ramana.

Labor room was extra slow this morning. Jenny and I were partnered together as usual and we got to monitoring women. Can I just mention how much I love this woman? She and her husband have become my very close friends and I don’t know that I would have made it through this school without them. They are an incredible example to me of what it means to be in a godly partnership, serving the world together. Amazing, amazing people who I will remain friends with throughout my life.

Anyways. There were maybe three laboring women in the room and the usual dozens of nursing students. We started to monitor one woman who was taken to theatre for c/s shortly thereafter. The next woman we monitored was the same story. It got to be a bit frustrating after the first couple of times. We spent the next few minutes standing and observing not really sure what to do with ourselves considering the lack of patients. Spent a couple of hours with a 20-year-old woman who was brought in. First pregnancy and her labor seemed to be progressing normally, surprisingly, without any administration of oxytocic drugs or other medical interventions… a rare occurrence at GMH where they immediately hook the woman up to fluids with syntocin, give epidocin to ripen the cervix when needed, and are quick to cut an episiotomy.

We took a quick break for lunch which is where we came across the husband of a patient that Jenny had cared for the day before. An incredibly kind and gracious man, he was endlessly grateful for the excellent care and love that Jenny had given to his wife. A shocking yet refreshing occurrence to come across a man so gentle and loving who obviously cared deeply for his wife and children. He followed us in to the canteen where he bought all of us (Jenny and I along with three other girls from our school) samosas and fresh juice. I wasn’t involved in his wife’s delivery the day before, but felt incredibly blessed by his generosity and gratitude. Jenny got his phone number and we went upstairs to visit his wife and her newborn son before they were discharged. The father was so proud of his children and showed us a picture of his first son. A beautiful and well-loved boy. He said over and over again that he would wait for our call and that he would come to pick us up from wherever we lived and make all of the arrangements saying, “We will have a small party.” That experience alone was enough to get me through the rest of the day… No, the rest of the week! 

When we arrived back in the labor room, the woman we had been taking care of, Ramana, was getting close to delivering. After some uncomfortable conflict between my staff and a student who wanted to claim the delivery, we agreed to work together. She pushed and pushed with very little progress. Why are the women here so tiny!? I reluctantly prepared to give an episiotomy. An awful procedure when you only have dull scissors. Sometimes I think it would be better to have a blade like they did at Temeke to saw through the perineal flesh. At least it would get the process over with faster. Ugh. I waited for her to give a good push and got my fingers in to hold out the skin while I injected lignocaine to numb the area. On the next push, while her perineum was well stretched, the fetal head well applied, I got my scissors in and started to cut. There are few things that I hate more than having to do this. I think I must visibly cringe each and every time while I am imagining in my mind and body what it must feel like to have someone cut that part of my body. I didn’t want to cut more than a couple of cms but Rachel kept encouraging me to cut more. I was literally hacking away at this woman’s flesh with very little success while she cried out in pain. I made it through what I thought was about 3-4cm but when I came out I realized that it had only really gone through the top layer of flesh. At that point, it was a matter of life and death for the baby whose heart rate was low. I went in again to cut and it still wasn’t enough. Rach went in a third time and extended it to provide adequate space for the baby’s head to finally be expelled. Once the head was out I realized there was a cord around the neck. Here, unlike at Temeke where they slip the cord over the shoulder most of the time, they immediately clamp and cut the cord before the body has delivered. I had never done this before but I quickly reached for the clamps and secured them closely together while the student cut in-between. We unwrapped the cord and pulled the remainder of the body out while the mother gave one final push. A boy! He was a bit blue, had poor flexion and muscle reflex and didn’t cry right away. I cleared his airways with the bulb suction while steadily rubbing his back to stimulate him to cry. He was still a bit limp, but let out a good sounding cry before I had the mother verify the sex and placed him in the tray to be carried to the newborn room.

It’s always a bit disappointing to have to cut the cord so soon. In an ideal world with a normal delivery, we would keep the baby attached until the cord has stopped pulsating and the placenta has detached. Ah yes. In an ideal world… Baby would receive plenty of oxygen from the blood still flowing through the placenta while staying warm on the mother’s abdomen. Nope. Not in these hospitals… Probably not in most hospitals actually!

Anyways. After the placenta was safely delivered, I took on the daunting task of teaching my student friend (wish I could remember her name) how to suture. She had only ever done it once before. Terrifying? Yeah. But kind of exciting and fun at the same time. Really enjoy suturing. It was disastrous at first but she steadily improved as time went on. It was a quite the tear. We put in about 13/14 stitches. 

Nathan.

Ramana.