Baby 22

....to be read in continuance with the previous story, “Explanation”.




I woke up to the hot morning with a sick ache,
a tightness in my stomach,
almost a shaking in my ribs.


Yet amidst the violent storm of the state of my soul,
glimpses and pieces of scripture flashed on the scene like something solid, an anchor.
.
Isaiah 65 ..... infants of but a few days.... Psalm 84 ... passing through the valley of tears... Psalm 23.... valley of the shadow of death.... 2 Corinthians 1....God of all comfort......

We had an hour in the morning before we started the day together,
and there in the hot stillness of my bed
I was searching these verses,
investigating their truths,
typing the thoughts and reflections...

It wasn’t so much me clinging to them,
as it was them wrapping around me and holding me like a lifejacket.
I still was in the water and feeling the waves,
pretty helplessly,
but the words of God were buoyantly keeping me afloat.

Here is what I wrote from that morning:


The Promise.

"For behold I create a new heavens and a new earth;
And the former things will not be remembered or come to mind.

But be glad and rejoice forever in what I create;
For behold, I create Jerusalem for rejoicing
And her people for gladness.

I will also rejoice in Jerusalem and be glad in My people;
And there will no longer be heard in her
The voice of weeping and the sound of crying.

No longer will there be in it an infant who lives but a few days,
Or an old man who does not live out his days;
For the youth will die at the age of one hundred
And the one who does not reach the age of one hundred
Will be thought accursed.

They will build houses and inhabit them;
They will also plant vineyards and eat their fruit.

They will not build and another inhabit,
They will not plant and another eat;
For as the lifetime of a tree, so will be the days of My people,
And My chosen ones will wear out the work of their hands.

They will not labour in vain,
Or bear children for calamity;
For they are the offspring of those
Blessed by the LORD,
And their descendants with them."

Isaiah 65:17-23



Today I woke up clinging to this promise.
There is a time that is coming.
There is a time that will come where there will be no more sound of weeping,
there will be no such thing as a child that only lives for a few days or a few hours,
and there will be rejoicing.

Families will be able to build and plant, and eat the fruit of their hands.
They will not be subject to another people,
they will not have their vitality taken from them,
they will be able to live so long and so full that
they will wear out the work of their hands.
The sturdy chairs they have made, their quality garments, the stable houses.
All these things will become love-worn, used to the maximum, used to be a blessing for generations to come.

And women will not labour for nothing.

They will carry life to the point of delivery.
They will bear children who will grow up strong,
valued, loved,
and knowing the deep love of God
that transforms.

They will be influence-makers,
exhorters,
watchmen,
watchwomen,
fierce for love,
passionate,
movers of the Kingdom,
bringers of heaven to earth,

and their descendants with them.



Raw journalling in the morning....
Psalm 84, verses 5-7

How blessed in the man whose strength is in You,
In whose heart are the highways to Zion!
Passing through the valley of Baca,
they make it a spring;
The early rain also covers it with blessings.

They go from strength to strength,
Every one of them appears before God in Zion.



notes from my Study Bible, page 805:
valley of Baca: “Baca” can be translated as “weeping” or “balsam tree”. The valley was an arid place on the way to Jerusalem.
they make it a spring: The pilgrims traveling to a festival of worship at Jerusalem turn an arid valley into a place of joy.
from strength to strength: Anticipation of joyous worship of God in Jerusalem overcame the pilgrims’ natural weariness in their difficult journey.



Psalm 23

Even though I walk through the valley of the shadow of death,
I fear no evil,
for You are with me;
Your rod and Your staff, they comfort me.


Study Bible notes:
rod and staff: The shepherd’s club and crook are viewed as comforting instruments of protection and direction, respectively.


2 Corinthians 1:3,4

Blessed be the God and Father of our Lord Jesus Christ,
the Father of mercies
and God of all comfort,
who comforts us in all our affliction
with the comfort with which we ourselves are comforted by God.
For just as the sufferings of Christ are ours in abundance,
so also our comfort is abundant through Christ.


***



It was time to go to the Hospital.
I didn’t know if I was ready for this,
but at the same time, it was the only place I wanted to be.

When we gathered outside with our bags, regrouping to sort out money for the rickshaws and lift up a quick prayer for the day, I was sitting on the concrete with my bag, and
I knew I had to speak up...

“I just wanna ask for prayer...
I’m still feeling a bit shaken up from yesterday.”

My team came around me and prayed out strong prayers, undergirding me with support,
and resisting lies that it was my fault,
or that I’d never want to be a midwife again,
and tears started to rim inside my closed eyes.
I was so on edge and fragile,
that when they were done I could hardly whisper,
“Thanks.”


“Fifi, why don’t you pray out.”

I knew that was what I had to do,
but it was the hardest thing.
There was some silence for a moment
as I didn’t even know where to start,
and as soon as I began to pray,
each word was laced with brokenness and tears.

I prayed for Balamani and her state today,
waking up in Postnatal,
with milk but no baby,
I prayed for her family,
I prayed for myself
and the very weakness I was feeling,

I prayed out not understanding,
I prayed to focus on God’s Truth,
and to trust Him for a
good
last day...
“...whatever ‘good’ means in Your eyes.”

Amen.


My mascara was fully off of my eyelashes and on to my cheeks,
and Rachel did the “mom thing”, and rubbed it off with her fingers.

On that note,
we left.


The labour room was full.
and even though I was on familiar ground,
I treaded softly from place to place,
well aware of the thinness of the state of my soul.

But as I think about it now,
in my weakness,
God truly was being such a perfect strength.

It was 10:25 am.
I was just washing my hands with the hospital bar of red soap by the window, and Rachel walks up to me.

“Do you want to do a delivery?”

“--Yeah!”
Nothing like getting right back in there!


A gentle, fair faced Muslim girl is laying on the bed.
She has big gorgeous eyes
with long thick eyelashes that were so cute!

When she would look
innocently over at me,
blinking and fluttering her dark,
naturally fluffy eyelashes,
she reminded me of a sweet little
storybook jersey cow named Buttercup.

I introduced myself to her, and gave her a big smile.
Rachel was with me,
we looked at each other and knew what the other was thinking.
First thing we did:
check the fetal heart.

