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.

Storms.

Gusts of grey carried them in, bags in hand. Behind them, black grumbling clouds glowered on the horizon, sending a steady stream of chilly air our way.

As I walked into the clinic, they followed with quick steps --eager to hide from what was coming. Then together we shook the wind from our clothes and smiled conspiratorially at one another.

We were safe.

Heavy drops thumped on the roof above as I asked them why they’d come. He handed me her book in response and sat down. She then crawled quietly on my bed and moaned.

After a few minutes, it became clear that she was in labor... but that she also had malaria. I started her treatment immediately as she looked preterm; I didn’t want her contractions to push her into labor.

But when I looked a bit closer, I realized it was too late. Her contractions were well under way. So I asked to do a vaginal exam to see if I was right; she consented with a slight grunt.

She was already 3 cm dilated.

I wasn’t sure when she’d deliver, but I knew it’d be soon.
“The baby will come tonight,” I informed them, “and since this is your fourth, it might come pretty fast.”
They clicked their tongues in agreement, then looked up at the skies.

I think if the storm hadn’t been raging, they’d have taken her medicines and left. But with night falling early, they resolved to stay.

Once settled in, I counted contractions. They were short but frequent. It was hard to tell how fast she’d progress.

“Abuoc, if your water comes out or you feel the slightest need to push, call for me right away. I won’t be far.”
She nodded but said nothing. So I informed the health worker on duty to watch carefully for any changes, and went to rest a few minutes; it’d been a long day.

A half an hour later the health worker was knocking on my door; her water had come out.

Watch. Pen. Gum boots. Umbrella.
        -- Check.

I ran out into the rain.

The storm was just above.  Howling angrily and pushing things about; it whipped my clothes and bustled my hair as I hurried.

As I stepped into the observation room --mud splattered and wet-- chaos greeted me with a wall of backs and loud voices. As I peeked through the throng, I could see a blue baby covered in goop, barely stirring in his father’s unsteady hands.

She’d delivered without me.

The room was filled with a half-dozen other patients and their families, who stared unapologetically while screaming for her to push even though the baby was obviously out.

When I asked them to step aside so I could help, they ignored me. Perhaps they couldn’t hear in all the commotion.

I also had to physically removed her husband from the bed so I could help. He just knelt there staring at me in horror and disapproval --his hands covered in fluids and blood --his boy not breathing.

The incrimination in his gaze was hard to miss, but I didn’t care. The baby wasn’t breathing!

“Out of my way! Move!” I screamed over their chaotic chatter, “I need to get to the baby!”

My translator was worse than useless. He stood there looking at me with nonchalance and haughty derision. I had to ask him to translate everything three times before he opened his mouth!

“Tell him to put the baby down and move. I need to get to the baby!” I asked, forcing the anger from my voice.

He translated and the father eventually moved. Only then was I able to resuscitate the baby.

Pale blue and coated in sticky vernix, his little frame moved slightly to my touch. I could see he was alive, but hadn’t taken a breath yet. So I rubbed him vigorously and spoke to him.

“Come on, little buddy!” I cooed, “Breathing’s fun.”
As I turned to my translator, I was surprised to find him doing nothing. I told him I needed the birth stuff (towels, gloves, cord clamp, etc.) but mostly the ambu-bag.

“Go get me the Ambu-bag!” I called over my shoulder.
“The what?” he asked.
“The bag used to give the baby air... to resuscitate.”
I was screaming by now. Frustrated.

The little guy before me blinked from time to time... but he hadn’t taken a serious breath yet. I continued to stimulate him and pray.
“Go now!” I screamed, “If you don’t know what it is... ask the doctor.”

It felt like ages before he returned, but by then the boy was on the mend; his color had improved and he was making shallow gasps. Every now and again, he’d whimper and whine.

Progress.

My translator returned with the Ambu-bag and I gave some rescue breaths. He responded quickly. Within a few minutes, he was breathing on his own!
    --Hallelujah!

Only then did I lift up my head and look around the room. Her husband was staring at me in horrified bewilderment, holding his hands up in disgust. They were still covered in gunk.

I ignored him and eventually he went to wash them outside with the hose.

The rest of the looky-loos had also quieted down. However one was still instructing Abuoc to push-push-PUSH her placenta out. He didn’t shut up until she did.

By this point, my translator was no where to be found. I waited thinking he must be just running for a few more things... but when 5 minutes turned into 10, I gave up waiting and screamed for him to come.

I had to scream louder than the storm since he was most likely in the main clinic, 10 yards away.
    --Where could he be?

He came running, mumbling something about a convulsing child that the doctor was treating. He looked annoyed that I had the audacity to call for his help. I was ready to beat him and chase him from the clinic with our guard’s AK-47... then I remembered that such things are not nice and I took a deep breath. 
       --Thank you Lord! Thank you that their son is alive despite all this chaos!

Once the dust settled and the room was once again in order, I stepped out into the storm and splashed though the puddles.

He was alive!

Sure... things hadn’t gone as I had hoped, but he was alive! It was time to celebrate.

I splashed away excitedly --my arms lifted high. I couldn't hold it in! What an awesome God we serve! He’d rescued me in the storm.
    --Thank you Jesus!

And as God would have it, their son wasn’t preterm after all. He was just small for gestational age. He and his parents recovered quickly from all the excitement and slept well. I discharged them the next morning... after the storm had passed.

EASY ... AS... ONE... TWO... THREE...

Birth story to remember.... don't let them tell you that it's always hard work!

A night or so back, i was working the night shift. That shift starts at 10pm and finishes at 6am. There was NO ONE in the clinic. No labors. No postpartum mama's with their precious babes. No one but three tired midwives (and one want-to-be midwife in training... aka: Me :-)

I am now assisting, so I was a bit disappointed that it was a 'dead shift'. But i was glad for the sleep we were all going to get. We turned out the lights... or achumm... shall we say..... "started conserving energy" and turned in to get some sleep.

At 3:30 am a 'Buntis' walks in. She is a sweet younger mother and this is to be her second child. She also happens to be the patient of one of the midwives on shift. As we are checking her in we ask her what time the contractions started. She said 2 o'clock. We ask her... 2 o'clock yesterday afternoon? She says 'no, 2 o'clock this morning!'

By this time, she is holding her belly and acting like the contractions really hurt. But labor just started an hour and a half ago! How far along could she really be? :-)
On top of that she is not responding well to our questions. We have to ask them over and over again to get a response. I'm confused but hey... who am I to say it doesn't hurt?

So we get her washed up, checked in and on a bed Either she is in transition or she is not handling labor well. I figured it had to be the later. Come on! she has only been in labor an hour and a half!

So the midwife on duty did an internal exam and wouldn't you know it she was FULLY DILATED! We quickly got her husband washed and in the room and she started pushing! Shortly after, her waters broke and 6 minutes later her baby was singing 'Hello'! :-)

The baby was born at 4:25 am. So all in all, she had that baby in 2 hrs and 25 minutes!
There is hope for me after all!!!! :-)
Plus I learned a valuable lesson... transition can happen faster than you may think! :-) And labors aren't always long and drawn out!