me thru darkness in my life, complaining only defeats Your purpose for me. Talking to others about my struggles does not help my darkness—and more times than not it can drag them into my dark circumstances.

Yes, Lord, the wise thing to do is listen and obey. The only one I should speak to is You during times of darkness. Even if I shout to You it is better than a whisper to another. My heart and dependence must remain upon You and not the counsel of others. 

Listening and obedience are very difficult for us when we are feeling all alone and less than able to walk the steps You have called us to during in our everyday life. But Your power can only be funneled into me during these trying times as I focus all attention on you. This same lesson You taught to the children of Israel when they come to the bitter waters of the desert. Their nature was to complain, but You began to teach them the power of listening and obeying and having total trust in You. It was after they heard Your words to them that they found an oasis in the desert.

He said, “If you will listen carefully to the voice of the LORD your God and do what is right in his sight, obeying his commands and keeping all his decrees, then I will not make you suffer any of the diseases I sent on the Egyptians; for I am the LORD who heals you.” After leaving Marah, the Israelites traveled on to the oasis of Elim, where they found twelve springs and seventy palm trees. They camped there beside the water. Exodus 15:26-27 (NLTSE)

While reading the story of the two blind men in Matthew I realized they were living in total darkness—both physically and spiritually. As they were sitting in their usual spot they were listening to a large crowd passing by and heard that Jesus was coming. They began to cry out to Jesus and did not seek or follow the aid or counsel of those around them.

In fact, when the crowd told them to be quiet, they became more focused on Jesus and called all the louder. They had no way of knowing if Jesus had already passed them and gone on his way, but they continued seeking Him in their darkness until they personally heard the Master’s voice. Then in an attitude of obedience they were able to hear and in response to His question, simply responded, "We want to see".

This moved Jesus to touch their eyes and remove the darkness from them. The power to radically change their situation came thru listening for Jesus and then hearing His voice.  All of this was done with humble and obedient hearts. Light flooded their eyes and their hearts as they submitted themselves to Him.  See Matthew 20:29-34.

A grumbling, self-centered, self-pitying and immature attitude will never move the spirit world on my behalf. Praise and perseverance are the only way thru, but honestly I often feel that I am wavering deep within myself teetering to and fro.

One minute remembering the truth, the next hearing a lie. Why, Lord, do I struggle with raw emotions when others achieve more than I can? This should not make me feel as if I am less than, but it does. I know that it is only when I am secure in the fact that You love me and created me special for your purpose that these fleshly emotions will begin to cease.

Lord, I want to strive to remember all the great things you have done in my life. I choose to press on to remember all the great things I have seen You do. I will cling to the truth that you have been there and moved obstacles that were not possible for anyone other than You to move. I am listening, Lord, and need to hear my Master’s Voice to give me the strength to continue. I am willing to be obedient, but I must hear Your words in me to give me the confidence I need to be victorious. I am listening for You. 

I hear You say:
"I am the Lord, your God that opened the Red Sea, am I not powerful enough to open your mouth"?

"The words you will use, whether many or few will be inspired by me".

"The words will indeed come, but it is the heart from which they will spring that I am shaping now".

"My Spirit within you, when needed, will form the words of your tongue, as well as forming the example your life will portray".

Those who seek will find and blind eyes will see and deaf ears will be opened.  Tongues will be loosed and the lame will jump for joy. 

The next time you are struggling, and feel the darkness of life covering you, submit your life to Him, walk in obedience to His word, turn your ear to no other and you too will hear the Master’s Voice.

(Copied with permission.)

Post Script: Bubba and his wife Cathy are M-workers among our cousins here in Africa. Please pray for them to be used powerfully for His glory among the tribes. His insights have blessed me over and over this week. I pray they bless you all as well.
Love ~SW

Update: Transport

We saw Awut about a month and a half ago. You might remember that she was expecting her 10th baby and her labor was not going well. She had CPD and we ended up transporting her for a cesarean. (Her story here.)

Well, I’m happy to report she and her little girl are both doing famously. Her scar is healing nicely and she is determined NOT to have any more children!

I laughed with her about her decision while bouncing her bright-eyed babe in my arms.

It’s not every day we hear back from our transport patients. Too often we cannot follow up on what kind of care they received, or even if they lived. But when I do, I’m always overcome with gratitude at God’s abundant mercies to us.

They named their girl “surgery”. Yep, only in Sudan! Thank you for praying for them and for all of us here in Tonj. Your prayers make a huge difference. Thanks.

Aid Sudan Links.

Kerri is a missionary on staff with Aid Sudan. She arrived this week to do a little investigative research on health teaching topics for the upcoming radio broadcasts. But since she is a highly trained nurse, we've been using her at the clinic, too.

It's great to have another set of trained hands to help!

Anyway... she's a blogger too, and I thought some of you might enjoy her perspective on things. You can read her blog here.

Speed Birthing.

Prayer night had just ended, and I was settling in for the night when I heard a timid knock at my door and went to answer it.

-- “Moses needs you,” our new guard whispered. Moses, one of our health workers, was working the night shift.
-- “Is there a labor?” I asked.
-- “Yes. Mother in labor,” he continued quietly.

When a health worker is too busy to come himself.... there’s an emergency. When he’s calling ME... there’s a birthing emergency.

I didn’t bother changing into scrubs. If it was a birth, I’d never get there in time if I did. So I grabbed my watch, a pen, and slipped on my flip-flops.

I didn’t run though. I find that running in flip-flops in the middle of the night can be hazardous to my toes. Plus, you’ve got to take your time in scorpion season. You’ve just gotta!

I arrived a minute later to find a mother pushing so hard she trembled.
    -- No wonder he sent the guard to get me!

Moses was moving faster than normal to get the room set up, but it had only been a few minutes since she arrived. It still wasn’t prepared.

As I watched silently off to one side for her contraction to fade, I took note of her body language.  She was having this baby; and she was having it fast!

Jaws clenched in determination, she continued to push on the edge of the bed. And just as the contraction peaked, a clear jet of waters jumped across the room, splattering four feet away.

Moses was still gathering the basics, so I asked her her name.
-- “My name is Adut,” she grunted between contractions.
-- “Adut, where’s your booklet?”
-- “At home. Forgot it.”
-- “Do you have a file with us?” I continued. I’ve started keeping records at the clinic, for just such occasions.
-- “No. You did not give me a file....”

