Today we were accompanied to the hospital by two other Midwives for Haiti volunteers- Jenna and Phoebe. Jenna is a Labor and Delivery nurse from Illinois and Phoebe is a nursing student from Virginia. They were both excited to be helping at the hospital.
Shortly after we arrived, the Haitian
midwife told us that there was a patient in labor who was complete.
They believe that this patient is possibly pregnant with twins. Whoa.
“Possibly?” As if, we don't really know for sure? As it turns
out, this is the mom that Glen and the Haitian OB had scanned
yesterday with such difficulty. They thought they saw two bodies but
could not make out the second head, and therefore were left puzzled
with a “We're pretty sure this is twins, but we're not really
sure.” Keep in mind the portable ultrasound that we have to use is
about exactly what you would expect to have in Haiti- ancient, dusty,
on it's last leg. This patient had ruptured early this morning and
according to the midwife, had filled a very large bucket with
amniotic fluid. I understood one word as she spoke in Creole-
|Our team for the day! Nursing student, Doctor, Midwife, and L&D Nurse.|
The midwife then asked for our help. We entered the unit, happy to be asked for help, and proceeded to set up for delivery- again, emphasizing to the midwife and the students the importance of preparedness. While the delivery instruments, bulb syringe, and pitocin wasn't out, I notice that each delivery station is set up with the supplies to start an IV. I also notice an Ambu bag at two of the stations. I comment on how great this is.
The girls and I make a plan for after delivery. They are each in charge of a baby. If they need resuscitation, Jenna feels confident that she can do it. We do a 10 second NRP refresher, she nods, and we move on. We do a quick run down of supplies, get the towels, blankets, bulb suctions, and everything laid out on the tile counter, which is our makeshift resuscitation station. I feel confident in our team.
The midwife asks me if I would like to check the patient for myself. I decline and tell her that there is no need to re-check since she had just checked. If the patient is complete, then we will just wait until she gets the urge to push. Simple. Easy. No rush. But then she says that she really would like me to re-check. I honestly don't understand why she wants me to re-check the patient, but I shrug and take the cue and tell Jenna and Phoebe that perhaps she is feeling something she is confused about. I joke and say, “Maybe it's baby's butt instead of head.”
I introduce myself to mom, “Bonswa. My name is Tara. I'm a midwife. I'm going to be taking care of you today.” I ask to check her, she nods, and I find that she is indeed complete, and the baby's head is +3 station. I explain to Jenna, Phoebe, the Haitian midwife, and the 2 student midwives what I'm feeling, and they all peek to see baby's head, just visible.
I ask Glen to check heart tones. They are great. 140's. Only he doesn't seem to be finding a distinctive heartbeat for baby B. It's very difficult to tell via doppler (especially with someone with poly), if you are picking up the same heart beat or not. I tell him to stop trying to find it. We are going to deliver, and like we've already learned, there is no such thing as a STAT section here. We can get these babies out quicker this way, so is our plan of care going to change? He listens again and baby A is in the 70's. And stays there.
I explain to mom (and everyone else) that the baby's heart rate is low and the baby needs to be born. She needs to push hard. I'm thinking to myself that this seems to be a repeating chapter here in Haiti...it feels like deja vu. Low heart tones...episiotomy, full rescusitation. Only I exhale with some relief thinking to myself that this mom has plenty of room and no tight band in the vagina. She can do this quickly. I realize I don't even know her history, but I can tell that she's likely had babies before.
We push a few times- a room full of people (literally, we are like packed sardines), encouraging this mom and telling her to push hard! Baby needs it.
Baby comes out and I immediately see her face and know that something is wrong. I say nothing. I put the tiny, limp baby on mom's belly and unwrap her from the tangled cord. I try to stimulate while Glen is clamping and cutting. I pass the baby to Jenna. We don't skip a beat.
