Multiparity

The last two weeks of May involved teaching at a maternity ward downtown. My job was to help introduce fourth year medical students to 'normal' birth. Much of our time was spent labour watching, timing contractions, evaluating fetal heart tones, and palpating fetal positions. However, we also got to do a number of newborn exams and assist in a few births.

One day we arrived to find a young woman occupying one of the labour beds. Naturally, we assumed she was pregnant (as her fundal height was marked), so I told two of the students to time her contractions. Ten minutes later when I came back to see how things were going, I was informed she was not in labour and that her babies were in the other room.

So I instructed them to get her obstetrical history instead.


The new mother explained that she was a 20-years-old mother of six. Earlier that day, she had delivered twins at home. She came to the maternity ward for the birth certificate but did not seem very interested in any other service. Since her babies (a boy and a girl) were cold and covered in sand, the nursing staff had taken them for evaluation and placed them in a warmer.

The mother explained that she had delivered her first child at the age of 11 and that her previous four pregnancies were simple. This was her first set of twins, however. 

She didn't want to talk much about the particulars, so we didn't press her for more information. Although I know 11-year-olds can get pregnant, my heart hurts to think that this mother has so many mouths to feed and so much responsibility...  at such a young age.

What were you doing at the age of 20?

Spinning Plates. Juggling Chainsaws.

My last month --despite every possible precaution against it-- has been a blur of spinning plates and juggling chainsaws.

Okay. Maybe that’s a slight exaggeration. Please note...the chainsaws were not running at the time.

“What does a month of spinning plates and juggling chainsaws look like?” you ask.

Great question. 

Let’s see... when I got back from Haiti, I hit the ground running.

The winners of the MGC!

Early the next morning, the Second Annual Missionary Golf Cup was underway in Mesquite. This fundraiser drew out twenty-eight golf and missions enthusiasts to hit balls and support the work in Moz. We were able to raise quite a lot.
    --Thank you for all those who attended.

The following day was Easter --a delightful and most incredible time of remembrance. At church, we celebrated with a fish fry and potluck.
    -- Yum!

Afterward I spent a week and a half hosting and being hosted as I entertained a dear missionary friend and then caught up with my family in Chicago.

Yep. You read that right. I spent a weekend in Shy-Town hoping that my sister would deliver the bambinos in her belly.

Yep. Bambinos. She was expecting twins!

My newest niece and nephew!

But alas, she did not deliver while I was there despite our natural induction attempts and lots of prayer. Nevertheless, it was great to be there during this exciting time.

(I’m happy to announce that she delivered the following week to our family’s delight. Welcome babies T and E. I sure do love you and can’t wait to meet you.)

The day I got back, I spoke at Calvary Chapel Meadow Mesa in Las Vegas. Although I was invited to speak, it was God who did all the speaking... to me.

What a wonderful whirlwind of emotion and clear anointing. What a blessing being a part of such a move of His Spirit! But more than anything, I just flat out needed that fresh touch from the Lord... as I was starting to wane.

“Then what?” you ask. 

Well... that’s when the plate spinning got a little faster, and more chainsaws hit the skies.

Bright and early the next morning, the Simply the Story workshop began.

STS leaders before the workshop.

This workshop took a week and a half of my life. Twelve hour days, stacked end to end for eight days straight left me blessed, but also very spent. It took another two days to recover.
    ---But WOW was it worth it!

When we started, I had no idea the joys and spiritual blessings God had in store.
   --What a ride! What an exhausting but thrilling ride!

At that point, I had just three days to say goodbye to all (aka: attend a funeral, a wedding, and a going-away party) and re-pack my bags.

Packing was easy compared to all the goodbyes.

Never before have I wept so much at my going. Never before have I longed so much to cling to those that stayed.
    --Truly, I love you all so very much!

And that is how my month was spent.

To those who prayed, Thank You! Believe me when I tell you I felt your prayers and so desperately needed them.

Moreover, I’m happy to announce that no chainsaws were destroyed in the making of this month... and only a few plates hit the ground.

Ooh-PA!

Seeing Double.

This last week I got a special visit from Akout and her twin boys. She wanted to let me hold them and kiss them, and show me how much they’d grown.