Humm... that’s odd. Her face was ober familiar. I was almost sure I had a file on her.

-- “Give me your full name... I’m going to look it up.”

She gave it to me through clenched teeth, and in between purple pushes. But then it occurred to me, I’d never have time to look it up anyway.

Instead I slipped a pad under her butt, and started looking for heart tones. They were low (100s, 90s), but that’s normal right before the birth, due to head compression.

All I knew about her was that she had been here before (because her face was so familiar), her name was Adut, and she really wanted to push.

So I let her.

-- “Push hard, Adut. You can do it!” I coaxed. The head was already started to peak out.
A friend supported her head while I supported her perineum, and Moses stood to one side, handing me things.

Three minutes later her precious boy was born!

She delivered exactly 6 minutes after arriving at the clinic! And it wasn’t another five minutes after that when her placenta plopped into my hands. It had an additional lobe, so I took the time to show it to Moses so he could learn. 

As I inspected it, Adut cocked her head slightly in disgust, but Moses came in closer for a better view. It’s not everyday a Dinka man is willing to get so close to a placenta. Kudos to his teachable spirit!

-- “Adut, your placenta is healthy. I’m just looking at it to see if it’s all there,” I explained.
She nodded she’d heard me... but the look of disgust didn’t fade.

Another five minutes later, she was breastfeeding her munchkin and asking to go home.

-- “Normally I ask you to stay for a few hours for observation. Can you stay the night and go home tomorrow?” I asked a little pleadingly.
-- “No. There is no one else to care for my kids at home. I cannot stay.”

I had suspected as much. Frankly, the fact she came at all was a miracle. She had stayed at home until the very last minute. And now that the baby was out she needed to hurry home... and soon.

Her bleeding was very slight. So I promised her she could go home early if no clots came.

They didn’t.

And an hour postpartum she was cleaned, dressed, and prayed for. I discharged her with a few mild warnings, and she was off.

She walked out without the slightest hint of pain in her gait. Her friend walked beside carrying her little boy in her arms.

Humm.... I’m still not sure what to think. All I know is the women around her are STRONG!

Prayer Project: Scoliosis

Sarah came for her first prenatal a few months ago. She stood out from all the other ladies though because she brought her own chair.

Born with congenital malformations and scoliosis, making walking impossible, she stands at roughly 4 feet tall and gets around in a wheel chair.

Early on we discussed the need for an elective cesarean, and she completely understood. Her family had already started saving money for her to deliver in Wau.

I was glad for this insight, but even more so when I heard a surgeon was coming on staff. I discussed her case with Dr. Mike shortly after he arrived, and he reviewed her in person this week. He says she would be an excellent candidate for surgery here.

It's hard to tell with her shorter-than-usual abdomen, but I'd venture to say she's 7 months pregnant (or roughly 30 weeks gestation). I know that means her due date is two months out, but I feel the need to cover her in prayer now.

Will you join me?

Please pray for her to carry her baby to term, and deliver without any complications --whether that's here or in Wau. Also pray that she would not be fearful. Every time I see her she seems more withdrawn and afraid. Thanks. 

Feverish.

Ajer showed up at 3:30 pm saying she was having a bit of bleeding on and off and was worried. She insisted there were no contractions, but as I checked her I noticed several mild ones in short succession.

“But Ajer... that is a contraction right there,” I argued, “Isn’t that painful?”
“Yes, but I’ve been having those for a few days now...,” she explained.
“Oh...”

When I touched her belly to palpate position, I was surprised by how hot she felt --even for such a blistering summer day. It could be simple dehydration... or it could be something worse.

“Have you had any fevers recently?” I queried, trying to pinpoint her diagnosis.
“Yes. I had one last night, but it went away this morning.”

This felt like more than simple dehydration, so I got out my thermometer. She was burning up with a temperature of 38.0 C.

Her baby’s heart tones were also high (168, 172). Not good. Perhaps the fever was causing the contractions, but I doubted it was the other way around.

She was sick... but with what?

She tested negative for malaria and complained of no other symptoms except contractions.
    --Humm....

The vaginal exam showed she was dilating; but with such mild contractions, I didn’t expect her to deliver any time soon. (For any midwives out there: she was 2 cm, 80%, 0 station, IBOW.)

So I started her on prophylactic malaria medicines and antibiotics --just in case-- then hung some IV fluids. The minute I hydrated her though, her contractions picked up speed.... and strength.

I had barely finished giving her IV antibiotics when she started getting grunty. Her fever soared higher (38.8 C), and her baby’s heart tones raced even faster (176).
    -- What was going on?

She felt something come out from between her legs, and I looked down to see water.
    -- Humm.... strange that she’d have rupture at 2 cm. Very strange, but okay.

I started counting contractions and measuring their strength. They were strong now, lasting 45 seconds... and happening like clock-work every 2 minutes.
    -- Seriously.... something was up.

Then she started pushing.

“Ajer... please don’t push. You are only 2 cm dilated. It’s not time now.”
“But I’m not doing it on purpose,” she promised. “I just can’t help it.”
“Please don’t push...” I continued. “Don’t...”

Then I looked down.

Her bag of waters was bulging, and the baby’s head was right behind.

“It’s coming,” she half grunted, half pushed.
        --Yes. It most definitely was.

My helper moved lightening fast to prepare the room for the birth, and I slipped a pad under her butt. The next push he was born.

She went from 2 cm to baby out in 43 minutes with a fever of 38.8 C!

Unfortunately my story does not end there. Even before the placenta was born, she started dumping blood. And by the time I got it out (15 minutes postpartum), she had lost over 1500 cc. Fortunately, oxytocin helped stop the bleeding, and she slept through the night.

This morning everything looked normal and I was about to discharge her when she reminded me about the tear.
    -- The tear? Which tear...? She didn’t tear during the birth.

She went on to remind me of how she got a severe 4th degree vaginal tear after her last birth at home. She came to us initially for help, but we referred her to Wau for an operation. She went but never got it fixed; she didn’t have the money.

However a few months later she got pregnant again, and was told she could not get the surgery until after she delivered.

As she explained, I remembered running into her in town a few weeks back. Yes, of course I remembered her. We had discussed the option of her getting surgery with our surgeon instead.

