The students had struggled to find heart tones and now the midwife was apparently struggling- moving, turning, and adjusting the doppler in search of a heartbeat, but to no avail. I look at Glen and tell him he should just grab the portable ultrasound. He grabs it and begins to speak with the VBAC mom, introducing himself.
While this is transpiring, I go to tend to the first time mom. The Haitian midwife assigns two students to me- one a nursing student and one a midwifery student. They will be assisting me with the birth and she would like me to guide the student midwife during the birth, explaining things as I work, and hopefully allowing the student to get some “hands on” experience.
I watch as the students take her vitals. The student nurse tries to tell me that mom's respirations are 6. I say I sure as heck hope that's not the case, and we re-do it. She is in fact alive and breathing normally. We listen to baby and they are confused at the concept of counting for 6 seconds and multiplying by 10. I tell them perhaps an easier option is counting for 30 seconds and doubling. They look at me equally confused. I explain maybe we should stick to counting for a full minute, but eventually they will learn by ear what 120's, 130's, 140's, 150's, 160's, and what abnormal heart tones sound like.
I check mom and she is 8cm with a bulging bag. I ask her if she would like to go walk but she does not want to. We tell her she is doing great and we stay beside her to support her.
Through the plastic, tattered shower curtain I hear Glen, in the soft, gentle voice that I love- as it is his and only his- say, “I'm sorry, but I don't see a heartbeat.” I have heard these words come from his mouth too many times. It doesn't matter- at home or in Haiti, someone I know or someone I will never know- the words slice like the dirty razor blade that is sitting contaminated on the counter to cut cords.
The mother says nothing. I can't see her but I am sure she is stoic and just nods. It is not that she doesn't care. Not that she does not feel the spiraling panic and loss that you might imagine or even know yourself. It's something beyond our understanding- she knows it happens. Babies die. Especially here in Haiti.
I stop what I'm doing and go to the bedside...to support mom, to support Glen? I don't know.
The baby starts to slowly crown and Glen touches the baby's head. He looks at me and whispers that there are no bones. I do not know what this means.
The baby starts to slowly come out and the sight of it causes my translator to instinctively recoil and close her eyes, as if the sight is equivalent to a hand touching an open flame. I want to look away too. I want to leave. But this is real. I can walk away and block my eyes and my heart from what is happening and go on with my life, but this shit is real and THIS is forever this mother's story. She cannot escape. Haiti cannot escape from this reality. And so I stand firm, eyes and heart open.
The baby's head comes out and it is like a half deflated water balloon- bouncing and sloshing around as if here is nothing within the skin of the face and scalp. The baby has been dead so long that the brain has liquified.
I cringe on the inside. My imagination is running wild and I wonder if the baby's head might pop, letting what once consisted of brain with dreams and thoughts and potential, ooze onto the bed.
When baby is out, it is apparent what likely caused this baby to die- he is wrapped up in his cord. Glen places him on the bed and covers him with a towel, trying his best to form the towel around the deflated head. Mom glances down at baby and quickly looks away.
I look at mom and tell her, “There is nothing you did to cause this, nothing you could have done differently. This just happens sometimes and we just don't know why.” She looks at me, says nothing, expresses nothing, but nods in acknowledgment.
The midwives take baby away and put him in a cardboard box, which will sit under the delivery table for hours, 3 feet across from where my patient will give birth.
A shower curtain away, my laboring mom begins to involuntarily push, preparing to give birth to her living baby.
I go back to my patient and two students. I talk to my students and explain the importance of frequently listening to heart tones during pushing. The student midwife is in charge of heart tones and she does a great job.
Mom is pushing and baby is ever so slowly stretching the perineum. As baby encroaches on a full crown, mom stops pushing and baby retreats back. We watch for about 30 minutes as this happens. The students anxiously tell mom to push harder, and I have to let them know that what she is doing is great. She does not need to push harder. As she pushes baby closer to a full crown, it is ever so slightly stretching her tissues and hopefully will prevent a tear. They absorb my words and just watch.
Mom pushes and slowly the baby's head begins to fully emerge. I put my hand out to guard the perineum and verbalize that she's doing great, to keep guiding the baby out nice and slow. The student midwife's hands are right with mine. Baby comes out into our hands- a double handed catch, and I swiftly show the student how to unwind baby from the umbilical cord that this baby is wrapped in.
And the baby in the cardboard box remains on the floor.