The oldest was all grins. He cooed and drooled happily as I made silly faces. They named him Santino Ngor. His younger brother by three minutes is named Jacob Lual.

It was such a joy to see them growing so well and to be able to hold them in my arms! Aren’t they adorable!

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.

Boy Oh Boy!

Akout came to the clinic on Monday in labor. She was 7-8 cm dilated but her contractions were mild and ineffective. I wasn’t there but Margaret told me that Akout labored for a few hours at the clinic, then just up and went home without an explanation. Margaret assumed that she’d decided to deliver at home.  

However, on Wednesday Akout was back... and still very much pregnant.

As I reviewed her book and asked her about the last few days, she explained that her contractions never really got any stronger. She couldn’t figure out why.

When I did another vaginal exam I laughed to learn she was still only 7-8 cms dilated!

Since she had never come for prenatals, I check her out thoroughly. Her belly was much larger than most of my prenatal girls, and there were tons of little parts when I palpated. I could feel one normal sized head engaged in her pelvis, but the heart tones were found in two separate places. 

This could only mean twins.

When I told Akout my suspicions, she didn’t seem too surprised. She did raise an eyebrow however and chuckle. Then she informed me that her husband had a strong family history of twins. 

Since both babies were doing great, I opted to augment with oxytocin. And boy was it effective!

She didn’t need much of the medicine before dilating to fully. In fact, she was ready to push in just 30 minutes.

Her first baby came out head first with a happy cry. He was term but small.

I barely had time to dry him off when she pushed again and the second bag of waters burst open, splattering me in hot, sticky fluid.

-- “Wait, Akout. Wait! Du chol! (Don’t push!),” I ordered.

She didn’t hear or didn’t care, and kept pushing.

-- “Please, Du chol Akout. Du chol! I need to get your first baby out of the way,” I explained.

She wasn’t listening.

Since she refused to wait even one minute, I double clamped his cord and cut it. Handing his pint-sized frame over to Margaret, I turned back in just enough time to help the second baby as he crowned.

He was born 3 minutes after his brother!

Both boys came out head first. They appeared to be identical (shared a placenta, and a chorion) and weighed almost the same weight.



Baby boy #1: Born 10:30 am, weighing 2.5 kg.
Baby boy #2: Born 10:33 am, weighing 2.8 kg.

Their father didn’t realize he could come inside the birth-room and therefore watched eagerly from the window. When I realized he was out there, I excitedly called him in.

The grin on his face was intense as he held his sons in his arms!

None of them suspected twins! And when I woke that morning... I certainly didn’t either!

Thank you Jesus!

Month of Madness!

We’ve had a record number of births so far this month and there seems to be no end in sight! It gets even better though. Many of these births are coming to labor with us!

This is a remarkable change as often those that do deliver with us wait until the last possible moment before coming. These ladies barely have time to lie down on the bed before they push their babies out. Although it’s good they come... not having them labor with us leaves me a little sad.

Well, this week has been very different. They are coming to labor and deliver. And they are bringing their entourages! Frankly, it’s been a Preggo Party for the last three days!

Margaret and I have delivered 12 babies this week; and there is a 13th in the wings right now!

Yesterday one of our ladies delivered twins!

Everything went smashingly well --despite the fact the first one came out footling breech.

We thought his brother would come out breech as well but were happy to see a hairy head emerge instead! 

Their father was in the room for the birth and was so pleased he asked to stop and give thanks in prayer. Then removing his leather cowboy hat, he bent his head and prayed. It was a tender moment I won’t soon forget!

But it gets even better!

Because not two hours later he came back with another wife, saying she was in labor too!

At first I laughed thinking that he was playing a joke on me. Perhaps I misunderstood and she was really only his sister. But no. She was one of his other wives; and she was most definitely in labor!

Apparently when he learned she was getting active, he went to get her and insisted she deliver at the clinic, too. She delivered another boy 4 hours later.

Think of that! Three sons all with the same birthday!
    --Only in Sudan.

Also this week, I got another name sake. His mom walked 3 hours in active labor to get to me! I marveled at her dedication and love for her child.

When I asked if she really walked 3 hours to come, she nodded gravely and explained she wanted to be at the clinic in case of trouble. I’m so glad she did.