Dr. Mike reviewed her and said she was a good candidate for surgery; he wants to schedule her back for the beginning of April.
         --What a blessing!

It’s strange that she neglected to say anything during prenatals, or even during the birth. But I’m glad she reminded me of it this morning!

Her previous tear helps explains the unusual fever and lightening fast birth though. It helps explains a lot.

Praise God she got to us in time for a safe birth and quick antibiotics for both her and her new son! Thank God that she can now get the surgery in town! Please pray for them to heal quickly, and for her to have a successful surgery. Thanks.

Wild, Wild... South?

The white pick-up truck blasted its horn with annoying persistence as it sped up to the clinic doors. Urgent voices shouted instructions as a handful of soldiers waved their AK-47s about like sticks.

Another emergency, Lord? Really...? How many this time?

I wearily slipped on gloves as I watched the cargo being unloaded. Our staff had to fight to carry the broken soldier in our front door; each one held a limb.

It took four strong men to lift him; their hurried instructions and shuffled steps left a steady trail of blood as they went.

Once on the bed, everyone seemed intent on getting to him at once. Five of them attempted to cut off his shirt while two others turned in circles. Getting close enough to help was next to impossible.

Fortunately Dennis arrived quickly... and then Tom, so I stepped aside and let them do their thing.

In the next room, I found another soldier who had not been assisted yet; so I got to work. He’d been shot in the neck; and though he was in obvious pain, he was stable. Remarkably, the bullet had missed his carotid... and his spine. 

But as I worked to start an IV and get his vitals, crowds of looky-lous screamed through the window demanding to know details. I could not hear myself think.

Why, Lord? Why must these strangers harass us while we work?

I asked them to leave but they refused. Over and over, I told them I could not work with them yelling like this, but it made no difference.

Meanwhile, more gun shot wounds filtered in, and I turned to help them.

One man had a compound fracture and was losing a lot of blood. Another had his foot filleted open, exposing tendons and nerves. The last to arrive, stumbled in on his own. In obvious shock, he barely made it to the bed before he collapsed. His shoulder had been grazed by a bullet, leaving a gaping wound.

Five soldiers. Five gun shot wounds.

We had to lock and bar the clinic front door to keep people from walking in, but even that didn't keep them all out. And although the clinic gate was locked as well, people climbed over it, insisting they had the right to bother us. It was a constant battle to keep them away.

Thankfully, all the soldiers survived. Three were transported to Wau for surgery, but the other two were stable enough to stay.

When I asked what the fighting was all about, they explained there had been more cattle raiding. The soldiers had gone to protect them and a shoot-out ensued.

Honestly with all these cattle raids, I’m reminded of the wild, wild, West. But instead of saloons we’ve got tukels; and instead of cowboys, we've got soldiers.

Please pray for them to heal quickly, and for the cattle raiding to stop. Also pray for the staff here (me in particular). I can’t speak for the rest of them... but I am tired of trying to save lives while simultaneously shooing away demanding crowds.

Tired. Disgusted. And dangerously close to burned out.

There. I said it.

Please pray as the Lord leads. Thanks.

Lost and Found.

So yesterday after all our patients were stable, the commissioner and a few of his friends came to help identify the injured. Those who could not talk (unconscious, or dying), had been identified by other travel companions, except for one.

He had sustained neurological problems after a concussion; and although he was conscious, he could not speak. So our compound manager spent the afternoon allowing small groups of spectators to filter in, to see if anyone could identify him.

I watched the eager rubber-neckers come, click their tongues in empathy, talk over him with hushed excitement, then grow bored and move on.

Then a few minutes later, a new crowd would come, and it would start all over again.

Gawking. Clicking. Whispering. Bored.

Dozens came and went, but no one identified him. Eventually, the spectators grew tired and hungry and made their way home.

Our John Doe stayed on the back porch until this morning when a couple came by asking to see him. When they realized he was their missing son and that he was alive, they exploded in joyful thanks.

The father was some high-ranking military man. He had been informed his son was dead and had come to collect the body. But when he and his wife could not find it among the rest of the cadavers, they decided to stop by our clinic --just in case.

“What if... what if he was still alive?” they wondered.

When they realized he was in fact alive, they were thrilled! He was disoriented and suffering from partial paralysis, but he was alive!

They decided to take him back to Wau where he could get more specialized care. What a blessing!

Please continue to pray for these hurting families. Thanks.

Emergency.

Last Monday night a semi (yes, a semi!) drove up with patients in it. Thirteen to be exact.

Thirteen bleeding, broken, and seriously hurting men.

They said they had been racing down the road at top speeds when a front tire blew, sending them rolling.

And rolling. And rolling.

The worst case was a man with a dislocated jaw; all of his front teeth were gone, and he was having trouble breathing. Once stabilized, we transported him and a few others with worrisome head injuries and broken bones to Wau.

When the dust settled, bruised and bloodied men were strewn about everywhere on make-shift beds. Some snored loudly; others moaned for water.

It was intense.

Afterward, Dennis commented that this was the worst car accident we’d had to deal with to date.

That was true, until today.

Today as church ended, a few government officials asked to use our cars and ambulance. There had been an accident. They needed our help.

The reports said there were lots of injured, so some of the medical staff went to help. But it took over an hour for the first patients to trickle in.

The first batch had two expectant mothers, a three-year-old boy, and a semi-conscious man.

One of the mothers had bitten three-quarters of her tongue off and had a large gash on her forehead, exposing her skull. When she woke up in the clinic, disoriented and scared, she thrashed in confusion.

I asked for her name but she couldn’t speak; her bloody grunts were unintelligible. We tried to guess what she was saying, but gave up, figuring it’d come out in time.

When I asked how many months pregnant she was, her eyes flashed with the unspoken question, “Is my baby alright?” Immediately she started gesticulating wildly, then held up 6 fingers.

“You’re six months pregnant?” I asked to confirm.
She nodded slowly.
“Can you feel your baby moving?” I continued.
She grunted no, adding a slight hand shrug for emphasis.

She was the right size for six months. The baby could be easily palpated; but I couldn’t find the heart-tones.

Each time I asked her anything about the accident, she would shake her head in confusion. Finally it occurred to me that she’d missed it all. Only later, once her tongue was reattached did she explain: “I don’t know if my belly was hit. The first thing I remember was waking up here.”

