Sunday, September 20, 2009

Experience.

Greetings! Thanks for reading!

So this week involved another full load of birth shifts, prenatals and life with Tim and Promise.
On Wednesday, I had the pleasure of delivering a baby boy, named Raven to "Chubby". Yes, my patient's nickname is "Chubby", though she is far from it!

Chubby's birth story is one of somewhat confusion. She had multiple bantays and when asked to bring her "bana" (husband/boyfriend) in, a very boyish person came in, though there were very feminine aspects about her/him. Confused at who this person was, my supervisor inquired..."This is her boyfriend". Oh...not the father of the baby, but her boyfriend....okay. But we were still confused. She/He didn't look too much like a boy. Mmm.

Chubby's chart indicated that she had a very low pubic bone and that her pushing stage would be very difficult. When she desired to push, we tried several positions.....she pushed with every piece of her making very little progress. After almost 2 hours of pushing in different positions, the baby's head popped out from behind the low pubic bone...we all sighed a sigh of relief and Chubby slowly and carefully pushed her Raven's very large head out....unfortunately because of the position we'd chosen for birth and because of the size of the baby's head in comparison to her outlet, she tore....in a huge way.

I won't go into details, but my supervisor graciously assisted me in suturing, teaching me new techniques and how to repair such a large and complex tear. Chubby was amazing. Quiet, but amazing. Upon moving her and her handsome baby boy to the postpartum area, it was time to do the birth certificate....still confused at who her bantays were, my supervisor went in to get the FULL story communicating strictly in Visayan. Her "boyfriend" was a girl and they were partners living together. In the Phils, a "tomboy" is a lesbian and her boyfriend is a "tomboy". Upon learning this, we asked further questions as to if she wanted the biological father on the birth certificate and where he was currently. Chubby clearly communicated that he was NOT to be a part of any paperwork or processes.

I left shift feeling sad...Chubby's Raven was having trouble breastfeeding and his respirations were high. Chubby's pulse was rising and she was running a low fever. I was concerned. She seemed so hurt and her birth experience was less than ideal. I later found out that the next shift had to transport Raven to the hospital for high respirations. Chubby was encouraged to come back to MMC for baby checks and post partum care, but she never returned. The cell number in her chart does not exist and has been changed multiple times. Her address is vague and I am not sure if I will be able to track her down. I am concerned for her health and well-being. Please pray that I will be able to find her home or that she will come back to MMC for follow-up care. This is her first baby and what should be a joyous time in her life, has turned out to be one of great cost in many areas.

Thursday's shift was interesting, as well. I was not first up, so I got to assist in an insane birth! Well, actually, at the start of the pushing stage, I was first assist. By the time baby was out, I was fourth assist....no joke. So Ate May (AMAZING supervisor) took a continuity who was in labor with her very first baby. She was accompanied by her husband and his mother....both were amazing labor supports, praying and thanking Jesus for every part of the evening.

However, Ate May knew that her patient would have a difficult delivery because the baby's head was ENORMOUS, but she felt strongly as though her patient could do it. She started pushing on the bed, then on the antipolo, then in supported squat...Ate May tirelessly provided pelvic floor pressure and tried to usher the baby's head down....her patient continued to push....I was simply assisting in position changes, retrieving supplies and keeping the area clean of fluids (there were a lot flying around). Then Ate May's hands started to cramp (she had been in the same position for over an hour). She called Ate Susan as reinforcement.

Ate Susan (AMAZING supervisor #2) continued, but felt strongly as though an episiotomy needed to be cut to make room for the baby's head....she called for Ate Estef (AMAZING supervisor #3) who came in to prep the episiotomy area and start an IV stat. Again, I become the gopher..."Beth...go get gauze....Beth go get Betadine....Beth...MORE GAUZE!...Beth...go get the vacuum extractor." Yes, with episiotomy cut and the vacuum extractor on the baby's head, oxygen given to the patient and prayers being lifted up from everyone, the baby's head started to come down.....There were 3 supervisors, 4 students and 2 bantays in her little cubicle, but that baby came out...and what a HUGE baby boy he was!!! HUGE! We all cried and cheered after 2 hours of pushing and a grueling and risky labor. Praise God. And May's patient did fantastic despite her pure exhaustion and multiple interventions! Had Ate May desired, she could have transported her patient early on to the hospital, but she knew that her patient could do it...God was there and gave her incredible strength. He rewarded her with a beautiful, huge, healthy baby boy, named Joseph. :) What an experience that was for all involved. I learned a lot.