I tried with my stethoscope,
couldn’t hear anything.
She tried with hers,
nope.

Classic.
It’s so common to not be able to hear it close to delivery,
because the baby is making its way down and in different spots, manoeuvering through bones, etc.
I wasn’t worried, this usually happens,
especially if you only have a stethoscope to listen with... it’s harder to pick up.
So we just believed the baby was alive and well and descending,
and spoke out in faith that everything would be okay.

The mother was calm and strong.
Her name was Hameeda,
19 years old,
first baby.

She pushed well, she stretched well,
I had to do a little episiotomy to help with the end,
but the baby came fast,
and as soon as the head delivered,
the baby opened its eyes!!!
The cord was loose around the neck,
we did a little manouevre and slipped the baby through,
the shoulders turned and restituted nicely,
and out she came,
a beautiful baby girl at 10:45.


As soon as she came,
the Lord started to speak Promise to me.
It was just like yesterday,

A baby girl.
2.75 kg.

But this one was
alive, active, moving.
This one had life in its limbs,
a cry in its chest, colour in its face.
What a difference Life makes in a body!


Yesterday,
it was a baby girl,
2.8 kg.

Same gender, same weight.
Parralleled beside each other in my mind.
Wow, God.

What an interesting way to redeem the last day.


There was a rest, and a joy, and a sense of peace after the delivery.
The mother was shining and relaxed,
and she had no complications.
Very little blood loss, uterus contracting well.

The baby was quite possibly the cutest baby I had ever seen!
She was moving and kicking and looking around and being a darling little girl.

As I doted over her and prayed for her,
I just kept firmly hearing the word
“Promise”.
and “Hope”,
and newness.
I was praying for a name, though,
and nothing was fitting,
then finally, it came.

Daisy.

It was the only name that fit.
And it spoke of new life and promise, and the hope of spring flowers!

And then I realized that I had made one more baby hat,
it was blue with a little frill for a little girl.

I put it on her head and she looked like a little bluebell flower!


She was my little flower child,
my last delivery,
and promise of newness and life.





The Lord brought me full circle through that delivery.

He brought things to
a fullness and completion,
and healing
in my experience of birth.

It was such a good last day.


The mother had an episiotomy, (which I gave),
and she also tore some as well.
So I sat there with a headlamp and the suturing kit
and did my most complicated suture.
7 stitches,
with 3 different suture lines.

It felt good to be able to finish off the time at the hospital doing a skill
to the highest complexity you’ve done it.

I also put in an IV line without a single drop of blood (which is very satisfying way to end off!)

Everyone had a good last day,
a day of rising to our skills and knowledge of the past 7 months, and
doing them well.

We had a lengthy goodbye, and some final photos,
packed our bags for the last time.
Walked the hallways for the last time,
and wore our “labour room punjabis” for the last time.

We came home, exhausted from the heat and the traffic,
washed my clothes
and gave my labour room shoes
a good final scrub.


It was a long day, a satisfying day,
a thankful day,
and things
felt --
complete.


thank you Lord.

Explanation

*DISCLAIMER: this story is intense.


Baby 21
April 14, 2010

“I wish I had an explanation, but there is none to be found.
When we first discovered something was wrong,
it was already too late.”




I walk in, there are no nursing students.
Today is a holiday.
The power just went out and the hallway is dark.
There are squirming babies filling the newborn room, exhausted mothers in various states
(on stretchers, on the floor, leaning against the wall, in wheelchairs) waiting to receive their babies.
I walk through all of this
and am aquainted with the coziness of a busy day in the Labour Room.

I walk in, and I am drawn to a certain girl with a burgundy sari top.
She has dried blood caked down her hand and forearm,
from what looks like an unsuccessful cannula attempt.
She is hooting and hollering,
and her contractions are tight and strong.


Her face is dark, and moist,
and a scar of a double nose ring indents her left nostril.
One gold stud remains on her right side.
Her eyes are small, but her eyelashes are long, and signs of age have set in around her eyes... even though she is only 23.
She wears a tight burgundy sari top,
the clasps are bursting at the seams trying to accomodate her ever-growing pregnant chest.
She labours in a sari skirt the colour of a Hyderabad sky,
faded blue-grey,
stained with varying states of fresh blood.
Her arms are bare
except for the dull jingle
of a few orange plastic bangles on each wrist.



She locks eyes with me and asks for pani (water).
She is hot to the touch,
and I look for a communal water bottle,
but none can be found.
Finally I see one among some steel bars in the corner,
but when I go to the sink,
nothing.
The power is still out.
The hospital generator has kicked in,
and provided lights and electricity to turn the ceiling fans,
but the water is still not flowing.

I put on a
too-small
resterilized,
re-powdered glove
from the glove tin,
grab some cotton wool and go to a reserve tap in a different room to wet it slightly.

This is our first encounter.
I cleaned her hand, and she held mine.
I told her my name, and I stayed by her side the rest of the day.

The labour room is full of colourful sounds, and bustle.
I then think to myself, I could do this for the rest of my life.


A group of white-coats came in.... students in their early twenties,
that look very official,
much more official than us,
but are 3rd year medical students who have lots of textbook knowledge, but hardly any practical experience.
They hover in clumps,
watching, timid,
and occasionally flip through thin medical books they hold under their arm.

I have the labouring girl turn on her side, and I rub the small of her back.
5 of them attach themselves to me.
Excuse me,
what are you doing?

I explain to them that applying pressure to her lower back, coccyx, hips, etc. eases the mother’s discomfort as the baby descends through her bones.
We talk a lot,
they are eager and shy,
yet willing to learn.
They ask many questions,
and they get to feel a contraction for the first time.
We time some together,
and they get to learn with their fingers what a tight contracted belly feels like.
There we stand,
5 white-coats and myself,
six sets of fingertips on this large belly as Balamani sings a note of pain.

They smile timidly,
and their faces are soft with learning.
“We wish our teachers were like you.”
They freely ask questions, unintimidated,
encouraged and empowered.
Sometimes they ask silly questions,
innocently, such as:
“What does this mean that she has strong contractions?”
“How do you know when she will deliver?”
Things I would have assumed they would know, but hey, it’s great to be the one to explain it for the first time.