The other pregnant woman didn’t wake up for over an hour. She was in shock, and needed massive fluids to stabilize her blood pressure. But once she came around, I was happy to inform her her baby was alive. Fortunately, she only sustained a small gash on her thigh.

The young boy had no visible wounds and appeared stable. He had suffered a blow to the head and we were watching him closely. But as the second wave of injured were carried in, we needed his bed and moved him outside for observation.

The next batch had a hip fracture which needed to be braced, two or three semi-conscious men with only minor injuries, and two severe cases.

The first case was a man in obvious shock. He labored for every breath, fluttering in and out of consciousness. Starting an IV on him was next to impossible, since he fought me every inch of the way. I had to stick him 5 times before I got it in. Dr. Mike suspected massive internal bleeding.

The other case had massive head injuries and needed intubation. We don’t have any laryngoscopes, so we made due with half a speculum. Dr. Mike got the tube in without much trouble and together we bagged him until his breathing stabilized.

The third batch of patients came back with our missing medical staff (which was half of us), and we were able to start move IVs, get more medicines, and stabilize a few more patients.

Our guard did a fairly good job at keeping the looky-loos out of the compound. But he didn’t stop them all. I constantly had to chase away random gawkers, even walking some of them out of the compound myself.

I felt like a broken record asking them repeatedly to leave. But if I didn’t they would literally stand between the doctors and the patients, trying to get the best view. What a nightmare!

We started prepping to send the worst cases to Wau once stable. The broken femur and the internal bleeding were high priority. They also insisted the young boy go, even though he looked fine. Dr. Tom kept saying, “I just don’t feel good about keeping him here.”

But as we waited for the patients to be loaded into the ambulance, he died suddenly, surprising us all. He just stopped breathing.

Around the same time, the man Dr. Mike had intubated also died. His injuries were just too severe.

Only then did I have time to ask what happened.

I was told that two SUVs, carrying about a dozen passengers each, had a head-on collision when one SUV inexplicably swerved into the wrong lane. They were both moving at high speeds; the impact was catastrophic.

Fourteen people died on the scene --five of which were trapped inside the wreckage. 

Those that were not brought to us were taken to the hospital in Rumbek. We lost two within an hour. That gives us an estimated total of 16 dead, and another 15-20 wounded.

I don’t know how many were sent to Rumbek. But honestly, I’m surprised there were only two vehicles involved. How did so many people fit in just two SUVs?

I’m proud of how well the staff worked together, but I’m sad at how many we lost. Please pray for these families. Pray as the Lord leads. Thanks.

Post Script: After the ambulance dropped off the first batch in Wau, they came back for two more. The pregnant woman with the missing heart tones went back because that’s where she’s from. And one more of the ‘less injured’ developed signs of possible internal bleeding. So we sent him as well.

Radio Tower.

Aid Sudan, an organization with a large focus on health education and evangelism, came to visit us last year to discuss the possibility of building a radio tower on the compound. The tower would broadcast the gospel and public health messages to small hand-held radios that would be distributed within the community.

Well, I'm happy to announce that two weeks ago, the first part of the tower was dug.

Yes, dug.

Two engineers, loaned out from a German NGO named Diguna, came to plan out the project and lay the foundation.

It took them longer than expected to dig the necessary holes (as the ground was more marble than dirt), but eventually they finished. Then they re-enforced the holes with rebar, and poured the concrete. I’m told it must settle for three weeks before the tower can be erected.

Sam and Daniel, the diligent Diguna staff.

It’s an exciting project, with a potential for much fruit. I can’t wait to see what God does with it.

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.

Of Death and Blood.

Yesterday was a difficult day. After the grieving mother was carried off by her family, the crowd thinned enough for me to see Ajulla. She stood quietly beside the clinic entrance, looking scared and in pain.

At first I thought it was the fierceness of the woman’s grief, but as I approached her water broke. The suddenness of it surprised us all, especially Ajulla. Her eyes widened in astonishment as she looked around her as if saying, “Is this normal?”

Her belly looked suspiciously small for a term pregnancy, but I couldn’t be sure with her dress. As I walked her slowly inside for a check-up, I peppered her with questions.

When did the contractions start? Has any blood come out? How many months are you now? Have you been coming for check-ups?

She tried to answer our questions but was too confused. Once we got her on the bed, I understood everything without a word.

Two tiny black legs hung from between her legs. Her baby was dead and coming out breech.

As we waited for her birth to proceed naturally, I asked her the rest of her questions. She did not appear the least bit surprised when I told her she was delivering preterm. She actually looked relieved.

It took us only a few minutes to get the baby out, but the placenta was a challenge. I could not pull on it for fear it would tear.

With time she delivered half of it, but a large portion remained inside. She was not hemorrhaging so I did not go in after it. Instead I waited and prayed.

About an hour after the birth, her placenta was born. Ragged like hash, it fell apart in my hands.

Just as I moved her to the observation room, another woman arrived covered in blood. She knelt in the dust wearing nothing but a bloodied sheet.

-- “Are you pregnant?” I asked.
-- “Yes.” she said. The crowd gathered in to get a better look.
-- “How far along are you?”
-- “I’m 4 months...”

The crowd was getting larger, so I lifted her to her feet and together we walked inside. The prenatal women waiting to be seen, watched quietly. They would have to wait again.

Hers was less of a birth and more of a miscarriage (or incomplete abortion). Even though she claimed to be four months pregnant, her body told me otherwise. Tom had to perform a D&C to stop the bleeding, but she recovered well.

So much grief! So much loss! So much blood!

Lord, thank you for bringing these women to us. May the work we do glorify you regardless of the results. Bless them with health and heal them from their grief. Strengthen us so we can serve you faithfully. Amen.

A Grief Observed.

Yesterday morning I heard wailing coming from the clinic, and I knew. I knew from the strength of the piercing cries and the intensity of their sound that it had to be about the boy. The little cherub that I had prayed for the night before --the tiny toddler with pneumonia-- must have died.

He was very sick, struggling for every breath. We had put him on oxygen until we ran out of fuel to run the machine. But even when he was on it, he struggled.

His mother had come two days before, got medicine, and was told to return the next morning bright and early. Instead she stayed home, only coming late that night once the convulsions started.

She was frantic, wanting to take him to the witch doctor since our medicines were not working as fast as she liked.

