Pushing through fear ...

So, since that last crazy post, things have been up and down around here. Some folks left on Saturday, so it has only been myself and another midwife, Tania, to do births and pediatric clinic yesterday. Thankfully, another midwife arrived from Oregon today, another will arrive tomorrow and another on Thursday.

The weekend started out magically with our participation in a vodoo ceremony with an Mambo, vodoo elder, who is a family member of one of the guys who works on the building/gardening end of things. I danced my heart out, which was exactly the healing I needed. Although, evidently not enough, I guess. Or maybe it was the strength I needed to carry on...

Saturday morning saw me running up the hill to the dome, early on my own. The women, who was about to birth her 7th baby, was practically pushing as I walked in. Enough time to set up the equipment, and call the other midwife, but not enough time for her to get there! The baby came out with tons of meconium, the cord wrapped 3xs around his neck and wasn't super keen on breathing. He came around slowly, as his mama started to bleed. I of course, being alone, panicked. It sucked. As I am sure it is with everyone, something crazy happens in your work and you find yourself triggered over and over again. While the bleeding may have not been that bad (only about 700ml at this point), all I could think about was the last mama. I pulled too hard on the cord ... and yes, it broke (never happened to me before, never want it to happen again!). There I was, with my hand inside, trying to release a placenta again. Only this time, it didn't come. I tried over and over again, but it was different than the last time, it was adherent at the front and I couldn't release it. We decided to transfer to the hospital (not far, but the problem is a vehicle, because the one Bumi Sehat has is unreliable and is currently not working). Luckily the local funneral home car was available and before long I was in the back of a pickup truck, holding this women's uterus both inside and out. My arms are still sore, because it took about 45 minutes of squeezing with all my might before we were with an MSF obstetrician at the local hospital. I was shoeless, had blood up to my elbows and all over my legs and I was scared. They looked at me like I was crazy and asked if I always went without shoes ... I had my hand inside a woman who was bleeding, I wasn't thinking about my shoes! Anyways, the story turned out better than the last one, the OB was able to evacuate the last bit of placenta, but she had to work hard and she still thought there were membranes inside. The woman didn't bleed nearly as much as the last one, likely only another 500 - 700ml, and is now on antibiotics.

The best part for me was that she came, excitedly, to see me yesterday at pediatric clinic. She was happy to see me, which seemed somehow shocking, since I felt so awful about the birth. Her baby, of course, had spiked a temp, so he too is now on antibiotics. There is no testing for GBS here, a common bacteria that lives in woman's vaginas that is bengin to us/them, but can be deadly to babies. So whenever a baby spikes a temp in the first few days, antibiotics it is. And temps here are hard, because it is SO HOT, between 30 - 40 degrees at all times, but always hotter in the dome. We are constantly seeing babies with heat rashes and high temps, overheated from being wrapped up too much, so its a clinical judgement call if a baby is overheated or actually has a fever.

Sunday was quiet, if there is such a thing, spent organizing supplies, sterilizing instruments and, ugh, falling out of the hammock (sore butt!). And then just as I was about to sit down to dinner, the phone wrang. Up I went again to the dome and spent the night, with a very malnourished woman trying to birth her 3rd baby. She had been measuring small ever since we had met her at 26wks and we have been pumping her with protein powder at each visit, hoping she would be able to grow a healthy baby. In the end, baby was 2500g, which isn't that bad. But she was scared (terrified, bulging eye terrified) of something and wouldn't look me in the eye during the whole birth until I actually had to get into her face and tell her to push her baby out (it was right there, but it wasn't coming if she didn't push and we were up ALL NIGHT together). Once baby was born, she couldn't let go of her placenta, but luckily she didn't bleed much and Tania, the other midwife, kept reminding me everything was normal (thanks Tania!). Finally, again, she needed deep prompting to push out the placenta. I can only imagine the horrors that she must have lived, at some part of her life, for her to experience the birth of her 3rd child like that (she had the last 2 at home, by herself, her even coming to the clinic felt like a call for help, but I couldn't put my finger on what that was, besides the nutrition aspect). After being up all night, I did a full day of pediatric clinic. Some of the skin things that kids have here are horrific and we don't always have remedies, but we do our best. Saw alot of babies I and other Bumi Sehat midwives had caught, which is always fun. Scared one toddler out of trying anything I had to offer (kids vitamins that taste like candy, ymmy orange pedialite for diarrhea and anti-worm meds dissolved in above mentioned pedialite ... her mom took all the same to do at home, away from the scary 'blanc'.

And then, finally, to sleep, like a log throughout the night! The best part about waking up this morning was that my feet decided to catch up with the climate, and are no longer swollen. Day 12 and I am not walking awkwardly on puffy watermelons anymore. Over and out, from Jacmel.


12 days of adventures in babycatching ...