Her temperature is high, and the madam (doctor) permits me to give a paracetamol injection.
She’s burning hot on her skin,
but has now switched to shaking and shivering.
How terrible: to be in active labour, AND feverish.

Telagu sentences sputter out in long fluid bouts...
the students translate:
“She wants an operation,
she cannot bear the pain. She cannot bear it.”


Another birth is taking place,
and most gravitate to that one,
so there are about 12 white-coats peeking their heads over each other’s shoulders as this woman screams and pushes.
One of the guy students’ face drops,
and he steps out and goes for a little walk outside.
I forget how intense it is,
especially for first-timers, (I fainted the first time I saw labour in Africa!!)
and probably especially for guys.... this foreign thing called birth.

I look over and one of the other guy students is right at the bedside,
and holding the pushing woman’s hand as she sqeezes it tight..
He’s encouraging her,
and being very nice, and smiling. wow!
Don’t see that often.
Actually, I don’t think I’ve seen that --- ever.
The other white-coats keep their distance,
and have a deer-in-the-headlights look.

My girl, Balamani, wants to get off her bed.
She’s a character, that one.
She wants to stand and move around, and I don’t blame her.
She’s not close yet,
maybe 5 cm dilatied,
so she’s got some time to go.

I help her reach her toes to the ground from the high steel bed (she’s probably only 4’11’’),
and with her massive belly, she is quite the sight to see.
She has polyhydramnios,
which means she has an excess of amniotic waters.
That’s why she’s so big.

She wants to go out of the labour room.
I can see a woman in the crack in the doorway, watching her.
I’m guessing it is either her mother or mother-in-law.
She is a tall woman, she waves and me and smiles,
and puts her hands together in the “Namaste” way. She seems nice.

Balamani makes a few steps towards the door,
but gets the sharp hand-scoot gesture from her mother at the doorway to say,
“Don’t come out here,
go back to your bed and deliver!”

While directing Balamani away from the door,
her knees slowly give out and she finds her way to the ground,
and prefers the cold, dirty tile to her steel bed.
She lays right down against the wall in the corner,
and I’m not going to be the one to stop her...
she’s in labour: she can do what she wants.
She’s moving from sitting to laying to standing,
using gravity to get things going; I think it’s great!
I think I’ll be a mover-arounder too!

The white-coats are watching, in amazement,
and I’m kneeling down,
consoling a fiesty,
tiny,
big-bellied woman on the tile floor.
Not your typical “textbook” labour, eh?

But after some time,
we do need to hoist her up again, and she reluctantly complies.

She’s in a lot more discomfort up on her bed,
and she’s howling, moving around.
But soon she pulls it together, and comes into a strong focus.
I feel her belly, and there are contractions
but all she is doing is closing her eyes.

She has calmed down now.

Getting it together, while still slightly writhing on the bed.

After some time, the white coats get the cue from their instructor to leave,
and the darling one with the paisley scarf wrapped around her head thanks me again with a brightness in her eyes
and off they go.


Balamani starts to get off the bed once again, but we try to stop her.

She eventually gets on the ground again
leans up against a piece of wall right in the middle of the room
and she closes her eyes, nods off for a few seconds only to open them again with a burst of dazed awareness.

She must be so tired
she wants to sleep but her baby wants to get out...

she shifts to a different patch of dirty floor,
I hold her up and help her try to rest,
she’s quiet now,
even through the tightness of contractions
her head falls back into me, and she has glimpses of sleep.

it has been quite some time that she has been sitting on the dirty floor,
and we’re all kind of anticipating the madam to yell at her.

But the madam that sees her is a nice madam,
and nicely asks her to get up.

so with a burst of cooperation, Balamani energetically gets up on the bed, and the madam checks:

fetal heart: present.
dilation: 70% effaced, and 7-8 cm dilated,
0 station.


They give her some epidocin to quicken the effacement, and hook up an oxytocin drip.

Baby’s coming soon, now.

Everyone’s going to lunch, it’s almost 1 oclock.
I don’t want to miss this one
I don’t want to leave her

I get told to have lunch as quick as possible to be able to come back.

i put away my things and go back quickly to tell Balamani I’m leaving to eat but I’m coming back.

An intern doctor then scoops me up and asks me to be the tourniquet
for a cannula for another patient. So my hand is clenched around another woman’s wrist and I see Balamani across from me.

Balamani gets off the bed again
but now she has an IV drip so she can’t go anywhere
she’s standing, with her huge belly and her tiny stature, having contractions --

at this moment
I am standing across from her, holding onto a different woman’s arm as the doctor inserts a cannula.

It is then that I see Balamani’s mother, or mother in law
seeing the absence of visible doctors,
burst in to the labour room,
with a terrible
angry face
muttering things under her breath
gives her a forceful whap on the back
lifts her up by her back
squeezing her belly
barely reaching the edge of the bed
Balamani’s hips pivot on the high labouring table
and with the force of the mother’s push
and her own momentum falling
backward
she falls smash backwards into the steel railing.

I gasp in absolute shock and what just happened.

Oh
My goodness.


The mother gets forcefully ushered out

and Balamani lays quiet
as though nothing happened.


With that moment seared in my mind,
I take my lunch, stunned, and
absolutely horrified.

It’s like her mother wanted her to deliver
and stop fooling around
but this was total
abuse.
Balamani fell so hard backward,
and hit the back of her skull on a steel railing.
This is not okay.


I take some quick food
and within the first few minutes of eating,

Betty comes up to me,
“Rachel wants you ---run!”
I take my water bottle,
leave everything else,
and walk/run as swiftly as I can down the dark dusty marble floors...

Rachel is standing with her,
“She’s going to deliver, the head’s coming ---
get some gloves on Fifi,”

The head is starting to show
my tutor Rachel feels the heartbeat with the stethoscope
it’s fast, (a sign of distress) but it’s there.


Her skin is really tight,
but she is a G2 (gravida 2.... meaning this is her second pregnancy) so she should be able to stretch enough... her body has delivered and done this once before.


I reach in and feel the bony edge of the baby’s head not yet there yet, what we’re seeing is a little bit of caput.
But the skull has yet to pass through
she’s really tight.... is she going to stretch?

She’s pushing and I calmly smile back, good job mama...