Dr. Tom was not sure he’d make it through the night. But he did.

However by sunrise the shallow rasps coming from his chest finally stopped. He was dead.

When Tom pronounced him, the mother let out a guttural shriek that carried some distance in the dawn silence. It shook me from my bed.

When I arrived to check on another patient a few minutes later, I found her still shrieking and wailing sharply every few seconds. She punctuated her grief by throwing herself again and again on the ground --arms flailing --feet pounding.

Her family and friends sat quietly by and watched. Silenced by her grief, they did nothing to calm her.

Each wail eventually faded to a sob, then slowly she would stand again. Once standing, she would start to pace which eventually led to another wail more pitiful than the one before; and she would throw herself to the ground. Pounding. Stomping. Beating.

No one approached. No one comforted. No one joined in.

It was a difficult grief to watch --too fresh --too real. But eventually there were no more screeches to be uttered, and she quieted to a steady sob, prostrated in the dirt.

Only then did her family gather her up from the dust and walk her home. A friend followed with her child wrapped tightly in his arms.

The wails may have stopped, but the grief was just beginning. Please pray for her. I don’t know her name. But God does. Thanks.

Leopard Attack?

The other night a man in his 20's was brought in from the village. His head was sliced open, his right arm was punctured, and he was bleeding excessively.

As Dennis sutured his skull, I causally asked what had caused his wound, assuming it must have been another motor bike accident. But it wasn't.
-- “He was attacked by a leopard,” my translator explained in disbelief.
-- “A leopard? Really? Are they even around here?" I asked stupefied and scared. I had heard of hyenas... but leopards? Honestly... a leopard??
Once I got over my initial surprise, I said, “Tell me the story in detail. How did it happen?”

 By this time Dennis had already closed off most of the foot long wound on his head. A thick gauze bandage covered the man’s face leaving only right eye uncovered. He searched my face in fear but didn’t speak. So my translator asked his friends to relay the story, instead.

As they spoke, a half dozen people slowly inched into the room to hear as well.

He was fishing by a river in a far off village when he passed next to a large bush. He heard something and turned to see a leopard pounce on him, taking him to the ground. The beast swiped his head in the process cutting a wide, ragged wound from his left eye socket to the back of his skull. Then the animal turned quickly and sprang on him again. This time grabbing his arm he had raised it in his defense. Then without explanation the leopard left as quickly as he came.

Since he lives so far away, it took him all day to reach our clinic --all day with the muscles in his skull protruding and various holes in his body tied off with old rags.

I asked if I could take a few pictures and he nodded but still didn’t speak. After each picture, I flipped my camera around so he could see what we were doing. He had to lower the gauze to see them, but he did it readily and thanked me afterward.

I don’t know about you but if I had been twice attacked by a leopard, I would not have been so brave!

Dennis was able to sew the wounds closed leaving proper drainage to prevent infection. Please pray he heals both physically and psychologically from this attack. Thanks.

Update: Jan 29 2012
I saw him today and he's healing well. The wound on his head is not septic. Please continue to pray.

A Perfect Mess.

Maguet said she was in labor but didn’t look active.
    --They rarely do.

As my helper readied the room, I tried to count contractions and ask her questions. She had never come for a prenatal, and I needed a few facts.

But getting her to talk was an exercise in futility. She just flat out couldn’t.

Only then did I see the first contraction. Saying it was strong just doesn’t cut it --intense to the nth degree --powerful the the power of ten. Okay. So they were strong!
    --How could she be so calm?

As I stood by her side trying to measure their intensity, a sudden rush of wet warmth gushed down my legs and hit the floor with a audible splash!
    -- Had someone emptied a bucket on me?

Maguet and I locked eyes in surprise, then looked down in unison. Black, murky fluid stained our clothes as if we had waded knee deep in a lake of amniotic fluid.

My first response was to laugh; but Maguet was a bit more hesitant. She looked embarrassed. Or was it horrified? Eventually she realized I was not mad and laughed timidly along with me.

I didn’t have heart tones; I had not measured her fundal height; and I still did not even know her gestation... but she wanted to push.

Did I have time to change? --Unlikely.

My warm, sticky pant legs clung to my skin, growing colder by the minute. My shoes squished loudly at every step. Eek.

I really wanted to go get changed... and perhaps take a long shower with bleach.
    --Could I risk it?

The midwife in me worried the murky fluids could mean a compromised baby. Heck, I still didn’t know if the baby was alive! However, the non-midwife in me was thoroughly disgusted and ready to run for a decontamination shower.

What is the protocol when a total stranger expels ink-flecked slime all over you?

My translator didn’t know what to do or where to stand. The horror on his face was evident. I had to tell him more than once to get the mop.

Only when I rolled up my pant legs and started moving her into position for the birth, did he push past his disgust and prepare for the birth.

He ran for the mop. I slipped a pad under her. She got in the squatting position.

Ten minutes later her little girl was born.

The baby came out with another splash of blood and water coating me in a second layer of grime. But I didn’t have time to notice.

Green-gray meconium coated the baby and sputtered from her lips. I suctioned her mouth and dried her off before handing her over to her mom. Then I took a long look at myself. A mess.

A. Cold. Sticky. Wet. Mess.

What a bad week for the water to stop working at the clinic!

Once the baby was stabilized and breastfeeding well, I ran off to the compound for a quick shower. A bar of soap never looked so great!

Her baby was initially fine, but by the second day she developed an infection --most likely due to meconium aspiration but also possibly due to untreated STDs.

We have her on antibiotics now. Please pray she recovers quickly. Thanks.

Labor of Love January 2012

Labor of Love January 2012

Update: Clubbed

Baby Yom is doing very well. His mother brought him in to be fitted for another set of casts for his clubbed feet. Admittedly he was not a fan of all the prodding, but he didn’t cry --instead he stuck his tongue out at me!

So cute!

Dr. Tom is pleased with how well his feet are turning back to normal. And although he has not reached full range of motion in all his joints, I’m seeing steady improvements.

Surgeon in the House.

Dr. Mike is a general surgeon from Florida who has come to serve this community for the next 3 months. His happy manners and quick wit have already made him quite popular; and I’m confident his many skills will make him even more so in the coming months.

He will be working at the government hospital since we don’t have space in our clinic. Plus, the government hospital has a tiled room designed for just such surgeries.

