The title of this post describes me...a little crispy, but not quite burnt! I did another 48 hour stint at the clinic so last night I had to get home to sleep. It was so hard to pull away with 4 mamas in labor at about 8pm last night. My right lower back was so tweaked from hunching over 2 difficult perineal repairs yesterday, it is a little sad to be sore from doing births! My exercise has been squatting with the mamas to show them what to do or to get down on their level, holding mamas up and bending over tubs. Not exactly the same as a hike or trip to the gym. I was more emotionally drained than physically tired last night. We have had quite a few transports and some difficult births that have really been testing me. I am looking forward to just sitting down with Matt and some friends and just debriefing on everything I have experienced here. I don't have time to process the intense moments because I am just on to the next thing immediately. Speaking of the hospital, here is a pic of the nurses at the maternity ward desk...I couldn't really get any good pics of the hospital, regretfully.
Today I will go do a home visit on a couple who just had their baby 2 days ago. We resuscitated their baby and usually first time parents stay 2 nights, repeat parents only stay one. The father wanted to be released because it was a special ceremony night the next night so he convinced the local midwives to let him go early. Not such a big deal if the baby hadn't been resuscitated! He needed to be observed. We called them and checked on them and they are doing fine, however I will go with my friend and co-worker Ayu who will translate for me to check on the mama/baby. We had a pretty intense night the other night with this resuscitation. It was a strange course of events and I think it would be educational to hear about for many of you. This mama came to us in very light labor saying that her water had broken. A few hours later, no real changes. The protocol here is that the mama needs to be in active labor 12 hours (preferably she would give birth by the 12 hr mark) after rupture or, left to the local midwives, she will be taken to the hospital. So, she hung out all afternoon, still nothing. One of the local midwives checked her again, her membranes were in tact! Her water had not broken, great! At this point her labor was virtually non-existent. I thought, let her sleep here and if nothing is happening in the a.m. we will send her home. Her due date was in 3 weeks so it may not even be time yet! But no, for some reason, the local midwives and Robin gave her castor oil to get her labor going that morning and burned moxabustion over points on her feet. Moxa is a chinese herb that is burned over certain accupuncture points in order to get certain results, in this case it was to stimulate labor. So there I was, not quite sure why we were trying so hard to get labor going, but I went along with their call. She was in light labor and then I think the castor oil kicked in in the afternoon, she was making frequent trips to the potty to poop (a normal result of castor oil) and contractions were light but consistent. In a couple more hours something shifted and she was pretty much getting solid contractions with very little break in between. The uterus needs to be in a good pattern of contract/relax in order to keep the baby from getting overworked from constant contractions. Also, constant contractions are very exhausting for the mom. The baby began to stress, we had some very low decelerations in the baby's heart rate so we put the mama on oxygen. That seemed to help temporarily, but the decels came back. Fortunately, the baby was about to be born. Anticipating a problem I readied the resuscitation equipment. I believe the stress resulted from an "overdose" of castor oil that created an overactive labor that was too stressful for the baby. Good lesson: even natural methods of induction can be too hard on the baby. In addition the mom passed out during labor...that's right, just decided to go out cold for no apparent reason. She wasn't even exhausted or dehydrated. A passed out mom who was low b.p., low respirations and low pulse means insufficient blood flow for the baby, another cause of stress.
Side Note: I have never seen women go so far away from their bodies in labor until I came here.
The women here get really spacey and lethargic during labor. It is very hard to get them to walk or change positions during labor, they want to lie down the whole time. Lying down during labor makes labor longer and is bad for circulation for mama and baby. Also, we don't get gravity to help us out! When a mama doesn't move, neither does the baby and this can result in a poor position or presenting part for the baby.
Am I boring you yet? To try to wrap it up here...the baby couldn't clear the fluid from his own lungs so we suctioned and assisted respirations and now all is well. I got to visit the family in their home today and I am happy to say that everyone is doing well! Here is a picture of my visit
I know the family really looks thrilled:) but they never smile for pics here. Maybe that goes without saying, cameras are a pretty expensive luxury.
Here is a lovely picture of some of the offerings that are made for ceremony, and ceremony happens a lot here. I include this picture here because the above family took their newborn baby out of clinic care in order to have the mama/baby pair at home for this particular ceremony day. They are a particularly devout young couple. "It just wouldn't be right", he said, about not having the mama/baby home.