As it turns out, her baby was severely compromised when she arrived. His heart tones were all over the place. And when she delivered a few hours later, he came out flat.

Dennis helped me resuscitate as his parents watched on. By God’s grace, within a few minutes he was doing better, and we all let out a collective sigh of relief.

The father was so happy with the birth he asked if he could name his son after me. He wanted to give him my father’s name. I told him it was Steven, but ... such a name is hard to pronounce here. So I then told him it was Williams (my last name).

He jumped at that and decided his boy would be named William Deng. ‘William’ after me and ‘Deng’ (which means ‘rain’ in Dinka) since it was raining when he arrived!

I wish I could write each birth story out for you, but I’d bore you with the details. Suffice it to know that we are crazy busy, getting little sleep, and yet... I’m loving it!

Please pray for all the little ones born this week. Pray they thrive and these two lone midwives would somehow survive this month of madness! Thanks!

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.

Twin update...

Mary and her mom, holding the twins.

The twins I delivered a month or so back came in for a check-up today! (Read their story here.)

It was so great to see them, and to goo and gahh over their cuteness! It was even better to hold them in my arms and rejoice over their sweet lives! 

I didn't inform you all, but the day after they were born, they both came down with high fevers. They really gave us a scare since the day they were born we had a serious meningitis case at the clinic. We treated them quickly and they recovered...  no worse for the wear. Praise God!

Check out how adorable they are!

Twins: Waiting to push?

Mary was expecting twins. We were able to confirm it a few months back with two little heads, two different heartbeats and a mega-large fundal height. Not having an ultrasound machine, we were as confident as we could be that there were two... but I’m never one-hundred percent certain.

Since her estimated due date was in May, I was a bit concerned when she came in this week. Her belly was large, but if we were right on the EDD, then she was preterm.

However when I did the vaginal exam, it was too late to stop contractions (not that we have the medicines for that anyway, ha ha!). She was 9 cm and stretchy. The babies were happy. Both appeared to be cephalic (head down), but then again... I wasn’t positive.

Since their heads were small (another sign of prematurity), I informed the rest of the staff we had a possible preterm twin delivery on our hands that could go any minute.

Setting up the room, I sent my translator to send all my prenatal ladies home. Mary was the second labor to arrive in less than an hour that particular morning; Margaret and I were maxed out.

The preggos understood immediately, and wished us luck for the births. So sweet.

As, Mary walked about the clinic, I prayed. I wasn’t feeling the stress of twins like I did last year. I felt at ease. Monitoring them regularly, I tried to stay as ‘hands off’ as possible.

After about an hour, Mary started pushing. She wasn’t doing it very well; it looked strained and artificial. So, I asked her if she had an urge to push at all. She didn’t. So, I asked her to push only when she had an urge.         -- ha ha. But that time never came.

One hour flowed into two. Two hours flowed in to four. By four hours, I was nervous. What was wrong? Was there some kind of compound presentation? Could they be interlocked? Why hadn’t she delivered yet?

I did another vaginal exam.

She was fully with the head at a +2 station, so I encouraged her to push. Pushing should have been simple. It should have been straight forward and quick, but it wasn’t. She pushed externally but couldn’t figure out how to do so internally.

It was odd.

Could it be possible she didn’t know how? I tried to instruct her how to push, but she categorically refused. Round and round we went. I explained how to push and why. She would pretend to push then give up.

Mind you it had been close to 5 hours since she arrive. It had been at least four hours since she was fully. The babies where small; her pelvis was more than adequate. All she had to do was push, and the birth would be over.

But instead, she delayed.

Why she preferred the hours of contractions to pushing, is still a mystery to me.

Begging her to push, I explained that I needed to make sure there wasn’t a major problem, but she ignored me. I was racing the clock.

As I watched the sun settle lower on the horizon, I honestly worried. What if something was seriously wrong, and I couldn’t get her to Wau in time.

Nervous. Uneasy. Confused.

Tired of begging fruitlessly, I left the room in frustration. I needed a minute alone to pray. Was there an emergency, Lord? Or was I just being impatient?

Did we have a “labor problem” or a “midwife problem”? Which was it?