More of the head starts to show... this is really painful for her! ouch...
You can do it, mama!

My tutor tries to hear the heart again with the stethoscope,
this time she can’t hear it,
but it could have just been the end of a contraction,
or the wrong positioning...

a little more of the head is showing, and I see a small piece of white-jelly-something at the top, right against the skull of the head.

Is that cord?

I’ve never seen that before, but it could be a part of her anatomy being blanched white from pressure... it’s unclear.
We try to push it back in, but it still is pinched between the skull and the birth canal.
She is taking a long time to stretch... it’s been a few minutes now.

“Should we do an episiotomy?” I ask.

My tutor thinks for a second.
“Well, she’s a G2, she should stretch... I think she can do it,
let’s not cut.
She may tear a little, but that’s okay.”

Balamani’s giving some good pushes, but there’s still not “fast progress”, the head has been at the perineum for 3 -5 minutes...
time is a little unclear in moments like this,
and finally we see some really good descent.
This is it. Here it comes..
Things seem to be fine,
we’re both calm and expectant.
I don’t think twice about not having heard the heartbeat the second time, this usually is the case when the baby is coming down,
you just can’t get a clear sound in between all the muscles and bones of the descent.

I’m trying my best to keep things intact,
she is starting to stretch,
but as the head is finally coming all the way through (she’s screaming...)
I can see her skin get very thin and start to slowly rip under my fingers.

Head is out.
Baby is bluish,
and there is a little bit of blood from its nostrils.
Uhh...
we feel for cord around the neck. No cord.
We need to get the baby out though,
the bluish colour is not very good.

We ask the exhausted Balamani to push once again;
the shoulders are not turning properly,
and we can’t figure out which way the baby is turning.
The baby is just staying straight...
finally there is some release on the right side,
and then the shoulders and trunk just kind of come out straight,
instead of properly turning to the side.

As the trunk comes out,
I can see the body is quite blue,
and there are some white patches on the shoulderblades and back where there’s been pressure on those spots and lack of circulation while coming through the birth canal.
The body slips out with a little bit of a pull.

Out comes a flood of hindwaters.
Polyhydramnios, that’s for sure.
The baby lies limp on the table.
But lots of babies don’t have good colour at first.

Suction!!

We suction the mouth,
the nostrils,
not much seems to be coming out.
Now for the tactile stimulation.
We rub the baby’s head, back, trying to get things going...
come on baby!! Wake up!


I feel the chest, there is no pulse.
I’m trying to feel for any kind of beat,
but I can’t feel anything.
I feel the cord, there is no pulse.
What??

“Feel at the stump of the cord, at the belly button!”
My tutor says with alarm.
She’s rubbing the baby’s back vigorously.
No expression,
no grimace,
no muscle tone.

I feel the base of the cord,
nothing.
“Stimulate the feet!”
I’m flicking the baby’s limp blue feet,
trying to get some kind of response,
nothing.
This baby needs help.

The cord is cut,
the sex is shown to mom,
“Babu or Papa??” (boy or girl)

The mom lies, shocked, and quiet,
and answers,
“Papa.”
This is the first time she sees her child,
held in a tight grasp by my tutor,
non-responsive, and blue.

“Papa.
Right,
okay,
this baby needs to go.”
And with that she whisks her away with fast steps to the newborn room down the hall for rescusitation.
“Fia stay with her!”

So here I am, standing shocked.

No heartbeat?
But we just heard it 5 minutes ago.
She’ll perk up. She has to!

I smile to the mom,
and tell her she did a good job,
but there is not rejoicing or relief,
rather, a tension in the air....
a waiting,
waiting to hear the report.


I want to just run from my spot at Balamani’s bedside,
and run down the hall to be with the baby.
I want to do rescusitation!
I want to be praying over the baby and seeing her perk up,
seeing her respond to the puffs of air filling her lungs,
the chest compressions to restart her very recently beating heart.

But my feet don’t leave their place by Balamani.
I need to stay with the mother in to monitor her and check for bleeding.
I give her the oxytocin injection to help the uterus contract
and wait for the placenta to come.

I am praying in my place,
still in quite confident hopes that the baby will revive.
Any second now,
my tutor will come back into the labour room with a sigh and a smile,
and we’ll look at each other and be at ease.
We’ve seen it so many times before;
babies with rough deliveries,
start to cough and respond and squirm and grimace...
this delivery wasn’t very rough,
it was normal, and this baby’s heart was beating all day!

During those long hours of labour,
placing my hand on tight belly,
feeling the strength of contractions,
I would feel the baby kick under my fingertips.
She’s gotta be alive.

I am still standing there,
waiting.
It feels like no one is around.
The ward doctor is out,
and there is one intern doctor attending to some things.

Waiting for the placenta to come,
waiting for the good news.

Balamani lays on the table, watching me,
and I carefully deliver the placenta.
Good, no extra bleeding.
Thank you Lord. Mother is okay.
I check the tear of her broken skin. Not too bad. Will only need a few stitches.

My tutor walks back in,
but her face is expressionless.
She shakes her head, and looks blankly at me.
“No Fia.
She’s not alive.
The baby’s dead.”
She puts something away, and then leaves again.


What?....

This can’t be.

My face falls,
and Balamani is looking at me,
but she still doesn’t know what is going on.

She’s asking me something in Telagu,
but I don’t understand.

I feel so helpless.

I wanted to be part of the rescusitation,
I want to know the details!
I want to know WHY!?
HOW?


My tutor comes back in,
doesn’t say much,
but confirms again to me that the baby is dead,
it was not alive when it came out,
and asks if I have taken the mother’s vitals.

“No, I just finished delivering the placenta.”

“Okay. So take your mother’s vitals.”

Everything becomes surreal,
as I remove my bloody gloves and take a few steps to find a blood pressure cuff.
I take the mother’s blood pressure,
pulse rate,
breathing rate,
temperature.

Balamani is watching my eyes,
my face,
and I’m trying to be neutral as I stare at the blood pressure gage,
listen for the pulses,
go through the motions of taking vitals after a delivery.

I am in such shock.
I don’t understand.
I do not understand.
And here I am waiting for a thermometre to beep on a mother who doesn’t know that her baby is dead.