The staff has been organizing the equipment and setting up the room for the last few days. Yesterday they did their first surgery --a hernia repair on a 7 year old boy. I’m told things went very well.

It sure is nice to have a surgeon in the house!

Friendly Farewell.

Achan and me after her birth last August.

Achan delivered a few months back. She blessed me to no end during her birth with her serious promise of friendship.... if I could just stop her pain! When she delivered a few minutes later, she decided we’d be friends for life! (Read her story here.)

What an honor!

I’ve seen her a number of times since then. Each time she has greeted me loudly, while repeating over and over again the only English words she knows.

My friend! My friend! My friend!

I can’t help but just love her to pieces.

Well today, she came to say goodbye. Apparently, she must return to the village and can no longer come to visit.

She brought her doe-eyed daughter with her, and proudly handed her over for me to snuggle. Then through a translator and while continually repeating “My friend! My friend! My friend!” she told me that she named her baby after me.

When I expressed my happy surprise she explained, “Her name is Akuac Kowaja!”

You might recall that my Dinka name is ‘Akuac’ which means ‘White cow with black spots and uneven horns’.
          -- Yep, I'm a Jersey cow.

However, you may not know that ‘Kowaja’ is the term used for anyone who is not Sudanese. Technically it means ‘foreigner’ but it is also the term most often used for ‘white person’.

She is the first baby named ‘Kowaja’ that I’ve met!

I was happy to see my friend one last time and hope that we’ll get to meet again soon!

A Transport.

Last night, Judo, a 22 year primigravida was carried into the clinic by her family. Exhausted she fluttered in and out of sleep as I checked her vitals.

She is from the Luo tribe; and since no one else in her family could speak any Dinka, she pushed past her fatigue to explain her long and difficult labor herself.

Her contractions had started two days before. Everything looked good until her water broke and she started pushing. She pushed and pushed for over six hours, but her baby would not come. Eventually her contractions just faded away. 

She had not had a contraction since dawn --roughly 16 hours earlier.

Gesturing toward the wrinkled woman at the foot of her bed, she explained “My grandmother was my midwife. She said she could see the baby’s head, but it went back inside.”

I looked back and forth from her grandmother’s worried face to her oblong belly while trying to process her words.

What? She was in labor? She didn’t look like she was in labor. Could they have been mistaken? Perhaps she had malaria-labor and just dreamed up the fact the head was poking out?   
      --Doubtful.

I needed more facts.

A quick vaginal exam explained everything. Not only was she fully dilated, but the presenting parts were at a +2 station. Her pelvic outlet seemed adequate despite her low pubic arch, but the real problem was the swelling.

It took me a long, breathless minute before I realized the squishy mass of swollen flesh was her baby’s head. It was so edematous I could not find any suture lines. None at all.

Not good.

All the signs pointed to deep transverse arrest due to cephalopelvic disproportion (or CPD).

She needed a cesarean.

The good news was an American surgeon just came on staff last week. The bad news was we are not ready to start doing cesareans yet.

After discussing her case with the rest of the staff, we decided to transport her to Wau instead of risking an ill prepared surgery.

When we explained the situation to her family, they didn’t hesitate. They quickly gathered the necessary funds and an hour later she was en route.

I’m happy to say that this was the fastest transport we have ever organized. Originally when I heard that she’d be transported, I assumed we’d have to wait until sun up like before. But I was wrong. Apparently, we have a new driver who can go at all hours of the day and night.

What a blessing!

Today I am genuinely grateful for cesareans, ambulances, and willing drivers. By now, Judo and her baby should be recovering from surgery. Pray that it was successful and that they heal quickly. Thanks.

And also pray for our new surgeon and the many families he will bless in the coming months. I’m told that he is doing a hernia repair today. Exciting!

More about him later.

Monsters.

I have stories --lots and lots of stories-- but I can’t write. When I try to write, my mind races in circles silently screaming --arguing --raging, but nevertheless perversely mute.

Oh, to be able to write them down!

In all honesty, I don’t trust myself. I’m afraid once written, my words will grow into loathsome monsters that will shock, horrify... disappoint.

So I’m silent.

Please bare with me. I have many stories. Really, I do. But how can I write them when my words are mute, and my thoughts are monsters?

Please pray for me to master these monsters. Thanks.

“For though we live in the world we do not wage war as the world does... We demolish arguments and every pretension that sets itself up against the knowledge of God, and we take captive every thought to make it obedient to Christ.”
        2 Corinthians 10:4-5

Prenatals!

Now with the Christmas birthing rush behind us, we are back to only 2-3 births a week.           --Sigh

I miss having so many babies to catch, but I'm not complaining; I don't have time!

Why?

Well, the rest of the staff got back this weekend and we are open again for consultations.

Margaret and I (along with our very tired translators) have done just over 100 prenatals in the last 3 days.

Yesterday was our busiest day. We had 40 prenatals and a labor.

The labor, Elizebeth, spoke excellent English and was older than the average G1 at 25 years old. Her progress was slow, but she was able to cope well with the pain.

When it came time to push, her gap-toothed mother stood by her side and cheered. She delivered a healthy little girl over an intact perineum after only 15 minutes of pushing!

What a superstar!

Also, I heard that in a few weeks another doctor will be joining our staff for awhile. He is a surgeon and will focus on surgical cases. 

Perhaps he'll be able to help us with a cesarean or two while he's here. I pray that he won't HAVE to... but it'll be nice to have his skills if needed. Right?

200 Reasons Why.

 

I'm one of those midwives that keeps statistics. I write birth stories. I keep logs.

I do it so I can remember. I do it so I can learn. But mostly I do it because it's fun.

Today as I was writing down the ridiculously short birth story from this morning, I realized I'd passed a milestone.

Yep, today I caught my 200th Sudanese baby!

It was a brilliant birth. The mother went into labor at 5 am, arrived at the clinic shortly before 7 am, and delivered at precisely 7:02 am. 

I am glad she made it in time!

Side Note:
It's my 200th catch in Sudan, my 315th catch in total, and the 488th birth I've attended. But who's counting? :- )

Crying it out!

Athieng was hard to read.

Her contractions said one thing (i.e. “We’ve got a long way to go.”). But her response to those contractions said another (i.e “Quick, catch this baby. It’s coming out right now!”)