I'm expecting baby B now. I think. I get my bearings, but I can see Jenna struggling out of the corner of my eye. Jenna says my name, calling for help. Glen jumps in in my place and I go to Jenna. I only need to see baby a split second and without words, I know why Jenna is struggling. The baby has no lower jaw. She can't breathe and Jenna can't get air in because there is no jaw to open for an airway. I verbalize it and we hope that perhaps we can bag just through the nose. Only, without the jaw, it is so very difficult to get the mask with a firm placement. We do it though. Jenna continues bagging and air is going in. The chest is rising, the baby is pinking up.
Glen discovers that there are no twins. Just a massive belly and a case of polyhydramnios. He continues to care for mom and deliver the placenta.
I listen to baby's heart rate and it is thumping away at 140 beats per minute. She is trying to cry and attempting to take breathes. We keep bagging because they are insufficient gasps. We try to suction with the bulb syringe but the tip is way too big for this tiny baby. I get the delee and I suction out her nose. I try to find a hole where her mouth should be, but there's nothing there. She can't breathe on her own. We continue to bag. As long as we are bagging, she's pink, her heart is beating. She's gasping for air but she can't get any in through her nose. She's trying to cry, but she can't even do that.
We move her to a heating pad, wrapped in blankets, atop a filthy delivery table. We continue our resuscitation efforts. The peds resident, Aisling, arrives. We are doing everything that can be done, but t's apparent that this baby cannot survive. Not here. Not in Haiti. As soon as we stop bagging, the baby cannot breathe. Her heart rate declines.
We stop our efforts. Baby is trying to take sporadic breathes, her heart rate keeps declining. I ask the translator to tell mom that we have done everything we can do, but there is nothing left and the baby is not going to survive. We ask mom if she would like to hold her baby. She says yes. Aisling says that I should be the one to bring her baby to her. I struggle to keep it together. I pick the baby up, wrapped in her towel, and I bring her to her mother.
I show mom her baby and explain that she was born with a congenital abnormality that has made it so that she could not breathe or eat. We don't know why it happened, we don't know the cause, and there is nothing that she could have done to prevent it. I open the blanket and I show her the rest of the bay girl. Everything else is perfectly formed.
|Showing baby to Mom and Dad.|
Mom asks for her husband to come in so he can see the baby. He comes in and I explain the same things I've just said to mom. I ask if he wants to hold the baby. He says that the baby has already died and he does not want to. They are ready for me to take baby away. I place the baby down on the delivery table that we were just resuscitating her on and I begin to cry. “I'm sorry,” I apologize to the peds doctor. I'm not apologizing for anything I have done wrong, but apologizing because I feel like an idiot. I am standing in a room full of people and I'm the only one crying. I can't keep it together. I cannot honestly say that I am mourning this life. She was not my baby. I do not know these people. I have known them for mere minutes. I do not even know this mother's name.
I am not only sad for this loss of life, I am not only sad for this mother's loss of her baby, I am sad because that baby girl never even had a chance. Not here. Not in Haiti.
What if she had been born in America? In Australia? Canada? The UK? Any other developed nation? What if her mother had had prenatal vitamins, a healthy diet, access to a 20 week fetal assessment? Could it have been prevented? Could it have been detected? Could the baby have survived in a controlled setting and an appropriate hospital environment? Here in Haiti this- this dirty, run down place we are in- is called a 'hospital', but it is merely just a word.
What if you or I had been born into a developing country? What is it- chance, happenstance, divine delegation? Because I don't get it. Could have been you, could have been me. We have human beings dying because they do not have food or clean water, or access to basic healthcare. We have women dying from pregnancy and childbirth complications because they do not have trained attendants to care for them. We have babies dying because of this same reason- a lack of trained attendants, as well as no access to higher level of care.
A baby girl was born and died today. She lived for mere minutes. She never got to see her country or know her culture. She never got to experience life.
Not here. Not in Haiti anyway.
|Sweet baby girl who only lived for a few minutess.|