Mwaka Mpya mtoto

Temeke – Dec 31^st/2010

New Years Eve Baby

I spent the last day of 2010 back in Temeke’s labor ward. This time we went with three additional people. The 3 new staff has arrived for the second half of the school and our current staff was helping to orient them to the hospital. I didn’t quite understand that we were all going to actually work together. For some reason I thought we were just going to show them around. Anyways, it was a bit overwhelming being there at first with so many people coming and going each hour. Quite a few laboring women. Almost every bed was occupied. Rachel and I partnered together. We were with one woman for probably an hour or so. 30 years old, her third child. She had been admitted to the hospital four days earlier and I started to wonder if she might have obstructed labor. An hour or two later a laboring woman was brought in and put on one of the recovery beds as there were no more beds/tables left in the labor ward. I was called over and began the painful and long process of helping this incredibly exhausted, pre-eclamptic woman birth her first child.  I felt afraid, concerned and uncertain… I knew nothing about this woman’s obstetric history, no clue what the progression of her labor had been like, and had yet to discover her name. All I knew is that I was there to bring the peace and to assure this woman by my confidence in her and myself that everything was going to be okay. It was my third delivery and I was very aware of everything that was going on at each moment. To me this was a sign that I have now adjusted to the environment of the labor ward and am feeling quite confident in my skills as a midwife. Things were chaotic, but I was focused solely on the woman and the baby whose head was slowly but steadily descending and putting increasing pressure on its mother’s very tight perineum. At some point I was informed that she was a primigravida. This was her first pregnancy and delivery. There were people coming and going. I was aware of the presence of at least four others around the mother and me. Rather than being irritated by the chaos and questioning, I was surprisingly calm. Adrenaline rushed through my veins – my shaky hands were evidence of that – and all I could do was focus on this mother, Mariam, who needed a great deal of coaching and assistance. It was by far the most challenging delivery I have been a part of. Rachel was there as my support person. Initially I had Sarah as my staff who was talking me through it but at some point she had to leave and Marchien took over. It was my first time working with either one of them. The woman, Mariam was not in a good condition. She was exhausted, covered in sweat, and barely alert. She would fight to sit up and then she would put all of her weight on me. We would encourage her to lay back down but at the same time I knew it was far better for the progression of her labor and the baby’s descent for her to be in the sitting or squatting position. The hospital staff passed by a few times, yelling and scolding the woman for not being on her back. It’s mainly for our convenience that they are forced to be flat on their backs while delivering. Because it was her first, and she was terribly exhausted, she was not successful in her attempts to push. She would grunt and moan and hold her breath for a few seconds and then collapse in disappointment. Rachel and I really had to fight with her to cooperate. She kept swinging her head back and we needed her to tuck her chin to her chest and bear down. I noticed that her eyes kept rolling back into her head and at one point she did have a minor seizure. The lingering doctors and nurses confirmed that these were signs of eclampsia. A surge of anxiety and fear rushed through me as the situation became more serious and urgent. I got a bit stern with the mum at that point. “Mama! Sukuma! Sukuma! Kichua hapa!” Push, push, head here, as Rachel and I motioned and tried to explain that she needed to have her head down when she pushed. She was so exhausted that I wondered if it would even be possible for her to push that baby out. Marchien’s voice was a source of reassurance right beside me the whole time, guiding and directing me each step of the way. I was determined not to have this woman tear. My third time delivering a primi woman so I was used to the slow descent of the head and the apparent impossibility for the baby’s head to fit through such a tight and small opening. After a lot of grunting, pushing, moving, fighting, stretching, supporting, and holding down, the baby’s head finally came. The hardest part was over and I felt a surge of relief and excitement. “We can do this,” I thought. Not long after, I gently pulled the remainder of the tiny body out from the mother. A boy! “Hongera! Umepata wakiume!” (Congratulations, you have a son). She was mostly glad to have the process over with I think. I safely delivered her placenta and was delighted to discover that she had no tears! Thank you Lord! I had prayed and prayed as well as done quite a bit of stretching of her perineum. I was so proud of the mother as well as myself. By the end of it I was completely drenched in sweat. It is always an honor for me to be with the woman from start to finish of the delivery. I especially enjoy being able to clean her up and help her get dressed afterwards. Rachel took the baby away to dry him off, weigh him and do all of the necessary checks on him while I completed the process of taking care of the mum. A 20-year-old woman who successfully delivered a healthy little boy. Pure joy, relief and pride were all I felt after it was all over. The last baby of 2010.

On a side note: Back in October when we were still waiting to have our work permits approved and I was becoming increasingly eager to deliver a baby and be working in the hospital, I would read posts from a girl named Fia’s blog. She did her BAS last year and was also working at Temeke hospital. I love the way that she writes and now that I’ve been working in the same environment, I find that her words ring so true and she is able to put words to feelings that I am often unable to.

Here’s what she wrote:

“I then realized yet another reason why the labour room is a special place.

We get to see women with their heads uncovered, before they put on their veils and become a shapeless figure out on the street.

The labour room is a place full of rawness, transparency, trust, and where guards are let down.
A place of intensity,
vulnerability,
and nakedness.

Where it is safe to show your shoulders and reveal that which has been covered.

What a privilege, what holy ground,
to be in the place where
the veil comes off,
all is known,

and new life comes into the world.”

I have found that I deeply love and enjoy delivering babies. It is such an intense rush of emotions. I find myself going through the same emotions that the woman who’s baby I’m delivering is experiencing. That’s why the labor room is such a passionate and intense environment to be in. There are so many emotions floating around in the same room that you hardly know which thing to feel first. Over the course of a four-hour day I go through every possible emotion that it’s difficult to keep up and to process them all. One moment you are fearing for the life of a mother or her unborn child and the next moment you are rejoicing over the successful delivery of a healthy baby and overjoyed at the presence of a fresh new life – a life that you were able to bring in to the world and be the very first hands placed on it’s body, the very first voice that it hears –welcoming he or she into the world in the name of Jesus. What an extraordinary privilege!

mariam