Sunday, March 1, 2009

Ruby.

Greetings! Well, since we last chatted, I had the privilege of catching two babies!

First, Friday's day shift had me trying new things....Beverly came to Mercy shortly after 7 am and I was up to be her midwife. This was her second baby, so we were pretty certain she would go fast. Relatively healthy throughout her prenatals, all her vital signs were good upon admission. I did an internal exam - 6 cm dilated and very active.

Meanwhile, I had 4 continuities show for prenatals....first Irish, now almost 30 weeks, then Bel at 37 weeks (almost time!!), Ruby at 40 weeks (in mild early labor...so excited), and then Genelyn at 34 weeks. So in between Beverly bearing down, prenatals were had and two more labors walked in for my two classmates....getting busy.

Then in the middle of my prenatal exam on Irish, Beverly wanted to push. A few pushes and the baby's head was visible....a few more and baby's head was out - super healthy baby girl named Fatima was born at 8:17 am. Beautiful birth. Peaceful. In between postpartum checks, I did the rest of the prenatal exams and set up for suturing. Yes, I experienced my first time suturing. Just two slight first degree tears, but they needed some help closing, so that was my job. Except, my patient was unable to pee before suturing....and her bladder was excessively full...thus she was bleeding a bit....so before suturing, I had to insert a catheter to drain her bladder and then get started suturing. Birth is messy, to say the least. Suturing was awful and I hated every minute of it, but I realize it is a good skill to have and so I will persevere and suture when need be, but for the meantime, I will do everything in my power as a midwife to make sure my patients have little or no tears! OUCH! Baby Fatima was awesome, but I had to endorse Beverly at 2 pm to another midwife to insert another catheter...this time an indwelling catheter. I am pretty certain Beverly had an undiagnosed urinary tract infection making it almost impossible for her to pee. But from what I hear, she is doing great. I get to see her tomorrow for her first baby check.

Then there was Saturday. My dear, dear continuity, Ruby, texted my around noon stating that she was having a lot of pain and thought that the baby was coming soon, but that she could not meet me at MMC because she had no childcare and her bana was not home yet. Uh-oh. I warned her of the dangers of staying home and encouraged her to come into Mercy as soon as she could. I raced to the clinic just in case.

I waited almost two hours for her, praying that I wouldn't hear the honking of a taxi stating that she'd given birth in the taxi on the ride over....this being her fourth baby, I was a little concerned that she would wait too long to come in.

Fortunately, she came in around 2 pm looking mildly active, but still smiling her beautiful toothless smile.....so excited to be in labor finally, but still focused during contractions. I did an internal exam to find that she was only 5-6 cm dilated and still without her bana. So we waited, labored together, walked, ate a few eggs together, and when her bana arrived around 6pm, she began to get more active. More pain, more bloody show, not smiling near as much. By 9 pm, she was tired. She had been rolling on the birth ball with her hubby and I rubbing her back and encouraging her to continue. At 9:30 pm, myself tired, I did another internal exam. Only 7-8 cm dilated. This labor was taking a long time, especially considering this was her fourth baby and her last baby was only 1 1/2 years ago!

In the midst of her labor, her bana asked, "Ruby, what will we name the baby if it's a boy?" Ruby looked at me and said, "What is the name of your bana?" (she had met Tim earlier when he brought Promise for a feed). I told her and she reassuringly told her bana it would be "Timothy". I was blessed and texted Tim telling him he might have a Filipino namesake soon.

Within about 15 minutes, Ruby began to cry. Just a quiet weeping...transition. Tired, worn and wanting to meet her baby, she released her stress with her bana, Jerson, holding her hands and looking into her eyes. To be honest, their relationship in labor was so very peaceful, supportive, sacred. Though they are not married, they labored together better than many married couples I have seen. This is their third baby together and he was so very present in the moment for this baby.

Around 11 pm, Ruby began to bear down. Quietly, she pushed lying on the bed. The baby's head was still quite high and her pushes were not yeilding the results she was hoping for. A slight trickle of blood showed there was progress, but it was slow and her legs were beginning to cramp in the position. I gently asked her if she wanted to change positions...she quickly said no stating she was tired and wanted to lay down. After a few more pushes, I asked her again...she said no...but this baby wasn't coming past her pubic bone. She needed to sit up.

I looked in her eyes and said, "Ruby, you need to stand up. Your baby needs more room to get out....you need to stand up now." She shot me a look like, "What...are you nuts!?" My supervisor, Carmen, and I got her up on her feet relying on her bana for support and within 15 seconds, she says, "B! Baby's coming!! NOW!" She rolled right back on to the bed and the baby's head was coming out! Just like that! One change of position and that baby came down so fast!

Ruby gently pushed her baby's head out with such control. No tear. But a nuchal cord ....around the neck...around the body....baby blue....one big push and baby came followed by a fountain and river of amniotic fluid, blood and meconium....ALL OVER ME...AND THE FLOOR...AND THE BED.....AND MY ASSISTANT. What a mess! :) Covered in birth goo, I dried off this precious new baby girl and placed her on Ruby's tummy....baby girl named Bethany after her midwife. I cried. So did Ruby. Healthy baby.

Then things got very complicated. Ruby's placenta came looking like it had been beat to a pulp. It was black and full of dead portions, calcifications, and was missing the amnion. For those of you who don't know, the placenta has two layers of membranes, the amnion and the chorion. This inner and outer layer of membranes serves to protect the baby and is connected very firmly to the placenta. Well, Ruby's was missing a layer. That either meant that this unhealthy placenta was lacking one or that it was still inside her uterus.