This delivery was filled with such joy and expectation.
All day, I was with her.
All day I was the one who was with her in labour,
made sure she didn’t get yelled at when she wanted to lie on the floor,
I was the one who held up her head when she was falling in and out of sleep between contractions.
I was the one who cleaned her hand and stroked her hair,
who gave her water and massaged her lower back when her bones hurt.
And I would be the one to rejoice with her at her vigorious,
kicking baby as she entered the world...Right?

We could hear the baby’s heart before.
We couldn’t hear it a few minutes after,
but it was in the intensity of pushing, and descending... so naturally one wouldn’t be alarmed.

The mother was tight,
the baby was held back because her skin was not stretching as fast as it could have,
and it took a few minutes,
but not that long, before the baby was delivered.
This is normal.
There seemed nothing to be alarmed at during the birth.

NO heartbeat?
Not even a trace?
Not even a slow heartbeat that we could work with and stimulate and bring it back to a good pace?

How can a heartbeat go in 5 minutes??

So the heart stopped in the birth canal?
What?
How?

Did we do something wrong?
Everything seemed normal,
I don’t understand.

The vitals are done,
I walk swifty to the newborn room, and find my tutor there.
The baby is laying in a tray, already on the stillborn shelf.

“What happened?!”

“The baby is dead.”

“We can still revive her ----”
I lunge toward the tray...
“---Did you do compressions??”

“Yes, we did.
Nothing happened.
She didn’t respond to anything.
She never had a heartbeat. She didn’t respond to bag-and-mask,
her lungs never filled with air, even with air being puffed into them.
She’s dead.”


I open my mouth,
and pause--- and ask the unimaginable question:



“Did we kill the baby?”



“I don’t know.”

“I don’t understand---

Should we have cut an episiotomy?”


“I don’t know.”


And then a true, heavy sinking feeling set in.
Feeling shocked,
confused,
responsible,
but not knowing what we did wrong,
or if we did something wrong.
But now the baby is dead,
the mother is on the table
after hours of pain,
feeling the kicks of her unborn daughter,
suffering abuse from her mom,
feeling exhausted,
sleep deprived,
pushing hard,
skin tearing,
much labour,
and her baby somehow died in the final moments.

I don’t understand.
What is the explanation?
So much is unknown.

I remember that piece of white something looking wedged between the baby’s head and the outlet.

“---Do you think that was cord at the baby’s head?
Was it getting pinched off and stopping blood supply?
Do you remember it?”

“Yeah,
I don’t know Fia.”

So much is unclear.
Can anyone give an explanation?
Can anyone tell us what happened?
Did we do something wrong?
What could we have done?
Should we have cut?
If we had cut an episiotomy, the birth would have gone maybe 2 1/2 minutes faster. Is that enough time to make a difference?
Would that have even had made a difference?
Was that small piece of white peeking out, a glimpse of the cord slipping down and getting dangerously squished?
If so, how long was it getting squished for?
If so, by then it’s too late because the pressure is so forceful to be able to push it back behind the head.

Can anyone give an explanation?

Why is the baby dead!!??

Why did she die in the last 5 minutes??
Babies take about that time (or longer, especially first-time births) to stretch the skin and come out naturally.

Why could she have not been revived?
Why didn’t her lungs even fill with air when there was air pushed into them?
Was something wrong with her lungs?


This is too much.
I’m a student midwife.
There is so much I don’t know,
I’m still learning!

I did everything in my knowledge that I could.
And when I asked about doing an episiotomy, I was told, no, just let her stretch, she’s a G2.
Well,
what, then?


I looked back on her notes,
and on her case sheet it said on the front:
“polyhydramnios”
Meaning, excess amniotic fluid.
Which was quite visible;
she had a very distended abdomen,
when she was labouring,
her belly was so full that it looked like
she could even have twins in there.
But it was just a lot of fluid.

What I learned later that day was that with polyhydramnios,
there is risk of cord prolapse,
meaning the cord dropping down infront of the baby and then getting squished by the body on the tight way out.

The cord is the life line for the baby.
As it pulses,
it provides fresh blood, fresh oxygen.... if the cord gets pinched,
the baby will go into distress
as it cannot last long without oxygen.

So it could have been cord that I saw,
partial cord prolapse,
dropping down to the level of the head and then getting lodged there as the head was crowning.
That would pinch off the blood supply in an instant,
and suffocate the baby pretty quickly.

I checked the mother’s anatomy in the same place where I saw this glimpse of cord-like substance,
to see if it was part of her own make-up or not.
Nothing seemed to be there now,
so it could have been partial cord prolapse.

But we’ll never know.
There’s no way to know because we can’t see what’s going on inside as the baby’s coming down.

But what could we have done?
If the cord was being pinched right from the get go (remembering the fast heartbeat at the beginning) The time to do an episiotomy is only right at the end, not while the skin is still stretching naturally. By then, the baby could have been already severly asphyxiated....
there is just so much unknown.

And I don’t like it.

I don’t know what to feel.
I feel like I am responsible... but it is unclear for what.
I don’t know what I could have done differently.
I followed orders, I was supervised,
and yet the baby came out, unable to be revived.

So many thoughts are racing through my head as I stand beside Balamani’s bed.

An intern doctor comes over, all capped and gowned in blue.
You can only see her eyes,
and her voice is a little muffled under the thick cotton mask.
She puts her hand on the steel railing of Balamani’s bed,
leans over
and speaks down to her in
a matter of fact way.
She says a few sentences in the tone of voice
that one would deliver a casual message.

Balamani’s eyes change, her mouth stays open, she lays there, unmoving.

“What did you tell her?” I ask.

“I told her that her baby is dead.”


Then she goes, off to tend to other business.


I can’t believe this is happening.
This all feels so surreal. So not real.

Well,
what do I do next.


She needs to be sutured.

So I make sure all the supplies are there,
the lamp is already set up,
I put on my glasses,
mask,
new sterile gloves,
move the steel stool in close,
and it screeches against the tile.

As I am suturing her, I feel like I am just
going through the motions.
Doing what needs to be done
focusing on the task at hand
infiltrating with local anaesthesia
stitching one stitch at a time
knotting wrapping
cutting the loose ends after the knots

blinking behind my glasses
breathing hot breath through a surgery mask

Balamani is laying still on the bed.