Which was it?

Originally I waited and watched trying to avoid a vaginal exam, but eventually I caved in after another half hour of confusion.

She was only 3 cm dilated.

Normally I would have insisted she go home, but she didn’t look like she was coping well.

Tears. Sobs. Whines. Whimpers.

This was not the typical Dinka labor. Usually the women I serve are restrained to the point of stoicism.

She was different; she actually looked and acted like she was in labor. It was refreshing.

I told her it would be many hours before she delivered and that it was best if she went home to labor. However if she’d be more comfortable at the clinic, of course she could stay.

Shaking off the pain, mustering a half-smile, then wiping streams of tears from her eyes, she finally said that she preferred to labor at home. So I prayed for her and sent her on her way.

I half expected her to stay home, but she surprised me by coming back 6 hours later. But this time she was active. But as the hours progressed, so did her tears. 

At the start of each contraction the flood waters would open, gush across her face, then drip off her chin. Yet the moment the contraction faded, she’d wipe her face, sniffle a bit, then go back to pacing the clinic grounds.

These were no ordinary tear drops; these were brewing geysers, raging tidal waves, gushing rivers.

In all my years, I’ve never seen a coping mechanism quite like this one. However, it makes the most sense. I mean... why not cry?

Before I go on, there is something you should know about me. I’m a cry-er. Some would even say a cry-baby.
            --Heaven knows I’ve been called worse.

So when I saw her crying, I instantly understood.

You see, I cry when I’m happy. I cry when I’m sad. I cry when I’m stressed, pissed, depressed, blessed. I just cry.

I loved that she did, too.

Long story short, her crying eventually came to an end. The contractions led to her water breaking, which led to frantic pushing, which led to more crying. But this time it was her son making the noise!
    --What a beautiful sound it was!

Personally, I think I’m going to be much like her in labor. I’m sure I’ll do my fair share of blubbering, sobbing, and crying. I mean, why not?

It just feels good to cry it out sometimes. Right?

Anyway. I’m happy to report that the word is out. Women are coming to deliver with us quite regularly. Last month we had 40 births. I wonder what this new year will bring.

Thank you for praying that they would trust us enough to come. Now please pray that those that come, would see Jesus in our actions and words. Thanks.

A Traditional Sudanese Birth?

Akul first came for help two weeks ago. She was sure it was labor; but her contractions were unconvincing.

Although obviously painful, her contractions lasted no more than 15 seconds and weren’t bringing any progress.

Since it was her fifth pregnancy I admitted her for observation; and for the next 5 hours we watched and waited. But nothing happened.

Now, I’ll be the first to admit I’m cautious when it comes to Braxton-Hicks contractions. I used to educate women on them, reminding them that it wasn’t labor until there was progress, etc. But after a year and a half of malaria cases, I don’t like to risk it anymore.

Why? Because I cannot tell the difference between Malaria-Labor and Braxton-Hicks contractions.

Yes. It might only be Braxton-Hicks contractions. But what if it’s not? What if she has chronic malaria and the pregnancy is masking the symptoms? What if the paracheck gave a false-negative? What if...?

So when I have a woman like Akul --in pain with regular but short contractions-- I treat for malaria if I haven’t seen any progress for several hours.

This was the case for Akul; so I gave her the first line treatment and sent her home. When I didn’t see her the next day, I figured the medicine worked, or she’d delivered at home.
    --Follow-up on patients here isn’t as easy as you might think.

I didn’t see her for two weeks. Then two days ago, she returned with the same symptoms. In the course of her evaluation it became clear she did not take her medicines properly.

We were right back to square one.

More pain. More spastic-y contractions. More worrisome watching.

But since her symptoms were worse this time, I started her on IV medicines and kept her for the night. By morning she hadn’t dilated even a centimeter.

I gave her a new course of treatment and sent her home, warning that her labor could start at anytime and she’d need to come back if her water broke... or the pain got stronger.

She returned 12 hours later saying her water broke.

I wanted to believe she was in labor... but all I felt was irritation. Stupid malaria. Stupid, stupid malaria.

Grumbling under my breathe about the evils of this debilitating parasite, I watched her suffer under its torment.
    --Childbirth is painful enough without adding this nasty plague!

But when I re-evaluated her, she hadn’t dilated at all. However, her water had most assuredly broken. I wasn’t sure if she was in labor... but I figured it’d come soon enough.

I told her as much, then gave her the option of staying the night again or going home. She wanted to stay.

I didn’t argue. Even if she didn’t progress, at least she’d be close.

However her labor surprised me.

Her contractions got strong rather quickly, shaking her body like a ship in a storm. They went from being every 20 minutes to every 8 minutes in under an hour. 

Another hour went by and she was pacing --pacing and moaning rhythmically.

It was close.

Her husband, a man who had faithfully sat by her side each step of the way, watched us pace together but made no comment.

His dark, lanky frame stood in shadows and watched. In the black of night, the only thing visible was the reflection of the clinic lights in his eyes.

Less than an hour later, Akul was asking to push. No... she was NOT asking; she was grunting, moaning, jerking, clenching, and whimpering.

It was time.

I asked her if she wanted to deliver on the birth bed or on the floor.
-- “The floor,” she whispered.
-- “Okay. Once this contraction is over,” I said as a strong wave of pain rushed over her, “we’ll help you get positioned on the floor.”

Nodding, she answered with another whimper. 

Once set up, I invited her husband to join us. He had been sitting silently on the bench outside.
-- “Tell him that he can come in if he wants to...” I told my translator, “He doesn’t have to come in... but if he wants to, he should come now.”

My translator called for him over the thin wall, and he noiselessly entered and sat down.

Turning my attention to Akul, I said, “Only push when you have a contraction. Okay?”

She nodded determinedly but said nothing.

Her husband sat in the corner, firmly grasping his knees to his body in an effort to stay on the stool. It was a tight squeeze for his long legs.

After a few minutes, he spoke his first words.
-- “How do women deliver on a bed?” he questioned innocently.

It was child-like in tone. And I could see his mind whirling as he considered the plastic-covered birth bed in front of him. It had a hole at one end and a movable flap at the other. Very confusing.

He wasn’t asking me, but my translator, so I didn’t butt in until the conversation was over. I had understood a bit of it and asked my translator to help me understand it all.

