Second Day - Helpless

The day started out pretty calmly, but then quickly progressed to taking alarmingly swift action to save a life.

Among the 40 or 50 women, there was a 15 year old girl, Hadija, who was on the Antenatal side of the ward,
waiting to dilate enough to be moved along to the labour room.

The next thing I knew we heard the phrase
"cord prolapse",
and ran to the examination bed to see what was going on.

Cord prolapse is a very serious, dangerous, and rare occurence.
It is when the waters break and then the umbilical cord falls out into the open air... and no baby comes with it.
So there is a loop of cord just hanging there.
The reason this is dangerous is because the cord equals oxygen for the baby. When the contractions come, and the cord is not safe inside the uterus, but rather outside, the cord gets squeezed from the pressure of contractions and cuts off oxygen to the baby.
So a happy healthy baby of 9 long months can die within the last few hours.
So I’m praying. A lot.

The baby is also breech... feet first.
I feel like there’s nothing I can do, except pray and speak up to get this girl an emergency C-Section, or delivered NOW!

Hadija is on her knees with her bum in the air and her forehead on the ground, which is good. It’s taking unnecessary gravity pressure and weight of the baby off the cord.
The doctor says the cord is still pulsing. Thank you Jesus!

Just yesterday there was a cord prolapse in the labour room and the baby died in the womb because there wasn’t quick enough action. More fuel to my prayers.
As she waits there, trying not to move, I notice a thin purple piece of cloth tied around her waist. I thought it maybe was signifying her tribe, but others who are more familiar with Africa concluded that it was from the witchdoctor. Like a curse on the baby.

And now what a predicament we find ourselves in!
Cord prolapse, and the baby is breech, and she’s most likely not fully dialated which means the baby won’t be able to pass through.
After some minutes another doctor comes in and decides to try to deliver the baby,
right here, right now.
They tell her to push, they get two little blue feet out, but that’s as far as it’s going.
Now it’s even more serious because the feet put more pressure on the cord.
They wheel in a metal stretcher, we help her get on, and they tell us,
go straight to the labour room -- immediately!

My instructor and two of my classmates go with her, so I figure I should stay here on our ward. I tend to little things, all the while praying for this birth, feeling helpless and overwhelmed.
About 45 minutes go by, the three still aren’t back yet, and our ward is relatively calm, so I run over and check what’s taking them so long.
There I find Melisa and Marchien holding Hadija’s hand as she gets sutured up (she tore during birth) and Emily is like a mother hen furiously looking after Hadija’s blue baby boy on the resuscitation table.

I quickly get filled in on what happened:
they said it was "not a good birth to see".

They said it took a very long time for the body to be born and the head was still inside and would not want to come out... probably due to the fact that she wasn’t fully dilated. Ouch.
They said the doctor was being so rough and twisting the baby’s legs this way and that (but desperate times call for desperate measures),
and the way he was twisting on the little baby’s neck, when the head finally did come out, something was wrong with him being able to hold up his head;
very weak, very wobbly.
The baby looked dead when it came out.
A 1 out of a possible 10 points. Blue, not breathing, no muscle tone, no cry....
Emily took the baby and resuscitated it, prayed a lot in the name of Jesus, and had been caring for it since.
I saw him on the table; he had oxygen in its little nostrils...
still looked bluey, but he was breathing.
"Look," she said, and she showed me his left leg.
From the knee down it was dislocated and his foot turned inward.
The rough delivery, the twisting and wrapping.
And his poor neck... Emily thought he might have some kind of cerebral palsy from now on.

They said Hadija was in a lot of pain:
she was screaming and had terror in her eyes.
The doctors and nurses forcefully told her to be quiet and at one point closed her mouth with their hand.
She lost a lot of blood, probably enough to count for a hemorrhage, and now to be sutured without sufficient anaesthetic.

This is when I walk in the room.
Hadija’s teeth are clenched and her face winces as the doctor quickly stitches the best she can.
I was heart broken.
　
There is something so devastating about carrying a baby for 9 months, all for it to amount to nothing.


There is a verse in the Bible,

"We were pregnant, we writhed in pain, but we have given birth to wind." Isaiah 26:18

Instead of bringing forth a baby, how it makes the heart sick to only give birth to wind!
No substance, emptiness, no happy ending.

This is how I felt.
　
Hadija; her firstborn now with a twisted leg,

trouble breathing,

and a vulnerable neck.
She tore,

had a traumatizing painful birth,

and now with an unsure outcome even through all of that.

I observe the suture, and do a double take over my shoulder to the bed in the corner as a small baby is being born feet first!

He’s the second twin and having a hard time getting out... it’s almost painful to watch as the doctor puts stress on his little neck, and twists and overextends his fragile back in efforts to deliver the head.

Finally he’s born and lies still on the bed.

Once again, blue, and motionless.
I start praying again.

The long metal cord clamp fumbles out of the nurse’s hand and falls on the baby. The baby flinches.
Thank you Lord.

Oh man.
So much adrenaline.
It never seems to stop around here!

And the 4 BAS students that are stationed here in the labour ward are away on lunch break, so it’s just us and the few hospital staff. We are supposed to be on the postnatal ward, but we can’t really leave in the middle of this, can we!
My eyes follow the small, limp baby being carried to the Rescusitation Table behind me.