Thoughts are racing through my head,
but my movements are calculated and slow.

The last stitch is done, the last knot is pulled, the last thread cut.

I put the instruments down on the tray,
and sit motionless.

Blinking slow, breathing silent.
The big incandescent suturing lamp still burns hot by my face
and I stare blankly
at the broken skin that has now been restored
and ready for healing.

One of my classmates is standing there.
watching,
and rubs my back without saying a word.
I say nothing,
I am in disbelief,
I close my eyes, and I want to cry.
Actually, I want Balamani to have her baby
In her arms,
alive.

Waves of grief,
of unimaginable loss
are stirring inside.


I tell her it is finished.


She slowly sits up, slowly easing her way onto the pain of the fresh stitches.
As she gets up from the bed, I see the remnants of delivery;
There is blood all the way up her back.
Drying on her skin and seeping patterns into her burgundy sari top.

The daima brings in the tray holding Balamani’s baby girl.
The daima holds the shallow tray with two hands,
like one would hold a tray of cookies,
and they confirm the identity on the handwritten tag tied to the little girl’s wrist.

The baby lays on her back,
her eyes are closed,
she looks perfect,
but she is cold,
blue and lifeless.

Balamani’s stare does not break
as she beholds her little girl,
and then the lady walks away with it.
She shows the family at the end of the hall,
there is sorrow and shock,
her husband turns away.
He doesn’t want to see his baby girl in a tray.


Another daima brings a folded sari and underskirt from her family.
Balamani’s other sari is wet and dirty and in the garbage bin.
She steps into the underskirt,
ties it around her post-baby belly,
and stands there barefoot,
on the dirty tile by her bed,
still wearing the same bloody sari top,
and slowly wraps her sari like she’s done a thousand times before.
She carefully does the pleats with skill in her fingers,
tucks the folds
and swings the fabric over her shoulder.


Her hair is still a mat of tangles;
the strings by her face mixed with sweat and coconut oil.
I walk slowly with her to the door where there is some family peeking their heads.

She talks with them briefly in the dark hallway,
and then returns to the ward.
I help her up onto the dirty metal stretcher
and she lays in the hall to wait
with the 2 or 3 other women who have just given birth.

I take her vitals once again,
and my eyes start to sting
as I fumble with my thermometer and my notepad
my face starts to break
and I cry with her silently in the hallway.

I wish I had an explanation,
but there is none to be found.

When we first discovered something was wrong, it was already too late.

I pray with her and hold her hand.
I pray for her protection,
from shame,
from confusion,
from feeling like she did something wrong,
from her family and the opinions and judgements,
I pray that she would heal,
and her next baby would come to the point of delivery.

My voice is weak, and soft and raspy, and my lips are trembling from talking through tears.

and she looks at me.



***
The rickshaw ride home was surreal,
the warm wind in my face,
the weaving and dodging of motorbikes, buses, people...
I just sat looking out at the things passing by,
my head still full of unresolve.
It was the worst day.
It was not how I expected my second last day at the hospital to be.

The rest of the night was a blur...
it was Wednesday, the night where we take different hours to pray throughout the evening. (we’re plugged into part of a 24 hour prayer chain)

After the hour that I was alotted for with some of the other girls,
they left,
but I felt such a burden to stay in the prayer room.
I felt like there was an anchor keeping me there
and I knew why God was prompting me to stay.

So I sat on the bench with the hot fans whirring around me,
crumpled into a ball with my knees to my chest
and I cried
and cried
and talked to God honestly
and cried
and prayed
and felt
as if
I was
breaking.

45 minutes later, I came back to my room at 11:15 pm,
and everyone was asleep.
I got ready for bed in the dark, filled my bucket with water,
wrung out my sheet,
and tried to fall asleep.


**
I was lying in bed that night,
and my mind was a fast-slow scatter of tension and release,
of sickness and promise, the thick heat of the night and the thinness of my sleep
forcing me to wake up,
only to be made concious of the constant thoughts racing.

Flashes of reliving the horrific moments of the day;

her falling backwards and smashing her head on the steel rail,
her mother abusing her,
the full term, strong baby girl,
blue and lifeless
the feeling of a non-pulsing cord between my fingers
frantically flicking the soles of her limp blue feet

this is how my sleep was.



**to be continued.... see next post, "Baby 22".

Twelve to Twenty

Here is a summary of babies number 12 to 20 that I have delivered in India.


While we do their checkups on them, we pray for them and their new life, and ask God for a name for them.
Names have meanings, so afterwards we look up the names, and it usually lines up with how we prayed for them. It’s pretty cool.

But the parents choose the real name, later.


Also, in the photos, you may see a pink or yellow tag tied to their wrist.
Pink means girl, yellow means boy,
they write the mother’s name and other stats on the tag,
to not mix up the babies.


Here we go.

#12. Matthew Martin.

In India, I became a “preteen” starting with birth number 12.
The mother’s name was Leela, and she delivered a good-sized baby boy.
As I prayed for the baby I got the names Matthew Martin.
I couldn’t hardly get a picture with the mom because almost immediately after delivery she was already on a stretcher and being whisked upstairs to postnatal.
This is me giving her the baby and then running down the hall with her...


#13. Christian.

I became a teenager (number of births now in the teens)
with birth number 13.
As I was with the mother in her labour, she was crying out to Jesus, and asked us to pray for her.
Turns out she’s a believing Christian. There were five of us around her encouraging her as she pushed that baby out, and she was so, so pleased that for her first baby, he was surrounded by Christians at his birth.

Funnily enough, as I prayed for the baby, I got the name Christian for him.
She was very sweet, the mother’s name is Sunitha Esther, and the husband’s name is Timothy.

This photo was taken by a guy on our team who’s really good at photography. He was in the Hospital doing a documentary about healthcare, so I happened to get a pro photo with my precious little guy.
This is the newborn at one hour old.

A few days later, I bumped into the family again at the hospital when they came for a checkup. I was just about to eat lunch, and they bought me chapatis. This is the day when my parents came to the hospital, so they got to meet them too.
I also got to do a homevisit with them, this is the baby at 2 months old. He’s looking very cute. They are a very special family, wanting to do all things right.