Another hour went by.

Finally, I had had enough. If she was still unwilling to push, then she needed to go to Wau. Only then did she get serious. I hated having to threaten her with Wau, but I was genuinely concerned. I told her that she had the option of pushing, letting me use the vacuum extractor, or going to Wau.

Unwilling to push, or go to Wau. She chose the vacuum.

Surprised she’d choose the vacuum over pushing, I didn’t argue. Instead, I did another vaginal exam. Not only was she fully, but the head was at a +4 station. All she had to do was push once or twice and her babies would be born.

“Won’t you just push once, Mary?” I asked pleadingly.
“No. I don’t want to,” she said and stiffly lay down on the bed.

Grudgingly, I put the vacuum in place. I didn’t want to use it. I wanted her to push. But... that wasn’t going to happen.

The next contraction, I pulled. She pretended to push. The baby was born!

Mary screamed uncontrollably as the baby emerged. Strange. She continued to scream long after the baby was out. Bizarre.

Her precious little girl screamed with her, as I wiped her down. She was perfect... and term. (I guess we were wrong on the due dates! ha.) It was so easy... so simple. Sigh. 

We waited a few minutes, then double clamped the cord. One baby down. One baby to go.

I ruptured the second baby’s membranes, and fluid slowly leaked out. Reaching in to guide things along, I was expecting a head, but got a sweet, little buttock instead.

Mary continued to push, a bit more effectively this time, but screamed once again. One boney butt emerged, followed by belly and then arms. Then the head slipped out with ease.

They were born 10 minutes apart.

Once the placenta was born, it was pretty obvious that they were identical. Even though they had separate placentas (two distinct sets of cotyledons), they shared a chorion. (But I don’t think they shared the amnion.)

Plus, they weighed almost the same. The first was 2.1 kg while the second was 2 kg, exactly.

Afterward, we had a nice time hugging on the babies. There was laughter and joy as the family gathered around to celebrate these two perfect little ladies.

It was so great... once she pushed. Ha!

Placenta Pictures:
For those of you out there that love this sort of thing... and yes, I know you are out there! I cannot be the only one. Here is her placenta. Cool huh?!

Funny side note:
Afterward, we took tons of pictures. In almost all of them, Mary was shirtless. I tried getting pictures that were more discrete (for this blog), but it was an exercise in futility. Toplessness is not shameful here.

At one point, I instructed my translator to have her hold the baby up higher, so as to hide her breasts. He cocked his head to the side and asked why.
-- “Well. In America, it’s not proper to show a woman’s breasts.”
-- “Don’t the men in America know what breasts look like?” he asked innocently.
-- “Yes. I know it’s silly to you, but the men in America ... well, it’s just best not to show them.”
-- “Okay,” he laughed, a bit confused. I couldn’t help laughing with him.

Culture. Culture is a powerful thing.

And perhaps there are too few men reading this blog to care if breasts are in every photo, but out of respect for you all with Western cultural backgrounds, I don't. I hope you realized how hard it is to get a ‘decent picture’ around here. Ha Ha!

I don’t know what is attractive to Dinka men, but it’s certainly not breasts.

Oh Sudan!

A day apart!

Today a woman was brought in by ambulance, sirens wailing and lights flashing. I was already at the clinic, and watched it approach from my window. As I peeked out in interest, I heard them say something about a woman in labor, but all I could see were her feet sticking out the ambulance door.

If she was coming by ambulance, it must be pretty serious. Right? Since I wasn’t sure how long it’d take them to get her through our narrow halls, I started setting up the room.

I barely had time to pull out my instruments when a VERY pregnant woman wobbled in, a bit off-balance. She walked timidly, like her feet couldn’t be trusted. I figured she was just lopsided with such a BIG belly, but there was some swelling in her legs as well.

Gingerly she lay on the bed. Everything she did was slow and steady. My translator was still outside, so I instructed her in my limited Dinka to lift up her dress so I could check on her baby.

Just then, my translator interrupted me:
-- “Wait. Here’s the baby!”
-- “What baby?” I asked stupidly, while pointing at her belly. “Do you mean this belly?”
-- “No. She gave birth yesterday. Here’s the baby,” he insisted, handing me a pea-sized person wrapped in an endless stream of clothes.

