day 2

I can hardly function right now. I feel numb. Emotionally retarded or something. Like I can’t feel anything. Void of any emotion. I have this feeling inside of me like there is something huge needing to be processed or felt or thought through – but I just can’t. It’s like having an itch that you can’t scratch. I can’t feel. I’m worried that I won’t be able to feel again. It seems to be my instinctual coping mechanism. Not feeling. And it’s kind of scary. Especially in these circumstances. But the truth is that if I allowed myself to feel everything that I’ve experienced in the hospital, I wouldn’t be able to cope with it. It’s just too much. The sheer magnitude of emotion would be crippling. I delivered a baby today. And I felt nothing. It was just another baby. Out of the 8 or so that I’ve already seen in the last two days. It felt so normal. Like I had been doing it for so long. And there was nothing too extraordinary about it. How awful is that?  I don’t know what’s wrong with me. There are just so many women in the labor ward. It’s awful. There are women sitting, laying, and crawling on the floor around the beds. There are unidentified babies lying on tables needing to be weighed and labeled. There was a dead baby wrapped in a khanga this morning when we arrived. I don’t even know what to do with all of the things that I saw and experienced today. It was sheer insanity. I’m sorry but birth is a terribly horrific process. It’s disgusting and traumatic. Of course there is new life that comes and that is a wonderful thing. But the process of the baby coming seems incredibly unpleasant. It is like a war zone in there. Women screaming in agony all over the place. And all you can really do is run back and forth trying to assist in whatever way you can with what little knowledge you have.

I delivered a placenta and a baby today. I helped with the delivery of a baby and then prepped a dosage of oxytocin in a syringe which I had never done before. Melisa injected the woman with it and then walked me through the process of delivering the placenta. It was crazy. So much blood came pouring out. I massaged her fundus and reached my fingers in to get any clots that had been left behind. I checked the lobes on both the maternal and fetal sides of the placenta. The cord was inserted in a very strange way. I think it was a battledore insertion. The veins were huge and made a maze-like network.

We found ourselves fighting for life more than once this morning. There were 2 or 3 babies that needed resuscitation and it was so frightening. I could hardly keep track of the women that were about to deliver and also the babies that needed extra care.

Around 1:30 pm Melisa took over a delivery and was willing to allow me to do the delivery as she coached me through it. I am in a completely different zone when I’m in the labor room. It’s pure adrenaline and stress for 4/5 hours straight without stopping. I don’t think or feel much of anything. All I can do is focus on one task, one woman at a time. Which is not always easy. Even though it’s a labor ward, there is nothing prepared for when the baby comes. I tried to make myself useful by gathering everything that was needed for the birth as it was happening. I would see a head coming and immediately run to try and find a sterile kidney dish and forceps. I would then rummage through the woman’s belongings on the floor and bring out an extra khanga or two, a razor blade, a large roll of cotton, a syringe, sterile gloves, and the cord clamp.

My first delivery wasn’t exactly what I expected. But I’m very proud of myself. It felt very natural. Almost like it was what I had been created to do. There is only so much that you can do to support the birth of a baby, but it came so naturally to me. I stood on the woman’s right side. I had my sterile gloves on. Right hand held in the air and occasionally checking the status of the baby’s head and doing my best to carefully stretch her vagina so her perineum wouldn’t tear. It was her first baby and so she was very very small. I honestly didn’t know if the baby’s head would ever be able to come out. She was so strong and brave. I did my best to make steady eye contact with her while also keeping an eye on the baby’s descending head. Melisa was there for the first few moments but then Amy came running over from the other side yelling that Tiffany was going to deliver a baby alone and that the head had already come. Melisa quickly ran over and I was left with no other medical professionals in sight. My partner for the day, Liz, stood on the other side of the woman, across from me, and silently observed as I took over the birth. Even though I wasn’t entirely sure of what to do, I felt confident and at peace. Must have been God. I made sure that the mother felt safe and secure by my confidence in her and myself. She actually spoke a bit of English, but I only used Swahili words to coach her. I reminded her to breathe, “hema, hema,” told her that she was doing a good job, “nzuri mama,” and occasionally encouraged her to push: “sukuma, sukuma.” Her body knew what to do. As the head continued to descend bit-by-bit with each push, I did my best to guard the perineum and the upper labia and clitoris with both of my hands. One above and below the baby’s head. I could tell by looking at the perineum that it was on the verge of tearing. I prayed. I’ve been surprised by how many of these women seem to be Christians. Or maybe it’s just in their deepest moment of need and out of sheer desperation that they call on the name of God or Jesus. “Baba Mungu, Yesu Kristo, Bwana Yesu.” In any case, it’s a beautiful thing to hear them say the different names of God in Swahili. The same God that we serve and worship. So as the baby’s head was coming I continued to encourage the mother and hoped that there wouldn’t be a cord around the baby’s neck. I was lucky that there wasn’t. Thank the Lord. I hardly even had time to check though. Once the head was out, the rest of the body followed quite swiftly. I don’t really remember what I did or how it happened. It just did. And my hands sort of took over and seemed to know what to do. I took the baby’s head and pulled it a bit. The whole body came out swiftly and I brought the baby directly on to the mother’s belly and immediately wiped his face off with the khanga. I think someone handed me another khanga that I continued to wipe the baby off with and then I moved him down to where the mother’s feet were. I got someone to find me a clean bulb suction (which is almost impossible to find) and I suctioned the baby’s nostrils and mouth. He was breathing and crying well. I felt very proud of the mother and congratulated her with “hongera” and “nzuri mama.” It was a little boy. Absolutely gorgeous and weighing 2.5kg. I’m not entirely sure what happened after that. I think a nurse came over and delivered the placenta while I checked on the baby. I came back after the placenta had been delivered and the nurse was getting ready to suture a tear. She asked me to do it, and I reminded her that I am only a student and have never done suturing before.

The mother was in good health afterwards and was so pleased to have the whole process done and over with. She insisted on giving me money and slipped 5,000 Tanzanian shillings into my pocket. She asked me to name her son and I felt so much pride as I watched her walk away after surviving such a painful process.