#14. Christine.

I don’t have a photo for this one, because it happened so fast,
and once again, she and the baby were whisked off to postnatal right away.

The mother’s name was Ruby, she was twenty, and this was her second child.
She was married at 18. She had a baby girl, I got the name Christine for her.
She was Muslim, and she was saying that her grandmother will not be happy that she had a girl. But Ruby said that she was very happy, and her husband would be as well.

It’s a sad but true fact that a very large percentage of women are disappointed when they see that they’ve delivered a girl.
Boys just mean more promise and security to them, and there is usually a lot of pressure from the family to have boys.

In India, when they have an ultrasound, it is not allowed to tell them if it is a girl or a boy... because if they found out it was a girl early on, many of them would have abortions.
So they never know what the sex is until the baby is delivered.

It’s really sad to see some mother’s faces fall when they see that they’ve had a girl.
They experience pressure from the family, and anticipating raising a girl and what that means.

When girls get married,
they go to live with the husband's family,
thus officially leaving their parents, and never coming back.
So parents with sons inherit the wives and the families, whereas parents with daughters lose them to marriage, and are left with no one.

Also, girls are expensive,
because of the dowry...
which means the parents of the girl
give (pay) a large sum of money to the husband's family when she gets married. It's almost like paying to marry her off.
Apparently by law in India the dowry system is banned now,
but it still happens like usual.

So if you have 4 girls, and no boys, you have no one to take care of you for when you are old.
It has a ripple effect into the whole family.
So in India, news of a girl baby can be a "damper" on things.
Pretty much: keep trying until you get at least one boy.

It's terrible.
The value of women is much less than men,
and it is evident in so many ways.

But Ruby was happy.
Her first was a boy, and now she has a girl.
She was excited to have one of each.


#15. Josephine Clara

Well into the teens with
baby number 15.
Another beautiful girl.
Mother’s second baby.
She has such a cute little face!




I knit that little purple hat she’s wearing.
We usually put hats on the babies to keep them warm, as they lose heat pretty quickly.
We call them “helmets of salvation”, like Ephesians 6.


#16. Jason.

This was mother’s first baby.
She was 22 and did such a good job pushing.

Some interesting things to note:
there was history of cosanguinity,
which means marrying into the same bloodline.

Sometimes,
with arranged marriages,
people get married to their cousins,
or very close within the family... to keep money in the family, or for whatever reason.

The mother's name was Parveen,
she was Muslim, and very sweet.

When she saw that she had a boy, she was ecstatic!!
She kept saying,
“My dream has come true! My first baby, a boy!”



#17. Matthew.

Another adorable baby boy.
The mother was 18, first baby.
She was showing signs of pre-eclampsia, but to my knowledge never had any fits.
Praise the Lord!



#18. Noah.

This was my biggest baby!
Weighing in at a hefty 3.9 kilos... this baby was a full-term chubba!
He also came with a flood of waters,
hence,
Noah.


#19. Moses.

Another bouncing baby boy.
This was the mother's third child,
so it didn't take long at all for him to come into the world.

I prayed and got the name
"Moses"....
that his small beginnings
would become something large.









#20. Michael.

This little boy was really cute.

The mom (second child) was really calm and focused during labour.

I didn’t get a picture till upstairs in postnatal,
and the family had already dressed him up in baby clothes.
They put a triangle bandana thing on his head, probably from a piece of old sari,
and I think he looks like a pirate!
The 22 year old mom is out of the picture, laying down on the bed, resting.
The woman in the blue head covering is the mother’s mother. Proud grandmother.
I’m not quite sure who the one holding the baby is... but I presume a close family member.
They were also very excited it was a boy.

My last two births, 21 and 22,
turned out to be quite significant, and I ended up writing quite a bit for them.
Lots to process.

So those will come soon.


Thanks for tuning in!

The Lord Provides a Sari

(Beginning of April)


On Friday we made a home visit.

3 days before, on Tuesday,
Corinna went up to Postnatal to check up on a mom that she delivered, and after she checked up on the baby and prayed for the family, another husband motioned for her to come over.

So she sat and chatted with another couple who had delivered the day before, and they really wanted her to come to visit!
It’s very normal for the families to want us to come over, it’s really cool and a great way to follow up, not to mention experiencing the average Indian home.

So on Friday we went.
The baby was 5 days old, and we got picked up and welcomed into their one-room home.

The family business is Washing clothes.

Two brothers married two sisters (arranged marriage) and each couple has one room for their home.


Their shop is on the ground floor, then you go up some stairs to have two rooms and a bathroom, (where the two couples live) and then go up some more stairs to the roof and you have the washing basins and saris and whites laying in the hot sun to dry.

There must be some other rooms next door because there are kids of varying ages peeking out from every corner, and of course having two white foreigners gathers a crowd... let’s just say that you can fit quite a few people in one room and one doorway.

So we met the
grandmother,
(<---)
and the aunt who has 9 children and is only 45, and the uncles and the cousins and the other brothers of marriageable age... oh boy.

We sat on woven mats on the floor that also doubled as the space where they sleep at night. After eating some fried doughballs and chutney, we examined the baby and answered any questions the new parents had,
then had a chai interlude,
coupled with blatant staring by the two younger brothers who have yet to get a wife.
The baby was very cute, they slathered her hair in vegetable oil, they said it was for “peacefulness” or “calmness”.
But Indians are pretty keen on oiling their hair in general... usually with coconut oil, so why not start at 4 days old?


All in all we had a lovely time,
the varying family members thought it was just the coolest thing that two “nurses” from the hospital would come to their home to check up on the baby, and welcomed us once over and over again.
We told them earlier that we were going to an Indian Wedding later that afternoon,
and during a different conversation we were talking about how we loved the Indian clothes here and saris look so beautiful on the women.


Just before we got up to go,
there was a little pause in the room,
and then they opened up their one cabinet of possessions,
mostly folded clothes, and offered us to take a sari.

What!?

They insisted,
and started laying packages of unopened,
unused sari material at our feet and chose ones they thought were “suitable”.
They’d bobble their head, they even got the gramma in on the choosing,
and when they finally decided which ones were good, they’d smile and say,
“suitable.”
The boy who kept the unbroken stare chose mine for me.
It is blue and beige leopard print with orange flowers.
I like it.

