Approached the labor room this morning and knew very quickly that it was going to be “one of those days…” I felt out of place and didn’t really know what to do with myself because there was so much happening all at once. Found out that the group of student nurses that is there this week has to have 20 deliveries, and so—things were even more competitive than usual. Any time I would go over to a woman to start monitoring her, I was quickly reprimanded and told something along the lines of “This is my case madam.” It was chaos. To be quite honest, the doctors here piss me off. Once you’ve made it up the chain of hierarchy, you seem to have the right to sit on your ass for the large majority of your shift, only intervening or becoming involved if there is an emergency or complication. There are dozens of students with no instructor, very little experience and absolutely no guidance. Unless told what to do, most of them just stand there gawking and asking hundreds of really annoying and distracting questions. I hardly have the patience to make it through a day in the newborn room because you are stuck there with at least five nursing students questioning your every move, watching and staring at you, and asking the most ridiculous personal questions. Things such as, where do you live, what year of schooling are you in, how much does a nurse make in Canada, where did you buy your Punjabi, how much did it cost, how much does a flight cost to Australia, do you like Indian food, what is the weather like in Australia, do you like telugu, where does your family live… The questioning is incessant…
Anyways. I was sort of wandering in the labor room, feeling unprepared and unwilling to aggressively force my way in to a delivery. One of the students mentioned that there was a woman in the other delivery room waiting to be sutured. While there are two delivery rooms, most women are kept in the one room where all of the hospital staff is. If a woman ends up in the other room for some reason, she is often neglected because no one has the time to keep walking over to check on her. I went over to check things out and see if maybe I could suture her. I walked in and over to the only delivery table with a woman on it. It was horrific. She had delivered about 40 minutes earlier and was still waiting to have her placenta delivered. There was blood and fluids everywhere. I went back and forth between the rooms consulting Sarah, my instructor, and informing the doctors of the situation asking who had been responsible for the delivery. When I went over again, I watched as the daima (hospital cleaning lady) finished delivering the placenta… What?? I knew from the second I saw this woman that she was of lower-caste. She had darker skin and I wonder if she was isolated or kept in another room out of some kind of discriminatory motivation. Everyone interacted with her was as if she was untouchable and disgusting. She had been left there, lying in her own fluids and given no attention or care, during a stage of labor that is incredibly risky and dangerous. I put on a pair of sterile gloves and proceeded to check for clots, retained fragments and/or the presence of any tears. The first thing I noticed was a long piece of what I assumed to be a retained lobe of placenta coming out of her. It would have to be manually removed. I went back over to report the situation to Sarah and to ask for help in dealing with the situation. As she assessed her condition, we were both equally as baffled on what this piece of tissue could be. After pulling on it a bit and trying to find its starting point by going up into her uterus, we started to wonder if it could be a piece of her cervix. We decided to ask for the consultation of one of the doctors and asked them to do the suturing because she also had a second-degree tear.
When I went back over to the other side there were three deliveries that took place within minutes of each other. I didn’t know where to place myself within the hoards of crowded students fighting over who would do what. I think I carried a couple of the babies over to the newborn room. Poor things sliding around naked and cold in a metal dish for the first minutes of their fragile lives. After getting myself together, I decided to stay with one woman and monitored her for about an hour before leaving to go to lunch. Rajitha, primigravida, 25 years old. She spoke a little bit of English and with the help of one of the students as translator I was able to communicate quite well with her. I left and hoped that I wouldn’t miss the delivery while I was away.
Throughout the day I continued to check on the woman on the other side who was still waiting to be seen. I felt awful, guilty, and responsible for her situation and the lack of care that she was receiving since I was the one who had noticed her and notified the doctors. I wish I could have done the suturing myself, but with a cervix frayed and torn like that, there was just no way. I reminded the doctors, who didn’t seem to be too busy because they were all sitting on the bench, at least three times, but to no avail. She was moved to the main labor room around 2pm, four hours post delivery, and she continued to wait there without ever being checked or noticed until 5pm. Doctors and nurses walked past her over and over again without even a glance. Once they did check her, it was confirmed that the mysterious flap of tissue was indeed cervix.. I cringed when I found out. And to think that I had pulled on it thinking it was a retained clot or piece of placenta. Dear Lord… How awful. She was then made to wait for an additional hour or so for the head madam to suture because her cervix was so destroyed. I still feel so terrible over the way she was treated and completely neglected.
Anyways. Rajitha, the woman I had stayed with to monitor was not progressing in her labor. The baby was showing signs of distress and things quickly went downhill after about an hour of pushing. The doctors came over, cut a 4-5 cm episiotomy and extracted the baby with forceps. She was a very small lady with a very big baby… What I thought was going to be a normal delivery, quickly turned into a complicated and traumatic birth experience for a first time mother. Poor woman. She was incredibly grateful when it was all over. She explained, with the help of a translator, that on this same day last year she had been married. I was amazed by her joy and thankfulness after having endured such a painful process. Baby needed some suctioning and resuscitation, but he ended up being okay. She was so pleased to have a son. Sarah then coached me through the timely process of suturing her. Second-degree, but right down to her anus and two separate tears on the inside extending high into the vagina. I did twenty-four stitches in total. (Not including the cervical repair that was done by the doctor). That has got to be some kind of a record. It took just over an hour I think… she was incredibly compliant and strong. In the meantime, right behind us there was a group of student nurses delivering premature stillborn twins. Oh, and did I forget to mention that the woman right beside had a forceps delivery as well? And across from that was a viciously non-compliant woman (how can I blame her?) with a retained placenta that came out in pieces. Yeah… A little bit much for one day.
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