uzima.: Not one, but two!

Okay I take it back. Today was the greatest day ever! :)

We arrived at GMH with only three of us because the others had stayed back to wait for Jenny. Walked in to the labor room where Rachel was frantically looking around for a catheter. There was a patient with a visibly full bladder –a major obstruction to the progression of her labor. Once we found what we needed, I catheterized her and emptied 800-900ml of urine from her bladder. Holy crap! Since that had been our first priority, I hadn’t even found out her name or obstetrical history. After greeting her, I pulled back her petty coat to reveal a massive belly. Either this was a huge baby, or twins! Rach looked at the mom and said, “Twins?” She nodded her head and said, “Yes, twins.” She spoke a bit of English and was remarkably calm and relaxed considering the fact that she would have to push out not one, but TWO babies! My goodness. Her name was Haseena and this was her second pregnancy. Like most Indian women she was tiny, petite and quite skinny. But her general health seemed to be good. She was obviously drinking enough water!

Anyways. I got to monitoring her right away, giddy with excitement over the possibility of delivering twins! Her babies were so active. Any time I would touch her abdomen to try and find their heart sounds, they would move all over the place… a foot here, an elbow there. They especially didn’t like the Doppler. Both fetal hearts were strong and normal. Based on the position at which I found them, it seemed like both babies could be cephalic. Amazing! Most of the births I’ve participated in in India have been quite traumatic so I was hoping and praying for a normal and safe delivery of healthy twins. I did lots and lots of praying over Haseena and those babies. I’ve never seen a woman so calm and strong throughout each contraction. I couldn’t even tell when she was having them because she didn’t even flinch… no screaming, no groaning or grunting or panting. Once she decided she was ready to push the first baby out, she gave amazing, strong pushes with visible advancement each time. First baby was in the right position and still had a steady heartbeat. Nothing to worry about just yet! Within ten minutes she had that baby out no problem. A boy! The most amazing part was that she had absolutely no tearing. Perineum intact! He started crying instantly and we gave him an APGAR score of 10 at 1 minute. Thank you Jesus! A textbook delivery. As they took him away I got the names Benjamin and Joseph for the two babies. I didn’t know what the sex of the second baby would be, but the mom was hoping for a girl since her firstborn was a boy. We would just have to wait and see! Baby Benjamin, born at 12:14pm, weighing 2.5kg.

I went in to check for the position of the second twin… Baby was still surrounded by the amniotic sac and was coming cephalic or head first. Hooray!! A doctor came and ruptured the membranes and we catheterized her again since her bladder had already filled. We continued to monitor her and made sure there were no signs of fetal distress. Haseena took her time in pushing and was in no rush to get that second baby out. She was a champion. I really didn’t have to do much. Lindsay was there with me the whole time recording all of the information I would need for my paperwork.

It had been almost an hour since the first twin, and the second baby’s head wasn’t descending. We were a bit concerned because the heart was slowing. It was time to push. And push she did. It was obvious that the second baby was bigger because she had a bit more difficulty getting the head out. Once the head came I checked for a cord around the neck. Nothing. The rest of the body came in one or two pushes. Another boy! He cried instantly and we gave him perfect APGAR scores at one and five minutes. Incredible! Joseph, second twin born at 1:10pm, weighing 2.9kg.

Mom was still calm and seemed perfectly fine. We gave the syntocin and waited to see the signs of separation for her placenta. The umbilical cords were so healthy looking! Thick, blue, and strong. Her placenta delivered about 10 minutes after the second baby had come. It took some strong pulling to get it out since it had been supplying life for two babies. That’s when I made a mistake. After the placenta was out, I didn’t spend enough time twisting to make sure that the trailing membranes wouldn’t tear and be left behind or retained. This is what causes post partum hemorrhage for so many women… I pulled it out too soon, and sure enough, there were retained fragments of membranes and she bled profusely. We immediately called the doctor over who performed manual removal while firmly massaging the uterus. We gave misoprotyl tablets rectally, an injection of prostaglandins, and added more syntocin to her drip, all to help her uterus clamp down and control the bleeding. I felt awful. There is always a higher risk of hemorrhaging with twins so I should have taken extra precautions. Including the clots I expelled later on, she lost about 600ml of blood. Substantial. Excessive. She was all right though. Thank the Lord. Two healthy babies with an incredibly resilient and strong mother. PERINEUM INTACT!

Spent the remainder of the afternoon in the newborn room. Six babies came all within an hour, one right after the other. No cloths, no cotton, nothing to clean or dry them with. Talk about frustrating… There were two or three of them all lined up in their metal trays, rapidly losing precious body heat. Anyways. It was a busy, yet exciting day. Delivering twins was by far the greatest moment of my life! So far anyway :) Pure bliss. A dream come true.