Some days here can be challenging, frustrating even. The days you wake up with no power and no running water. The days your patient tells you she only took 3 doses of the antibiotic that was prescribed for 10 days because she couldn’t afford to buy more (yes, most medications here really are sold in single pill units.) The days you spend hours waiting in line and still haven’t managed to get all the required paperwork completed. But to make up for it, there are also days when I can hardly believe how lucky I am to get to live here and do the work I do.
Today I supervised swing shift at the birth center (2 pm – 10 pm.) As a supervisor I have more responsibilities and less time for direct, hands-on patient care but I get to do a lot more teaching, which I really enjoy. Seeing your student do something well is even more satisfying than doing it well yourself.
The shift started slowly: it had been a quiet morning without any births, and there was only one patient admitted, in labor with her second baby. Over the course of the afternoon, a few mothers brought their newborns in for scheduled check-ups. Most of these were uneventful — healthy mothers and healthy babies — but just before 4 pm a young couple came in with their new baby whose newborn screening test had just come back positive for G6PD deficiency. This metabolic disorder is not uncommon here and means that the baby lacks the enzyme glucose-6-phosphate dehydrogenase, and exposure to certain foods or medications may lead to hemolysis (destruction of red blood cells.) We spent a lot of time educating the parents about how to protect their baby and referred them for confirmatory testing.
As we were finishing up with this, another woman in labor walked into the birth room. She flashed me a big smile of recognition: I had been her midwife for her prenatal check-up earlier in the week. Her two adorable older boys peeked through the window from the waiting area outside. As J, one of our younger Filipina staff midwives, started checking the baby’s heart tones and the mother’s vital signs, we pulled out her chart and realized there was a problem: the baby was not due for another month. We try to avoid premature births at our clinic: as a birth center, we have everything necessary for normal births and full-term babies but we are really not equipped to provide respiratory support to babies whose lungs are not mature. We started to prepare for transport to the hospital but quickly realized there was not going to be time for that as her water broke and …ready or not, here comes baby! I made a snap decision that a late preterm baby here at the clinic was preferable to a late preterm baby in the ambulance van and we quickly got ready for the birth. A few minutes later a screaming baby boy was on mama’s chest and I was breathing a sigh of relief as I listened to him voice his annoyance with his untimely eviction: no resuscitation needed this time. At 2000 grams (4.4 lb) this little peanut was only half the size his next oldest brother had been at birth! He struggled a little with transitioning to using lungs that would really have benefited from a few more weeks inside, and there were a few moments when I thought we’d be sending him off to the hospital after all, but thankfully kangaroo care and close monitoring turned out to be all that was needed.
Once baby was stable the next step was sewing up his mama’s tear from the very speedy delivery. J needed a little help with her suturing technique — in fact, I had to tell her to pull out her first stitches and do them over again. I was proud of her for trying again instead of taking the easy way out and just having me do the repair, and by the time she finished she was proud of herself for a job well done and felt like she had really learned a lot.
By now the mother in the next bed was ready to push, so I left J to continue her postpartum watch and stepped over to the other side of the curtain to supervise the birth of another baby boy, a chunker by comparison at a week past his due date. He lost no time getting down to business with his new full-time jobs of eating and pooping.
At the same time that all of this was happening, one of the other midwives had been giving me regular updates about the young (teenaged) first time mother who had come in in very early labor shortly after our first birth of the shift. She was only 2 cm dilated and not having very strong contractions yet. Normally this would mean we would encourage her, explain the signs of active labor, and send her home. Unfortunately, this mother’s blood pressure was elevated — not to the point where we needed to transport to the hospital, but too high for us to just send her home. First, we instructed her to drink water and lie on her left side for a while, which often will normalize blood pressure — unfortunately, hers was actually a little higher when we checked it again. On hearing this, she started to cry and said she really did not want to go to the hospital. (Unlike our birth center, the hospital does not allow family members in the labor and delivery rooms and her mother who was doing a great job of supporting her would not be able to stay with her if she was transported.) I had her midwife quickly test for protein in her urine — all clear — and start an IV of D5W hoping to get her blood pressure to stabilize and buy her enough time to possibly be able to still deliver at the birth center. It worked — her blood pressure came back down to a more reasonable level — and she settled in to rest before labor really kicked in.
Our final patient of the night came in a little after 8:00. She was also a young first time mother, and also was not quite in active labor yet. Since there were no concerns about either her or the baby she was told to go home, eat dinner, and rest and instructed about when to return to the birth center. Later, the midwife who had checked her and sent her home was helping to clean up the birth room after our two patients who had given birth had moved to the postpartum area. She carried one of the big plastic trash cans we use for soiled linens out to the laundry area which is outside the clinic, behind the entrance hallway and family waiting area. She came back in laughing: “Remember the patient I sent home an hour and a half ago? I just found her hiding in the laundry area.” Like so many other first-time mothers, she was quite certain that her labor would be the exception to the norm and was deeply concerned that her baby would accidentally be born at home or in a taxi if she did not stay very close to the birth center! (While amused by this, I am also deeply sympathetic: when I had my first baby I was told “you’re not really in labor yet, go home” for three consecutive nights of non-stop contractions in a row until in desperation and exhaustion I finally dug in my heels and refused to leave the birth center.)
After giving report to the night shift team we all prayed together — for safety and normal, progressive labors for our two young mothers (the one with high blood pressure and the one who wouldn’t go home), for continued health and well-being for our little premie who was still struggling with breastfeeding, and with great thanksgiving for God’s mercies to us. Such a fun shift with a great team of midwives. I love my job.