It took me a minute to find her face. She was tiny! I sent someone to get Margaret; this was going to be a doozie. What was I looking at if not a baby?

Aluong, my very-pregnant mama lay awkwardly on the bed, and slowly explained she gave birth yesterday afternoon, but the placenta wouldn’t come out. Huh? This belly was just her placenta? I wasn’t buying it.

So, I sent for her family. I needed to hear this story from every perspective. In my head, she obviously had twins. The question was... was the second one still alive.

When her mother came in, she explained the baby was born yesterday afternoon, but hadn’t nursed yet. They clamped and cut the umbilical cord, but it was sucked back into her body. (I could see no cord handing from her vagina.)

-- “Did you tie the cord on two sides and then cut in the middle?” I asked. I still didn’t have time to check heart tones. But if they had let the cord bleed, this baby might be dead.
-- “No. We tied it just once,” the mom explained, looking a bit confused I’d ask such a strange question.
-- “Aluong, can you feel a baby moving inside?”
-- “Yes.”
-- “Good.”
-- “But the placenta won’t come out,” her mother insisted.

I had to laugh. In my head the most important thing was delivering this next baby, not the placenta. But in her mind, she was more vexed the placenta hadn’t come out.

Margaret arrived just then, and I caught her up to speed. She took over checking on the pea-sized person. Since she hadn’t nursed in almost 24 hours, Margaret got her some sugar water and checked her vitals.

Her fundal height was 39 cm, the baby was cephalic (head down), and in a good position. I found heart tones easily, then started counting contractions. Whoever was inside was happy-- so was I!  There was no excessive bleeding, so I did a vaginal exam.

The membranes were bulging, and as I pressed deeper, I could feel the head. Everything was looking great. She would deliver very soon.

We got everything set up for the birth, made sure the other baby was doing well, and then I ruptured the membranes. I had to do it twice. The first time I got a slightly bloody fluid. The second time, the waters were clear and fresh. They gushed out in one salty wave, making the room jump back a bit.

The head settled into the pelvis nicely, and she instantly needed to push. Heart tones were solid, so we just sat back, and watched this little patch of miracle peak out at us intermittantly. Three solid pushes and she was out! 

Her chubby cheeks cried astonished whoops of wonder as a tidal wave of salty waters burst behind her, and trickled to the floor in rivulets. She lay on the bed like some beach beauty, announcing her arrival. We laughed!

Her size and the fact Aluong’s belly drooped anti-climatically reassured me that there were only twins, and not triplets. (Yes, I had my doubts.)

After the cord was cut and the placenta was born, we discussed her obstetrical history a bit more in detail. She explained this was her second pregnancy. Her first was born dead at 8 months. She claimed she got in a fight and her baby died.

As for this pregnancy, her first baby was born almost a full day before her second. Their weights weren’t too different, but their appearances were striking. The first was thin, frail and weighed only 2.3 kg (5lbs). The second would have made sumo wrestlers jealous in her chunky folds and lusciousness, but she only weighed 3kg (6.6lbs).

Nevertheless, they were a delight to behold!

I taught Aluong how to breastfeed them both, since this was her first time; she was a natural. Both babies sucked vigorously, and they were all discharged a few hours ago.

There you have it... another almost twins story! Ha ha!

Oh, for those who like to know about such details, let me tell you about the placenta! It was super cool. They were two separate placentas (completely unattached). Both had remarkably short cords (less than 10 inches), but they appeared healthy. There were a few blood clots trapped between the amnion and chorion, and the smaller placenta (for baby number 1) looked as if it had partially detached (abruption?), since it had an extensive black clot over one edge.

Also, the membranes of the first (smaller) placenta had two areas where they had ruptured. The placentas were ONLY connected by these membranes. I’m thinking they may have shared the chorion? What do you all think? Check out these pictures. You can decide for yourself.

All I know is, had they shared a placenta, the second baby would not have survived after they cut the first’s cord. I’m thinking fraternal twins. What do y’all think? I think I can rule out twin-to-twin transfusion as an explanation of the size discrepancy. Right? Perhaps the blob on the smaller placenta caused her to get less of the oxygen and nutrients.