“Suitable.”

So we left their house with new saris in hand,
which is amazing,
because I was really wishing I had a sari to wear to the wedding that day.
I had one sari that I got while my parents were here, but I sent it back with them when they left,
and pretty much immediately regretted that decision, because it's so much fun to wear!
Saris are just so much more elegant, especially for more formal occasions.

So I really didn’t know what I would wear to the wedding,
I’d scrounge something together, I’m sure,
but here I am, with a blue leopard print sari in my hand,
given to us hours before we go to the wedding.


So we get home, get ready,
dab the water from our faces in the heat of the day in our concrete room,
and ask the lovely cooks downstairs for their help.
They lent me a sari top (as mine needed to be made at the tailor’s) and a petticoat, and they tied and folded and wrapped us up all nice,

“You are looking like Indian.” they say.It was great.
Corinna had already organized to borrow a sari from the receptionist downstairs,
so she came up all ready to go in her green beaded masterpiece,
and off we went with the rest of the team to the wedding.

By the way,
let me just say that we didn’t know these people getting married.

The day before, we got a call from a Christian doctor-friend who runs an HIV/AIDS clinic, we’ve helped out there a few times before.
Anyway, two of the staff there were getting married.
So she called us up the night before,
invited us to come,
and asked us to lead worship at the reception.
“The wedding starts at 3.”

Alrighty.
So we had an impromptu song-singing session the morning of,
figured out some songs we could sing
for our guest appearance
at the Indian Wedding
of two people we don’t know
and have no connection to.
But I’m sure they’re lovely.

We’re Christians, they’re Christians,
it’s all good.

On our way to the Wedding...

Here is Corinna and I smiling.

Here is Corinna and I smiling like Indians. (No smile.)
This is the common expression when a
camera is put in their face.
Even in Wedding Photos, everyone just stands up tall, side by side, and looks straight ahead.

Here is us singing. We sang two songs. It went well!

fixing the sari pleats...

Half way through the reception, the photographer’s camera battery died.
They saw that I had an SLR camera, and while I was sitting in the audience, one of the guys leans over my shoulder and says,
“Hey Fia, the camera battery died.
They want to know if you can take the wedding photos for the rest of the reception.”
So for the remainder of the night,
I was right up there with the videocamera man, snapping angles and closeups and other wedding moments,
in my new blue leopard sari,
(that was just given that day),
with the nice camera
(that’s not even mine),
it was amazingly lent to me for my time overseas.

The beauty of giving!
Blessed to bless others!



At the end of the night,
we ate fruit salad and gingerbreadcake and got jasmine flowers in our hair.
Then we walked home by the light of street shops and traffic
with the hot gentle breeze
still blowing like an oven.


A day with a full dose of Indian culture!

The Boy That Ravished My Heart

I spent a day in the Newborn Room,
just down the hall from the Labour Room.


So I was the one to receive the freshly born babies,
bathe them, wrap them in their mother's saris, and make sure they’re keeping warm, and doing well.


On that day,
I met a boy.
He has dark chocolate eyes and the sweetest little chin.
And he looks great in blue.

Look how handsome! He's winking!

Sometimes newborns look a little funny, their faces can be squished or distorted from birth, but this little guy was so cute.

I got to spend a little more time with this baby boy because his breathing wasn’t so good at the beginning so I had to give some supplementary oxygen.
He evened out and became steady in no time.

Of course he didn’t know how cute he was, but I sure did.

With a shock of black hair and the cutest little smile,
he won the hearts of the other student nurses too.
One of them parted his hair to the side like a proper gent!

We held him a lot, sang to him, and welcomed into the world.


In the newborn room, the fans are turned off,
because babies lose heat very easily.
I looked at the room thermometer and it was 35 'C!
Fully clothed with my thick blue unform and pants in the stagnant Indian heat,
once again, my handy dandy hanky was put to good use to dab my ever-moistening face.

This other little guy was a forceps delivery. He had quite the rough go.

Notice his distressed little hands clasped together!!

As you can see, he has forceps marks/bruises around his eyes from where the steel, unforgiving clamps reached in and pulled him out by force.
Ugh... forceps deliveries are horrific to watch.

I also paid lots of attention to him because at first he was virtually inconsolable.
But, with singing and rocking, and a nice tight embrace,
he settled right down and fell asleep in my arms.



It was a very nice day in the newborn room,
you take on the role of "mother hen", tending to all of your little chicks!

Feeling the Heat

Yes, we are feeling the heat in the city now.

We never really thought to check the temperature, we just knew it was “hot”.



Turns out it’s 39.40.41.42.45.... yeah.
At least it’s a dry heat,
Humidity would just be over the top!

We still wear punjabis and scarves though ... we just just drink lots of water.
Hot, room temperature water, that is.

The air, regardless or where you go,
feels like we are walking around in a convection oven.
The wind is warm, and it just blows hot air on you all day.
Outside, inside, it’s all the same.

In our room, the fans just circulate hot air.
It’s kind of insane when the power goes out and the fans stop. Then you really notice how hot you are because you body goes into significant sweat mode.
Almost immediately I can feel real drips running down my eyelids. We use hankies now to dab our faces.
Corinna and I have noticed that when we feel our skin, its like we have a fever, because our arms and foreheads are physically warm to the touch!

At night we fill a bucket with water by our bed and then dip a sirong in it to make it soaking wet and then lay it on top of our body.
So with the fan blowing it makes us feel “cold”... or you could say “less hot”, or “much warmer than lukewarm”.
This sirong or sheet dries in less than 10 mins in this hot convection air,
and then you dip it again,
until you fall asleep,
and wake up during the night to realize you’re dry again,
turn over to your bedside bucket
and dip it once again.

Yet, I still manage to crave a cup of hot tea.
It just feels nice to drink something really hot.
Maybe it makes you feel cooler because the drink is like 80 degrees, and you’re only 40 degress warm.

Anyways, when the fans go out it’s a different story,
but everyone’s in the same boat together,
so we don’t even really talk about it or complain,
because all of us, including the Indians;
are feeling the same thing.

Just thought I’d let you in on the Indian beginning of summer.