Then Saturday's shift came and somehow, it was busy enough for me to have 2 labors! My first labor, Ivie, was in labor with her fourth baby. Her baby was taking his time and she was coping well, though very frustrated that he was soooo delayed.

My second labor came in at 7 cm dilated. Lyn and her hubby, Noel, were expecting their second and were hoping it was a girl. She was a Samal (an island off the coast of Davao) patient and had been seen multiple times by Heather, a supervisor here. Heather had said she sadly could not make the birth, but said she'd be praying.

Lyn was a fantastic patient...she asked questions throughout her very painful labor regarding how to cope effectively, how to breathe effectively and when to push.....she was great to work with and totally responsive to instruction. She wanted to know exactly what was going on in her body with each stage of labor. I enjoyed rehashing all my midwifery education with her. we had a GAS despite her pain growing worse with each contraction. Less than two hours later, she was wanting to push. I texted Heather to give her a heads up and just 15 minutes later, Heather arrived to assist me. It was great working with Heather again.

We agreed that Lyn needed some position changes to get the baby's head from behind the pubic bone and her bana was a huge help in assisting. Lyn was fascinated by the process, though exhausted. The baby's heart tones began to rise abnormally and we were a little concerned that the baby was undergoing intense stress. We brought in a mirror so that Lyn could see her baby's head slowly coming towards the outside world...we had her feel her baby's head....she started to cry and with that, she gave all that she had to push her baby's head...she pushed HARD....seriously HARD, each time wanted to see the progress she had made and little by little, her baby's head made more of an appearance. Her husband never stopped praying to Jesus out loud so that Lyn could hear it. He would tell the baby's head, "Jesus loves you, baby! Come and meet your family, baby". I cried. It was so intensely beautiful.

Lyn, with such control, pushed out her 8 lb. 8 oz. baby girl whom she named Zchara. Cries of joy bursted out as well as 500 ccs of blood from Lyn...she was hemorrhaging. We had to manual control the expulsion of the placenta and with that, 500 more ccs of blood followed. She was bleeding fast. We told Noel to pray and he prayed with all his strength. We inserted an IV, gave multiple injections of oxytocin, placed and ice pack on her fundus and continued to monitor. She gradually stopped bleeding and though she was tired, she was able to smile and breastfeed her baby.

Her dear friends came to visit despite the late night for everyone and we all prayed thanking Jesus for a successful birth of a precious baby.

I was able to see her the following day to check on her recovery and both mother and baby are well. We had an amazing time talking about the faithfulness of our God....I even got to share Promise's story and we shared in an amazing time of gratefulness. After the heavy week of emotion and struggle I had, talking about the faithfulness and sovereignty of God refreshed me...and gave me hope.

I have a few more stories of God moving in BIG ways, but I will save them for another post. So I leave you with Lyn, Noel, baby Zchara and Lyn's friends. And two pics of what Tim does when I am at work...and Promise's "joyful" (?) expression when I return.... God is faithful.
Be blessed.

5 comments:

Anonymous said...

Bethany,
So was the green hue over Tim and Promise a hint on how they both were feeling?
Mom

Christina said...

Bethany you wanted more experience; you're sure getting it! I wonder if all those big babies have anything to do with the eggs you're always giving away? Keep posting; we love it! Mum

Jenny said...

I absolutely loved reading this post. It also gave me a glimpse into what MMC does for hard or emergent labors/births. Keep up the great work you missionary-midwife you!

navieira said...

Dear Bethany, I will be praying for Chubby and her baby and that you will be able to track her progress. It must be hard on you, wondering what happens to some of the women and babies that you never get to see again. You invest so much of yourself in the lives in such a short period of time, I imagine it's hard to let them go. I will be praying fo you too that you rest easy in Him, he's got it all in His hands.
Love Nicole

~*Spindelicious Handspun*~ said...

Ahhh what a birth warrior Lyn is! And her hubby sounds like and amazing one at that ;o)

I can't *wait* to experience this amazing life you are living (and meet these amazing Filippa midwives you are working with!) first hand!
You inspire me :o)

xoxo
Beth