So praise God with me that both girls lived! They are beautiful!

Twins, born a day apart, used to be things I only read about in books! Is this really my life? I have to say, I love it. I really do! It’s hard at times, but I really do love all this craziness.

What a grand adventure He has laid before me!

Thank you for following me around in these adventures! Thank you for encouraging me so persistently, and praying so diligently! You help me in so many unspeakable ways! Thank you!

The almost-twins.

Large, expressive eyes smiled playfully when I met her last November. A soldier living on base, Ayen was strong, lean and beautiful-- and very, very pregnant. Her belly was unusually large for her dates; Could she have twins? She had delivered twins once before, would she be up for a second round? Beaming, a toothy, yet tender smile, she explained: “One baby is a blessing, twins are a double blessing!” Her enthusiasm was infectious.

Unable to pin-point whether she had twins or not, she agreed to come back regularly. With time, we figured it would become clear, but it didn’t.

One month, the heart beat would be low, near the pelvis; The next month, it would be high, tucked up under her ribs. It was a quandary. And regardless of positioning, the fundal height kept soaring. I suspected twins because of all the tiny parts I could palpate, but... but... I wasn’t sure. The heartbeat was the same, meaning it could be just one baby. With no ultrasound, we had no way to confirm our suspicions. We’d have to wait.

Fast forward 3 months and several prenatal checks to this afternoon.

When she arrived, busting at the seams, my Twin-Alarm sounded in my head. Her fundal height was 40 cm (not outrageous for North American women but very uncommon here. In fact, the only other 40+ cm fundal height was on my twin delivery last year.), so I called for back-up. Margaret was happy to oblige.

Well on her way to fully, Ayen labored like a champ. She groaned and bit her lower lip in pain, twisting her mouth in a question mark with each contraction. It was child-like and sweet and so unexpected; I couldn’t help but smile in response. 

When it came time to push, she did it with gusto. In fact, a few pushes into it all and Niagra Falls exploded on the opposite wall and gushed down the bed legs, pooling on the floor. Startled, we jumped at the force of it all. The last birth with this much fluid was my twin birth. But then a normal sized head appeared, followed by a sea of more amniotic fluid.

That enormous belly sank to next to nothing once her boy emerged. Twins he was not. Instead, we got one healthy bambino surrounded by 3-babies-worth of amniotic fluid! Laughing at my miscalculation, I must confess I was a bit disappointed. I think she was too. Despite all the extra work twins can be, I think she really wanted her ‘double blessing’. Oh well.

... there you have it. The story of my almost-twins.

Rejoice with me! His birth is the 9th baby in 9 days. I like this season of baby-ness. It’s fun.

Twin update: Joy & Grace

We do weekly outreaches to a community called Malone. It’s a chance to offer simple medicines and care to a people even more remote than Tonj. It’s from this community that the twins are from. A week or so back, the twins came in for a review. They are about 4 months old now and going strong.

Read their story here. 

Grace and Joy ~ My first Twin catch.

Friday night.... Twins.

After a birth, after arguing with a mother insistent on starving her child to death (see blog below), after a long line of prenatals and finally closing down the clinic for the week, I went home to rest and have dinner.

I kept thinking about the twins I had diagnosed earlier this week. I’ve seen a number of women with way too many fetal heart beats. I’m starting to think there’s something in the water. I’ve had at least one person a day this week who is suspected of carrying twins.

So naturally, I thought of Ajong, my mama from Maloney, I wrote about earlier (see blog called Dream come true? below). She is the one with the crazy large fundal height who delivered twins last pregnancy and is surprisingly pregnant with twins again… or triplets.

Well she (surprisingly) stayed pregnant another 2 weeks. Each day she seemed to do better even though she was still quite tired. She didn’t seem so anemic and had more energy. But her baby’s heart tones kept moving on me.

One would always stay the same. But the second baby kept going from the right to the left side. It was impossible to know if it was two babies that somehow were hiding from me or if it was just one baby that was dancing inside.

As time went on, I no longer suspected triplets. Instead I felt more confident on twins… but I confess I was never really sure.