No breathing, no effort.
!!!
Quick, clear the airways! Suction out his nostrils and mouth!

"Where’s the tube?"
"The tube’s dirty."
"Where’s a new sterile tube?"
"I don’t know where they are! I’m not on this ward!"
"Ask the nurse!"
"Nurse! Nurse!"
"Yes?"
"A new suction tube! Where are they found?"

The seconds feel like precious minutes being lost, this little one need every second he can get.
The nurse clears the airways. Nothing still.
Bag and mask! Bag and mask!!
Puff--puff--puff--

breathe baby, breathe baby, breathe baby...

Each little burst of air fills his lungs and I watch the little chest start to suck in and out.
It feels like time has stopped, or has extremely slowed down.

The busy nurse puts oxygen in his nostrils and secures the tubing behind his head.

I am left with him. He’s getting slightly more pink, but still gasping for air, and I can see his skin stretch around his tiny ribs when he tries his hardest in attempting to inhale.

His small chest, his precious little hands... you can do it baby!

I watch over him for about 20 minutes, he isn’t necessarily getting any better, but he’s not getting any worse either.

I look over at the first twin, just as tiny, quiet and sleeping, but seems to be recovering.
We really need to go for lunch, and then back to our own ward.

How can I leave him?

Just lying there, with no one attending him, no one checking up on him.

He should only progress for the better now, right? He’s got oxygen...

It’s chaos in the labour room, there is another woman screaming, another one shrieking, another one taking frail steps to a delivery bed.

"Can you do this delivery?" We get freely asked by the nurse. Our instructor declines.

The understaffed doctors and nurses have their hands full and are working hard to be where the emergencies are.

The loud emergencies, that is.

The ones they can hear, the ones they can run to.

What about the little one who is silently gasping by the window?

The nurse asks me to weigh him. My instructor asks me to come for lunch. Together, we take out the oxygen for a moment and I gently place him on the scale.
1.5 kg.
He really is small.
I place him back on the table, oxygen goes back on, I stroke his head, and say goodbye.
　
　
A quick lunch break, and then moving on. Back to Antenatal/Postnatal Ward.
A very tired lady is wheeled in. She just got transferred here from a different hospital... She has quite the condition...
She slowly gets onto the examination bed for the doctors to take a look.
The baby is in fetal distress, the baby is too big for her pelvis, and she has a bulging cervix that is visible.

Cervixes are not supposed to be visible! Ouch.
All of this together equals an emergency C-Section.

But no one is rushing around.

A team of doctors discuss and talk about what the next actions are...
the 2 operating theatres are full right now, and since this is a delicate case, and enhanced by the intricacy of a visible cervix bulging and perhaps becoming gangrene... they decide they do not have the facilities to do this.

So she needs to get transferred again, to the national hospital across town...
I’m getting frustrated. They’re so casual about it!

Isn’t this supposed to be an emergency?
She’s still lying on the table...

I ask a few more questions and find out that they can’t take her yet because the ambulance isn’t back. So the ambulance isn’t even here!
Wow.
So there’s no transport at the moment.
I keep my eye on her and her fragile cervix that I shouldn’t be able to see... (the cervix is supposed to be way inside)... it looks so dangerous.
And the mama says she has the urge to push--- noo!!
She’s so thirsty, she asks me for water.
But there is no water available, you must buy it. I get the 30 cents from our team and rush down to the canteen to get some.

Finally

after 1/2 hour the car comes.
So we get her in the ambulance, and two other mamas with sick feverish babies... but now the transport nurse isn’t here to go with them. And the driver is not here either.
I’m so shocked. By this time it’s 3 pm and we need to go home.

The ambulance still hasn’t left yet, and I’m so frustrated.

But still, the staff are doing the best they can, they are just really short on people!
On the car ride home,
we hear the stories of the day. The girls from the labour ward said that some twins died.
There were 2 sets of twins that day.

Earlier on in the morning,
the first twin was born dead. The nurse said it had been dead for about 8 hours in the womb, and the amniotic fluid surrounding it was milky white. It is supposed to be clear.
They found out that the mother used some traditional medicine to "make the labour go faster" and put some leaves or herbs near the cervix (the opening).

Turns out that the first twin (closest to the opening) died during that time of labour.

The second twin (furthest from the opening) survived.

Later on in the day,
there were another set of twins. (the ones I saw).
They said that about an hour after we left, one of them went to check on the babies... and the second twin was dead. He had no heartbeat, no breathing.
The second twin. My little guy.

Alone and left to fend for his tiny little self. Only 1.5 kg, having a rough start, but with no one to watch over him, no one saw that he was struggling. And he died.
When I heard that,

that threw me way off.

The whole rest of the day I felt I was off kilter,
mourning, grieving.... my first encounter with perishing life.

That afternoon we had intercession. We prayed for the mothers at the hospital, the babies, and Emily prayed for Hadija and her little boy, that his leg and neck would be healed. It was a desperate and powerful time.

We realized after that day that there is so much warfare in those moments. As midwives we stand at the gate of life and death.

It really is a battle. And it is worth fighting for.