I thought this was a really nice pic of the placenta and how we treat it. I think I mentioned that we wait to cut the cord until 3 hours postpartum and cover it in flowers as soon as it is born. A nice tradition don't you think? One papa last night wanted to make sure he could take the placenta home for ceremony. Of course, we said. Apparently, the placenta is placed on a certain side of the family compound according to whether the baby is a girl or a boy, burned and buried with a pencil (so that the baby will be clever) and a few other things I can't remember:)
That is all for now...too tired. Need to go lie down now, I am on call tonight here at the clinic. Only one mama here, so maybe it will be quiet? Only about 2 more days here! See you all soon...
Today I will go do a home visit on a couple who just had their baby 2 days ago. We resuscitated their baby and usually first time parents stay 2 nights, repeat parents only stay one. The father wanted to be released because it was a special ceremony night the next night so he convinced the local midwives to let him go early. Not such a big deal if the baby hadn't been resuscitated! He needed to be observed. We called them and checked on them and they are doing fine, however I will go with my friend and co-worker Ayu who will translate for me to check on the mama/baby. We had a pretty intense night the other night with this resuscitation. It was a strange course of events and I think it would be educational to hear about for many of you. This mama came to us in very light labor saying that her water had broken. A few hours later, no real changes. The protocol here is that the mama needs to be in active labor 12 hours (preferably she would give birth by the 12 hr mark) after rupture or, left to the local midwives, she will be taken to the hospital. So, she hung out all afternoon, still nothing. One of the local midwives checked her again, her membranes were in tact! Her water had not broken, great! At this point her labor was virtually non-existent. I thought, let her sleep here and if nothing is happening in the a.m. we will send her home. Her due date was in 3 weeks so it may not even be time yet! But no, for some reason, the local midwives and Robin gave her castor oil to get her labor going that morning and burned moxabustion over points on her feet. Moxa is a chinese herb that is burned over certain accupuncture points in order to get certain results, in this case it was to stimulate labor. So there I was, not quite sure why we were trying so hard to get labor going, but I went along with their call. She was in light labor and then I think the castor oil kicked in in the afternoon, she was making frequent trips to the potty to poop (a normal result of castor oil) and contractions were light but consistent. In a couple more hours something shifted and she was pretty much getting solid contractions with very little break in between. The uterus needs to be in a good pattern of contract/relax in order to keep the baby from getting overworked from constant contractions. Also, constant contractions are very exhausting for the mom. The baby began to stress, we had some very low decelerations in the baby's heart rate so we put the mama on oxygen. That seemed to help temporarily, but the decels came back. Fortunately, the baby was about to be born. Anticipating a problem I readied the resuscitation equipment. I believe the stress resulted from an "overdose" of castor oil that created an overactive labor that was too stressful for the baby. Good lesson: even natural methods of induction can be too hard on the baby. In addition the mom passed out during labor...that's right, just decided to go out cold for no apparent reason. She wasn't even exhausted or dehydrated. A passed out mom who was low b.p., low respirations and low pulse means insufficient blood flow for the baby, another cause of stress.
Side Note: I have never seen women go so far away from their bodies in labor until I came here.
The women here get really spacey and lethargic during labor. It is very hard to get them to walk or change positions during labor, they want to lie down the whole time. Lying down during labor makes labor longer and is bad for circulation for mama and baby. Also, we don't get gravity to help us out! When a mama doesn't move, neither does the baby and this can result in a poor position or presenting part for the baby.
Am I boring you yet? To try to wrap it up here...the baby couldn't clear the fluid from his own lungs so we suctioned and assisted respirations and now all is well. I got to visit the family in their home today and I am happy to say that everyone is doing well! Here is a picture of my visit
I know the family really looks thrilled:) but they never smile for pics here. Maybe that goes without saying, cameras are a pretty expensive luxury.Here is a lovely picture of some of the offerings that are made for ceremony, and ceremony happens a lot here. I include this picture here because the above family took their newborn baby out of clinic care in order to have the mama/baby pair at home for this particular ceremony day. They are a particularly devout young couple. "It just wouldn't be right", he said, about not having the mama/baby home.
I thought this was a really nice pic of the placenta and how we treat it. I think I mentioned that we wait to cut the cord until 3 hours postpartum and cover it in flowers as soon as it is born. A nice tradition don't you think? One papa last night wanted to make sure he could take the placenta home for ceremony. Of course, we said. Apparently, the placenta is placed on a certain side of the family compound according to whether the baby is a girl or a boy, burned and buried with a pencil (so that the baby will be clever) and a few other things I can't remember:)
That is all for now...too tired. Need to go lie down now, I am on call tonight here at the clinic. Only one mama here, so maybe it will be quiet? Only about 2 more days here! See you all soon...
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