Saturday, November 14, 2009
Repellent in November.
Greetings!! It's amazing to me that though this is our third November here in the Philippines, I am flabbergasted by the fact that I have to put on bug spray in the middle of November in order to avoid chronic itching driving me to madness. The manufacturers of OFF! are getting good business off of me! :) Unfortunately, one of my dear friends has suffered greatly from the November mosquito population. My fellow midwife, Ali, has come down with Dengue fever passed by a nasty mosquito bite. She has been bedridden for days on IV fluids and constant monitoring. Please keep her in your prayers...she is finally on the way to recovery, but very uncomfortable! Thanks! Dengue is both awful and dangerous.
Sorry about the pics above, I will explain each one below...blogger is being difficult. ARGH.
I have appreciated Tim's last couple posts and enjoy reading his rants. Sometimes the words that he finds trouble uttering appear on the blog and I get a better sense of where he is at. It's good.
In the world of midwife-mommy-wife, I am excitedly looking forward to January when my schedule will be less exhausting and Promise and I can give Tim a break. Until then, it's busy busy busy. Since my last post, I have delivered 3 babies and have been grateful for God's mercy in the deliveries. They have not all been normal.
First came Neravic (last pic above). Having her second baby, Neravic was not at all worried or fearful. She smiled throughout her labor despite varying fetal heart tones and seemed perfectly content to labor as long as it took. I was impressed by her calm nature. However, around 8:30 am, November 6, the descent of her baby's head into her pelvis took away her beautiful smile and she decided her baby was coming as fast as possible. She gave two long pushes and a meconium-stained baby boy flew out of her with barely enough time for me to grab gloves. :) Unfortunately, her pushing with all her might caused her to tear a bit, but her baby boy was finally out. However, within minutes, it was clear that her baby was having trouble breathing. Having been deep suctioned because he swallowed a lot of meconium, little baby boy, Glen was monitored every 5 minutes along with his mommy. His chest retracted and he struggled to breastfeed. I did a quick newborn exam discovering that his metopic suture was open (the frontmost suture at the top of the forehead). This can be a sign of some serious developmental problems...or nothing at all. So I had to transport as quickly as possible. I came back to Mercy to suture Neravic and monitor her bleeding. Within just a few hours, her bana returned to pick her up to take her to the hospital to be reunited with her baby.
I went to the hospital the next day to find Neravic and baby Glen doing significantly better and his sutures were beginning to firm up and close. God is faithful.
My next shift proved to be quite eventful. I was endorsed a pushing labor named Gina. She was having her 4th baby and decided that shift-change endorsements was the perfect time to push her baby out. Her midwife from day shift, Amber, called in a panic.."Head out!" Coming in to assist, the supervisor told me to catch the baby, as it was now shift change. Well, the hard part was done. Amber had labor-watched and directed the head out. I just caught the baby as he was sailing out! Healthy and strong, baby Jepson arrived at 2:12 pm (first pic above)
As the placenta came out, I noticed that it was flat...without much shape. It looked odd. I made a note of it and continued to monitor Gina's bleeding. The shift was super busy, but Gina's bleeding kept me inside her cubicle. We gave oxytocin, had her pee, gave her an ice pack, but still, she bled....just little bits here and there. I moved her to postpartum to get her out of the busy birthroom. In postpartum, I checked her pulse...rising...and her blood pressure was dropping...fast. I checked her fundus and blood loss...250 ccs!! She was hemorrhaging! I called my supervisor, Carmen. As she started an IV with another supervisor, I tried to keep her fundus firm to stop the bleeding while trying to keep her awake to avoid her going into shock. Gina looked pale, but was able to stare at me without emotion as Carmen tried to do a manual exploration of her uterus. I continued to check her pulse and BP. The IV was working, but she was still bleeding. Then we found out she had gone to see a hilot (tribal doctor, witch doctor) when she was 5 months pregnant for fundal massage. This often causes the placenta to adhere to the uterus upon delivery causing postpartum hemorrhage. This required us to transport to the hospital so that they could do a D&C. The placental fragments were just too stuck on uterine was for us to scrape out.
After transporting Gina, baby Jepson and I bonded a bit, but the birthroom was too busy for me to babysit. I had to hand him off to another midwife living next door giving the occasion bottle of breastmilk for feeds. Then I was handed another labor. Via came in at 7 cm dilation and all smiles. She was having her second baby and was accompanied by her mother-in-law. They were a JOY to serve. Hilarious.
Clutching her Rosary, Via prayed throughout her contractions while her mother-in-law encouraged by singing Catholic chants. They were awesome...asking questions, joining me in prayer for her baby, laughing between contractions and anxiously awaiting Via's urge to push. When it came, Via was sure the baby's head was out....and yet, the baby's head was not even remotely visible. I had her get up to walk a bit and she came back to the bed grunting, but not actively pushing. However, by the time she lay down, the head dropped into place just behind the pubic bone...slightly visible. Suddenly, her bag of waters broke open and the baby's head began to come. I instructed her to breathe deep and "blow" her baby's head out slowly to avoid a tear. With total control and focus, Via pushed baby Noli's head out without tearing. Baby was super healthy and began to breastfeed right away. Via's mother-in-law kept thanking me as though it was all my doing! Ha ha. (second pic above) Via's bana arrived all smiles but had to prepare for work. (He works the midnight meat market at Bankerohan market here in Davao). All was well and I finished with Via in time to steal baby Jepson away again for another feed. Three more babies were born on that shift. Whew. Super busy, but peaceful nonetheless.
Upon the first baby-postpartum checks of Gina and Via, both patients and their babies are doing great. Via even brought me TONS of Filipino sausage (called Longganisa) from her bana's meat market! LAMI! (Yummy!) I am looking forward to seeing them again tomorrow.
In other clinic crazies...I had a few transports for high BP and was able to visit them and their babies at the hospital. All is well.
Bible study continues to amaze me. An-An and I see God move with each visit. We have had two consistent attenders and have been studying the life of Christ together. We seem to struggle with the same things...this week we studied the temptation of Jesus and His response to satan. We were challenged to change our view of temptation and to pray for those around us who struggle, as well. It has been a powerful journey for all of us. We've been able to give away 4 Bibles in Visayan and two of our Bible Study patients had their babies safely at Mercy already....an answer to prayer. This week, we are studying the Beattitudes. I am already convicted. It's good.
I am leaving out all kinds of news, but I will leave them for future posts. Many blessings as you enjoy the preparations for Christmas. :)