Carmen and I did some observing of her blood loss and decided we needed to get the lost membranes out. I found a little piece and clamped it with a hemostat, twisting to give it some strength. The membranes were so friable that they just tore with every slight pull. Ruby was beginning to bleed more. Now over 800 ccs. Hemorrhaging. Carmen requested that I change my scrubs as I was extremely drenched with fluids...she tended to my patient while I quickly changed. When I returned, she had found some more membranes...and they just kept coming....and coming....and coming....and then a placental lobe came out followed by more membranes, blood, clots, cotyledons, like a whole new placenta coming....and yet it was so stuck to her uterus, it just would not let go.

Carmen had to do a manual removal and get it all out otherwise Ruby could bleed to death. A manual removal involves placing an entire arm into the patient's uterus and scraping the inside to remove any placental fragments. My job was to make sure that Ruby stayed coherent and didn't slip into shock. An IV was started and I held Ruby's arms and forced her to maintain eye contact while Carmen reached deep inside of her tender uterus....Ruby was turning white under the pain and pressure. She breathed with me and I started to cry feeling so heavy for her. Baby Bethany was close by being held by her daddy and Ruby and I prayed out loud while Carmen continued to dig. More clots, more placental fragments. Too much.

Carmen asked if Ruby had been to a hilot (kinda like a witch doctor). Now, Ruby was advised NOT to go to a hilot because some of their methods are very harmful to the baby and can cause long-lasting damage. Ruby reluctantly explained that she had falled twice in her pregnancy and had gone to a hilot for a massage of her uterus to ensure the baby was okay despite the fall. However, the massage clearly had separated her placenta into multiple parts all over her uterus causing her to hemorrhage and creating a less-nutritive environment for her baby that was clearly IUGR (intrauterine growth retardation). Baby Bethany was only 6 pounds and very asymmetrical, cute, but growth restricted. The hilot had put both Ruby and her baby in serious danger. I was pretty upset she had not told me sooner, but I understood that she was shy to tell me the truth. If she had stayed home to have her baby with a hilot or even a midwife, she could have bled to death!

Carmen and I decided that Ruby needed to be transported to the hospital to get her placental fragments surgically removed (called a D&C). There was nothing left we could do but control the bleeding until the physician could remove all the remnants of her unhealthy shredded placenta.

I raced with her bana and our guard, Kuya Romi, to DMC. We prayed together and I promised to feed her baby when I got back to Mercy and encouraged her bana to come back to Mercy in a couple of hours to get the baby.

I lumbered back to Mercy to give Baby Bethany her bath, exam, immunizations, and breastfeed. It was an amazing moment to be with this precious life that came from Ruby named after me. Though small, she is a good eater and feel asleep quickly next to Carmen while I finished the paperwork and cleaned up.

Around 3:30 am, Ruby's bana, Jerson came back to pick up Bethany and reported that Ruby was doing well, resting and looking forward to feeding her baby. :) I accompanied him to DMC and then arrived home at 4 am anxious to see the Lady Bird and Tim...they were sitting up just starting to feed!

I was exhausted. Promise was hacking up phlegm in cough-form and was pretty fussy. Struggling to breathe and full of snot, I tried to feed her and took out my stethoscope to listen to her lungs....bad cold. Phlegm in her lungs. I cried. Overwhelmed with emotion...sadness for Ruby, and sadness for Promise, grateful for miracles and safety. Tired. Promise and I fell asleep finally around 5 am.

I went to see Ruby at DMC around 12 pm today to find her sitting up smiling and eating. When she saw me, she started to cry....she said, "ma'am, I am so happy for you!" I kinda looked confused and asked "why?" She said, "Just so happy to see you!" I cried. We cried. She thanked me over and over again for caring for her baby and making sure she was okay. I gave her some baby clothes (thanks to those who donated!) and Munsch's book, "I love you forever" (thanks, Lisa!) as well as some food and goodies. She was so excited. I even had some old stickers that my momma gave me of teddy bears with "Bethany" written on them that I passed on to Ruby. It's good to have another Bethany in the world!

I get to see Jerson, Ruby and Bethany again on Wednesday after a day or two of rest. So grateful, so tired, so amazed. I will post pics and soon as I get them. I friend took some with her camera as mine is still on the fritz.

Be blessed.

4 comments:

heather said...

Yay for the new Bethany. It IS good to have another Bethany in the world. Praise Jesus for safe, healthy babies.

Love ya,
Heather

Christina said...

Bethany I felt so tired for you reading this story. What an amazing story. Thank you for all you do. I pray healing for Promise, much strength for you and blessings on the new Bethany.
I love you, Mum

Anonymous said...

Bethany,
What an honor to have a new little life named after you! No doubt, someday Ruby will share her version of this amazing story with Baby Bethany. You have no idea of the legacy you are leaving there. We will pray for Momma Ruby and baby Bethany that God will impact their lives in a very special way. We also pray that He will bring healing and rest to you and Tim and Promise. I am so proud of you and amazed at your perseverance!
Love you bunches!
MOM

Anonymous said...

Great Story Bethany. I agree with Christina though... I feel for you loosing all that sleep.
You never know each day who you will touch and make a difference in their life.
Love and Blessings
Merr