The thing is, neither Maggie or I, have ever delivered twins before. Neither of us have ever delivered breech either. Even though it was a first for us,  fortunately we weren’t scared -- or we were too foolish to know any better. I’d like to think it was God just giving us grace for the day and peace for the task at hand.

I was thrilled to see her come in last night (Friday night) in labor. Could this finally be it? When I checked her she was squarely 4 cm dilated and contractions were solid – even if they weren’t very painful yet.

She was so cute waddling through the clinic in her stilted stride. She couldn’t go very far but I loved to see her labor standing up. The babies seemed to be doing fine but one of them kept changing the location of the heartbeat. What? I was thoroughly confused. That doesn’t happen this late in the game.

I kept a question mark constantly hanging over my head. I guess time would tell.

By 1 am she was making progress and at 2 when I did another IE she was ready to push… well almost. There was a bit of an anterior lip. I held it back and the membranes were ruptured. The first baby came not long after.

She came head first and did just fine despite her petite form. The second baby was then supposed to be easy to manipulate into the pelvis (according the textbooks that is!) but she wasn’t.

The fundal height was still enormous and I couldn’t feel a baby in there abdominally at all. Odd – very odd. Maggie was (I’m thinking for her here) just as confused as I was, “Where is this baby? Which way was the head?”

I could feel the membrane internally so I ruptured it. And the flood gates of heaven opened. Easily over 2 liters of amniotic fluid gushed out, soaking our shoes and splashing under the dividing wall into the next room. Yikes.

But immediately I found something soft and squishy coming out. It was a tiny foot and pointy bum. She pushed and the rest of this miniscule person made her way into the world. Blue as the stormy sea.

She moved a bit but made no effort to breathe. We resuscitated and within a few minutes she perked up considerably. But she was just so small.

Meanwhile I turned my attention to Ajong again to see Maggie handling things like a champ. The placenta with two cords not one was birthed not long after and the bleeding controlled.

I have to admit I felt strange looking around the room and seeing babies here and there. I was thrilled when the smallest went the breast without a hint of hesitation and cheered to know Mama Ajong wasn’t hemorrhaging.

Frankly… I just think God answered all your prayers (and mine).

Thank you for lifting her up in prayer. Pray with me still as tiny treasures head home to the village. Pray for health and Jesus to continue to provide and care for them all.

But know… there is another VERY pregnant mom who may have twins too. But she has polyhydramnios in a serious way (not good. Means she has too much amniotic fluid). Pray for her and the rest of the team God calls to deliver them.

Thanks. 

Surprise! Surprise!

Last week.... sorry so late in blogging.... a classmate caught "surprise twins"!

The story goes that this young lady came in fully and pushing... she made it to the bed and shortly thereafter birthed her first little girl. But something was amiss.... the mother's fundal height was 37 (considered large in this country) but the little girl was small (only 5 lbs). They noticed the fundus was still pretty large and so they checked for heart tones and what do you know another little one was still inside!

No one knew she was carrying twins. She had never had an ultrasound (not routinely done for cost reasons). Her sister was born a few minutes later. Both of them were born head first (PTL!) which is perfect because we have not done the lesson on breech deliveries yet. The second twin was IUGR (or growth restricted) due to a smaller umbilical cord and only weighed a little more than 3 lbs.

The mother didn't do so well in the postpartum period. She went into shock due to the blood loss and was transported to the hospital after vomiting several times. She had to have a blood transfusion and yet she couldn't take her twins with her! They were so small they would run the risk of getting ill. But God is an amazing provider! The classmate who caught the babies is a breastfeeding mother herself and she and her husband loved on these twins for about a week while their mother recuperated. She took them to see their mother everyday and helped them to establish solid breastfeeding patterns! They sure can eat!

But my classmate was definitely tired at the end of it all.... tandem feedings, midnight feedings, three babies at her breast continually (for she still breast feeds her youngest!) and an assignment to complete on top of it all! She just gave the babies back last night! Please pray that they will grow up strong and that their family can afford two of everything when they only planned for one!

The first little girl is named Shweety (but we called her Bean Sprout) weighed 5 lbs at birth
The second tiny girl is named Cutie (but we called her Sweet Pea) weighed 3 lbs at birth