Day 14/15- A Healthy Reprieve

Yesterday we said goodbye to the group of 11 volunteers that were here with us last week. It had been nice to have the full house bustling with the noise of projects being accomplished and laughter and conversation filling the walls, but once the van pulled away, the silence was a nice reprieve from the organized chaos of the week before. The loudest sound that projected through the house as we walked back in was Ina May and her incessant meows.

A few hours later, the pink Midwives for Haiti jeep pulled up, bringing the next new volunteer. Funny how that works...It's constant change around here- constant new names and new faces, starting from scratch and starting at the beginning- yet not. Somehow with the constant ebb and flow of new people coming and going, the program continues and trudges on making progress. It's interesting to sit back and be able to see how so many different, unconnected people, with varying experiences, backgrounds, and motivations, all come together at varying times to support an organization and its cause. Most paths do not cross- as Liz, the RN from Brooklyn, was departing, another volunteer- a chef from Brooklyn, was arriving. As we depart on Saturday, a CNM from Homer, Alaska will be arriving. The never ending story of paths nearly crossing, but not quite. And so goodbyes are said, volunteers return home to city life or suburbia, to go back to work in their busy practices...and life here in Haiti goes on. Carrie walks out to greet the jeep, she says, “Welcome”, she introduces herself, she gives a tour of the house. I wonder how many times she's given the same schpeel, how many times she has said those same words and answered the same questions. Things around here are like a well-oiled machine. It's fascinating how small pieces- individuals each bringing very small pieces of themselves- contribute to making a whole.

We rested up all day yesterday, knowing the demand that the nightshift would bring. At about 6 we ventured on a walk behind the house, as the sun began to lower in the sky. Glen and I walked up one of the hills and then just simply sat together. We sat and stared off onto the endless land below- a picturesque vision of anorexic cows grazing on intermittently green grass, a sprinkling of one room homes made of cement blocks or scrap wood, each with tin roofs, in a valley lined with mountains, under a sky of rolling dark clouds which promised to bring in the evening ritual downpour.

As the sun began to set, various Haitian men and women joined us on the hilltop, some clutching bibles, some not. As the sun receded lower, bringing to close another day of life in Haiti, soft but strong voices began singing- rolling, floating words in Creole surrounded us- the meaning of the words unknown to our ears, but the heart of the purpose translating across cultural and language barriers. I imagine they were thanking God for another day of life...another day in Haiti, and praying for the potential of what another day can bring. Ah, potential. Even in the most dire of circumstances, there is always hope and potential.

Our night at the hospital included no death but only life. We welcomed two new strong Haitian babies- one boy, and one girl.

I have to be honest and say that I do very much enjoy practicing here and being watched by the midwives. The nightshift midwives have been so welcoming and thankful for the help. When someone comes in, they welcome my help and seek me out to ask if I would like to care for the patient. I usually take the lead in a collaborative manner, explaining things as I go, but also taking the time to ask, “What would you do?” Or, “What do you think we should do?” It gives me the opportunity to learn the what and the why behind their practices, but also opens the door for me to say, “This is what I would probably do (and why...).” And we go from there, understanding each other better, and each learning a thing or two.

The first mom in labor last night was a primip who had been stalled at 6cm for several hours but at her last exam at 4pm had finally made change and was 8cm. It was now a little after 8pm (4 hours after she was found to be 8cm). I introduced myself to the mom, asked if I could take her vitals and listen to baby, and then spent some time with her. In the 15 minutes that I sat there, she didn't have one contraction. Situations like this are challenging for me here in Haiti. She obviously has a long, stalled labor. Mom is not having strong, frequent, regular contractions, which you would expect (and need) at 8cm. With the history of an already long, already stalled labor earlier in the day, I found myself pondering what to do next. I know what I would likely do if this were a client of mine at home- but the plethora of tools and options we have at home are just not available here. No breastpump, no herbs, no shower, no food to snack on to fuel mom, no electrolyte drink, and very often times, not even clean drinking water. IV fluids is as good as it gets. Further, Mom was exhausted already from walking the grounds of the hospital all day.