-- “He cannot imagine how the woman earlier delivered on the bed,” explained my translator.  (The previous labor delivered just an hour before and he had heard all the commotion. That labor had insisted on delivering on the bed.) My translator continued: “He wants to understand how it’s possible to deliver in such a way.”
-- “Did you tell him?” I asked, but then couldn’t wait for the answer.

She was pushing.

She delivered in the supported squat position a few minutes later. As her boy slipped out, a piercing screech filled the room --and then silence.

It was done.

Slimy and beautiful in every way, he complained as I wiped him down and placed him in her waiting arms. For several long minutes, we sat in silence enjoying the calm after the storm.

As we sat, I couldn’t help but think about his question. It was a good one. Very practical.

“How do women deliver on a bed?”

I’m willing to bet there are a large number of non-Dinka men (and women for that matter) out there wondering the very opposite question.

It could be equally asked: “How do women deliver on their knees?”

Ahh! Culture! Thou art a tenacious beast! You cling to our preconceptions like barnacles; you beat about our heads like waves; your flotsam and jetsam clutters our minds. How do we escape unscathed?

Underneath what we are really asking is, "What is the right way to give birth?"

There are just no answers, are there? There are just opinions colored by what is most familiar, comfortable, and common place.
           --Oh, the traditions we hold so dear! 

I’m happy to report that Akul had a traditional Dinka birth.

She delivered in a supported squat with her husband’s knees in her back while malarial parasites raced through her veins.

Afterward Akul glowed with satisfaction, saying “I’m so happy. Ana chi pou mieth. I’m so very happy.”

Yes, Akul. So am I.    --So very happy!

Please pray for them. Pray her chronic malaria goes away quickly. Pray for health and love and joy and peace.

I invited them to church on Sunday, please pray that they come. Thanks.

Primip Breech!

Last year a first-time mom was brought to me after several long days of labor. Exhausted and scared, she lay on the bed for an evaluation. But it was soon clear what was wrong.

Her baby was breech.

Now I’ve delivered my share of breech babies but this was the first time I had to deal with a primip breech (meaning one for a first-time mom).

In any industrialized nation, a primip breech would be an immediate (or scheduled) cesarean as the risk of the baby dying is quite high.

The worry is that the larger fetal head will not mold enough to be born after the smaller buttock is born. The head would then get stuck, leading to suffocation.

Although I’m sure we all know someone who knows someone who had a successful breech birth the first time around, more often than not, the birth can go wrong (or be mishandled) and the baby can die.

But I digress.

My point is that the young girl last year came to me fully dilated with her baby’s buttock already protruding from between her legs. We had no time to transport, so we informed the family of the risk of vaginal birth then prayed like mad.

The birth went horribly wrong. Everything that could have gone wrong, did. Everything. And her baby died. (Read her story here.)

Afterward I asked God to never give me another primip breech, and to always help me diagnose them early so I can get them the cesareans they need... and deserve. 

I grieved that birth for many months. I was haunted by regrets. “If only I had done this instead of that... if only I had insisted on a transport... If only I had reacted better... faster... smarter. If only...”

In fact, I was still grieving it when I went to Switzerland to visit two midwifery classmates last Spring, and we talked about it in detail. One of them also introduced me to a midwife friend who had read about this tragic birth and wanted to encourage me.

Long story short, this midwife poured out sweet comfort coupled with years of wisdom. What is more... she taught me what to do if it ever happened again.

I listened to her words carefully, praying that it never would, but thankful to have options if it did.

Well, it did happen again. It happened last night.

This time, however, I handled the birth differently.

As I readied the room for the birth, her words rang out in my mind: “Make sure you go slow. Allow for the woman’s body to dilate properly. Don’t ever take your cupped hand away from the perineum. Once the buttock starts coming out, push the buttock back in with counter-pressure. Push hard. Make sure the baby does not unfold... that way the arms won’t fly up over the head and get trapped.”

Nyibol, my labor, wanted to push like mad and didn’t like the counter-pressure. She asked over and over for me to “just let her push harder”. But I was determined not to let this baby get stuck. So I explained my reasons again and again, insisting she breathe through her contractions as long as possible and to push only when she couldn’t help it.

She needed to go slow.

Tom came to assist, but since he wasn't needed right away, decided to sleep in the other room. Having him there was a huge comfort.

Meanwhile, Nyibol pushed on. And I supported the perineum.  

The Swiss midwife’s words continued to echo in my head, “Make sure you never take your hand away. Not for one second. The baby must not unfold. Only remove your hand when most of the body is born... then deliver the baby like a normal breech.”

My hands cramped. My forearms ached. But it didn’t matter. The baby was doing well.

Plus, Nyibol was making good progress.

I called Tom in to assist once the body was mostly delivered, and he applied suprapubic pressure as the shoulders were born. I had to reach in to release the baby’s right arm, but the left came out on its own.

The following push the head was born!

Nothing went wrong. None of the emergencies happened. Amazing.

The difference between this primip breech and the last was night and day.

Night... and day.

Thank you Jesus for this healthy little girl. Thank you that she is alive. Thank you for sending me wise midwifery friends who taught me this simple technique. Thank You! Thank You! Thank You!

Nyibol did not get an episiotomy; she did not even tear. Her baby had decent APGAR scores (6/8), needed no resuscitation, and transitioned well.

Night and day.

I share this story with you so that if any midwives out there find yourselves in a surprise breech in a primip, you might remember... cup the perineum. Never let the baby’s body unfold. Basically, make your hands like a second-perineum so the baby stays in a compact position. This will dilate her body most effectively, permitting enough room for the head to emerge without delay.

I realize this is the OPPOSITE of what almost every textbook says on the issue of breech delivery. And for that, I would be remiss not to comment. I agree with the textbooks. Hands off a breech. Never pull on the body.

Never. Never. Ever.

What I am suggesting is that you PUSH on the body --not pull. Give counter-pressure as the baby descends. Provide a place (aka your cupped hands) for the baby’s butt to pivot naturally as it passes over the perineum.

I did not "touch" the baby (and never pulled on her) after her legs and trunk were born. I only assisted in the birth of one arm, so the head could emerge.

I hope that makes sense. If not... let me know.

Thanks for praying for these women. Thanks for praying for me. I could never do this without your love, encouragements, and prayers.

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.