Helen lay on her back, legs splayed, the end of the bed removed to allow the midwife to get closer...and pull harder.
She was delivering her first baby and having a very difficult time. When I saw her bloody ear, lips crusted with dried blood, and the evidence of a bloody nose, I asked if someone had hit her. This wasn't an unusual question. Many women arrive in the ward bruised and cut. If it isn't the rigors of their hard lifestyle, it's at the hands of their husbands. One mama had to nurse her infant with one hand because the other was covered in bulky bandaging. When I probed her, she told me that her husband had cut her with a bush knife just days earlier.
Helen couldn't speak so she just shook her head in reply to my questions. The midwife explained that Helen had had such a difficult labour, she had smashed her head into the metal on the bed and bit through her lips. These details should have given me some idea as to what kind of labour journey I was about to embark on with this woman.
I put on gloves and moved in close so that I could support her while she pushed. First babies can be a longer wait but this one was taking too long. And Helen was small. We encouraged her pushing for a long time before the midwife took scissors and gave her the largest episiotomy I've ever seen. The first cut was at least two inches in length and each time she pushed, the midwife cut a little more.
Still the baby would not come.
The midwife was getting anxious and called for more help. I held one of Helen's legs and the second midwife held the other, high up on her chest, while the first midwife pulled with all her strength, twisting and pulling, pulling and twisting.
And still the baby would not come.
Then the midwives swapped places. The second midwife took up the position of the first, leaning back and applying all of her body weight to pull the infant out. I cringed while she twisted and yanked on the baby's neck. Already I could see that the infant was oxygen-deprived and it was bleeding from it's nose.
Finally, with one more herculean effort, the baby came free and was flopped, limp and purple on his mother's chest.
No cries. No movement.
With glacial pace, the midwife clamped and cut the cord and moved the baby to the warmer to assess him. I stayed with Helen but kept glancing over toward the warmer where the staff were slowly hooking up oxygen and getting the neonatal mask from it's drawer.
I wanted to scream. It was all taking too long! Each second was precious and each second they spent fiddling with a bit of tubing or trying to get a good seal on the mask was time wasted. At one point, someone drew up an immunization and injected it into the baby's limp leg.
Why?! I wanted to yell. What good will that do? Help the baby breathe!
For some time, the midwife struggled with the mask and each puff of air leaked out around the baby's lips, and his little chest didn't rise and fall.
Meanwhile, exhausted Helen had delivered the placenta and was still complaining of considerable back pain. Each time the midwife would come over to suture the record episiotomy, she would get called away. I rolled Helen onto her side and rubbed her back. When the midwife would head our way, I'd help Helen onto her back again to spare her a scolding from the tired midwife. We went on like this for a while until...
Helen lost consciousness and began bleeding uncontrollably.
By now, there were three doctors trying to resuscitate the baby. One stepped over to access Helen and immediately started giving orders. Midwives were running for one thing or another, lines of fluid were started, and Helen was washed so that any new bleeding would be easily distinguishable.
The doctors working with the infant wrapped him up and covered his face with his blanket. He wouldn't be saved. Now everyone turned their attention to the mother. They hung bags of blood and monitored her vitals but no one made any attempt to get her to the operating room.
"It's too late. Surgery won't help her." The attending doctor told us.
They brought Helen's husband in so that he could be with his dying wife. He sat on the floor next to her bed and with one hand, he reached up and touched her feet while repeating her name over and over through his tears.
A man from the lab came into the ward and told us that they didn't have anymore blood for her and that the father should be typed and donate, if possible. There are inherent risks when giving blood in a third world country, yet something in me jumped up; all fear and reservation gone.
"I know my type. I'm O and I want to give!"
"Me too!!" My friend volunteered.
The three of us followed the lab tech down to be blood typed before going over to the blood bank. He pricked our fingers and squeezed our blood in dark, shiny drops onto a large plexiglass plate divided like a grid. Little pools of blood from other people were still sitting in other squares.
"You're all O. You all can give."
We followed him again out of the hospital and around to the public entrance to the blood bank. The corridor smelled like stale urine and other filth. A man and little boy wandered up. The man was wearing street clothes and chewing on the remains of a toothpick. I was beginning to wonder if I had made a wise choice.
Clearly relaxed and in no hurry, he unlocked the door to the bank and we stepped through onto mopped floors and in among neatly arranged donation supplies and records. I immediately felt relieved. Things are looking up, I thought. Let's get these donations done and the blood upstairs!
The entire donation process took at least 45 minutes and I was anxious the entire time, thinking of our patient who needed it so desperately. I watched him like a hawk as he opened up his supplies. The needles were unused and wrapped, opened just for us. He pushed a 20 gage needle into my vein with a practiced, steady hand and the blood ran into the bag hanging next to my bed. He taped the needle and moved to the next bed to repeat the process with my friend. By the time he got the husband started, I was finished and he came back around and removed the needle from my arm and tied off the tubing.
Our blood went warm, right upstairs to our hemorrhaging mama. I've never given blood in an emergent situation such as this and I've never had it used so promptly. I was thankful that there were no further delays.
The last image I have of Helen is of her, lying unconscious, face so pale. The bright, cheerful paintings next to her bed looking rather out of place in what is otherwise such a desperate scene. We left only knowing her poor prognosis and we didn't know if our blood had made any difference.
It wasn't until yesterday, two weeks later, that I learned that she survived! She received a total of 10 units of blood and spent a week in the hospital. She didn't have a chance to grieve the death of her child amidst her own emergency. I can imagine her loss is officially sinking in now. Pray for her when you think of her.
The other stories from this day are of the woman across the room who also hemorrhaged around the same time as Helen. This woman passed out and narrowly missed dropping her infant on the floor when a midwife reached across her chest and caught the baby by its arm. Both mother and baby are well.
Another woman, whose baby lay transverse, was told she couldn't have a c-section. I'm not sure if this was because of unavailable staff or a free OR theatre, or for other reasons, but when I left, she was laboring hard and no one was caring for her.
It's days like this one that strengthen my resolve to get more training. When there is so much that is preventable and lives are still lost, my heart feels like it's going to explode. I'm burdened afresh for the estimated 830 women that die every day from preventable causes related to pregnancy and childbirth. That can change!