I asked if I could check her and she said yes. I found her to be the same- 8cm, with a head too high to safely rupture her bag of water (hoping that that would get things going again). Hmmm. I asked the midwife what she thought. She says pitocin. Eeek. I hate it, but I think I agree. This mom would likely be a transport to the hospital at home. There was, of course, the option to do nothing and wait. But how long? To what degree do we wait and push it? I talk to mom and she agrees to pitocin. Watching the midwife prepare it scares the crap out of me. She takes 10 units of pit, plunges the needle directly into the plastic IV bag and injects it, and opens the drip, seemingly measuring by eye. Now, this is only my perception. She could have used some mathematical equation to calculate how much pit she injected and what speed the drip should be. But it's unbeknownst to me.

I stare wide-eyed and say, “Since mom is now on pitocin, we need to be diligent with listening to baby to make sure baby is tolerating it.” She nods in complete agreement. It would be nearly impossible to continuously monitor mom with a doppler indefinitely, but I spend the rest of the night never venturing far from mom, very frequently listening. At one point I listen to baby and baby is in the 90's. I ask mom to get on her left side, take nice deep breathes for baby, and we turn off the pit. Baby recovers and we have no more issues. The good news is that mom is now complete and pushing.

The midwife supports the primip, while I triage another mom in labor who just arrived- a mom on her 9^th baby. I welcome her, take her vitals, listen to baby, and then check her...she's 7cm. I encourage her to be upright and/or go walk. In the meantime, I make sure we have another delivery set-up ready to go. She comes back and for some reason one of the midwives tells her to stay on the exam table. When I go back to check on her, Glen is watching Glee out in the corridor and the midwives are nowhere to be found. Perhaps they've gone over to check on the postpartum and antepartum unit. The primip is still pushing. Baby sounds great. The multip is saying she wants to be upright. “Well let's get you up then. You can be in any position you want to be in,” I say to her. Gladias, my translator, reminds me that the midwives don't like this- the floor is dirty. “I know Gladias, I know...” And I smile big at him. “The worst position a birthing mom can be in is on her back. It can be the most painful and least productive.” Gladias hopes to go to medical school. He soaks it in like a sponge.

As the mom is getting off of the table, I slowly get my gloves on. Gladias looks at me and laughs and says, “Oh, you are getting ready...” I say to him, “Of course. You do see the events that are about to transpire, yes?” He understands what is about to happen and smiles.

Mom squats down and her water breaks. I squat down beside her, just in time for her to bear down. I extend my arm and her baby slides out, supported by my hand and the length of my forearm.

“Would you like me to call Dr. Glen,” Gladias asks? Sure, Gladias. I'm thinking a little bit of help up would be nice.

Glen comes in to find mom and I squatting on the floor together, each supporting the baby up to mom's chest. Baby needs a little suction and possibly PPV so we clamp and cut. Baby perks up, mom delivers placenta right there on the floor, and we get mom and baby together on the delivery table. Mom and baby are healthy and mom is happy. It makes me feel good.

Taking baby with mom over to the postpartum unit.

As soon as I can, I go back to the primip to be with her while she pushes. The midwives return and I tell mom that she's doing great but baby is just not coming down, and it would help if she got upright to push. The midwives look at me like I am crazy. We continue pushing for another hour. I go take a break and am slightly frustrated that they seem to have an aversion to pushing in any other position other than on mom's back, on the exam table.

I come back 5 minutes later and when I see the scene, a big smile spreads across me face- The midwives have mom off the table and in a standing squat. Pretty awesome.

We push for another hour like this. This baby is right on the perineum but is not budging. We continue to push, in every position known to midwife-kind. I'm desperately looking around for a birth stool or a something I could turn into a birth stool, but to no avail.

I get two large pads to put under mom and we squat on the floor, then slowly work our way down to the floor to do side-lying. The midwives watch and thankfully, don't say anything about the dirty floor. Yes, it's dirty. But like I've said before...everything else is just as dirty.

After more than 3 hours of hard, active pushing, a healthy baby girl is born over an intact perineum. I make it a point to tell mom that she worked so very hard for this baby and she is so strong. She is obviously proud of herself. She thanks me for helping her. Wow, what a feeling.

Mom wanted to have her leg up. And so my shoulder was the resting spot. ;-)

Gladias and I with the new baby girl. We make a good birth team!

We leave the hospital as the sun is rising, to go home and get ready for church, and begin our Sunday.

Our day of rest could not have begun any better.