That Skill You Hope You'll Never Use

Oh you guys, God is gooooood. Nothing surprises Him. Nothing is out of His control. I'm so humbled to be reminded of these simple truths.

I've practiced CPR so many times throughout my healthcare career. Like any healthcare provider, I've had to prove my competency at frequent intervals. This meant attending uncomfortable classes where I knelt on the floor to kiss plastic dummies, or found my unfortunate partner's navel for the Heimlich maneuver. To have a working knowledge of CPR is important, obviously, but when you're talking to a hunk of plastic that only slightly resembles a human torso, it just feels a little embarrassing. I have always hoped those skills would never be needed. 

When Seme was told that her baby's cord had prolapsed, the hospital staff promised her a c-section. She signed the release and then waited. And waited. And waited. She was so composed and I was working with several women, so I only popped in occasionally to check on her.

Before long, she was transitioning and making more noise so I moved over to be closer to her, wondering when the OR staff were going to come and take her to the promised c-section. A doctor wandered through the ward (literally, wandered) and casually checked her. 

"She's fully dilated. We can't do a c-section now. She'll have to deliver vaginally. And it looks like the cord has retracted back and is in a normal position now anyway."

Seme labored on. When she was ready to push, a midwife came over and checked her again.

"Yup, there's the baby's head. And oh, I think that's the cord!" She called to another midwife to come verify.

"Yes, that's the cord presenting first!" Then she swore.

Both midwifes began to shout at Seme. "Look, you have to deliver this baby fast! You have to push it out right now or it's going to die!!" I stared at them, aware of the danger the baby was in, but disbelieving their approach to a safe delivery. Looking back, I shouldn't have been so surprised. As long as I've been going to the ward, midwives have been shouting at expectant mothers. 

Poor Seme was red in the face and every vein on her forehead and neck were bulging. She pushed with all her might with barely a breath in between efforts. The midwives were getting increasingly more anxious and so their shouts became louder and more urgent.

"PUSH!! Don't stop!!"

Fear was clearly written across Seme's face. I leaned in close to her ear and spoke softly, "Seme, this is your fourth baby. You're practiced at this and I know you can do it. God will give you the strength you need." And I fully believed He would. I stood over her praying fervently for her strength and for her baby's life.

Only three more pushes and a baby girl came sliding out onto the bed. She was completely limp and gray. I've seen so many flaccid infants. The images are seared into my mind. No flailing limbs, no gurgling cries. Just a sickening flatness and silence. 

The midwife felt the cord. She felt the baby's chest.

And then, out loud for all of us to hear, "There's no pulse."

Immediately, I reached over and started giving that sweet baby chest compressions. It was as if my hands were moving independent from my body. I vaguely remember asking if I could give compressions as I moved in to do it. No one answered my question and it didn't matter. My only experience with infant resuscitation was on a baby doll in all of those CPR classes. This felt entirely different. Yet somehow, it felt right. Praise Jesus for His help and confidence when I needed it! There was no doubt about what needed to be done.

The midwives now rushed to clamp and cut the cord. As soon as she was free, I scooped our girl up and all but ran to the warmer where a midwife began bagging oxygen through a tiny, neonatal mask. I was so relieved that she got a good seal right away and that each squeeze of the bag made the baby's chest rise and fall. I continued to give compressions for a few more seconds.

And then...a pulse! We put our hands on that tiny chest and her heart raced under our fingers. How can words tell what that felt like?! I just stood there in awe while that darling midwife and I exchanged beaming smiles. She continued to bag and it was a long time before our girl began to gasp and try to pull air for herself.

After some time, the midwife exchanged the mask for a nasal cannula. Baby girl's lips were puckered tight and she looked beautiful but stressed, and I was still worried for her. She'd had a rough beginning and I knew she wasn't out of the woods. After the urgent rush of activity, I realized that Seme was alone and no doubt worried. I went back over to give her an update. I told her that her daughter was breathing on her own and practicing her suckle for nursing. I delivered only the positive facts, but my mind was reeling with the baby's obvious respiratory distress and how I could speed up the process to have her further evaluated. 

A long half hour later, a resident from the special care nursery came and took her away to be examined. There didn't seem to be any rush and I never saw her again.

During our exchange, Seme took my arm. She smiled. "My baby will have your name. I'm going to call her Jessie."

Oh the joy and relief of restored life, the hope of health, and the sweetness of sharing that moment with Seme. What a privilege to be the namesake of her baby girl. I gifted them a little pink knitted cap before I left; the beautiful handiwork of a friend in the States. 

Please pray with me for baby Jessie. She was deprived of oxygen for too long. I will never know the effect it had on her brain and development, but she's a miracle nonetheless. 

"Oh the depth of the riches of the wisdom and knowledge of God! How unsearchable his judgements, and his paths beyond tracing out! Who has known the mind of the Lord? Or who has been his councilor? Who has ever given to God, that God should repay him? For from him and through him and to him are all things. To him be the glory forever! Amen." Romans 11:33-36

Life is precious. God is good. 

Return of the Doula (sans Obi-Wan Kenobi)

How's that for a cheesy title! And how nerdy is it that it keeps cracking me up?? Oh dear.

After a near two-month absence because of a long strike at the hospital, I returned to the ward this month, anxious to be with the mamas again. In fact, I was so excited that I dreamt about babies all the night before! I am happy to report that I have seen nine deliveries this month already and have held more sweet babies than I can count. Hooray for new life!

Side Note: All the details of the strike are fuzzy but money was misappropriated, vital needs weren't being met, people were laid off and after promises of soon-to-come supplies, the staff returned to their work. Today was further proof of the horrible conditions when a missionary from another organization popped into our little mission clinic asking for a feeding tube. When we asked why, she explained that a friend is a patient at the hospital and is so sick, he can't eat. The staff there pulled the existing tube before they realized that they didn't have another to put in. Folks, tell me, what do we have to complain about?! Seriously.

On my first day back, I was visiting with a midwife when I learned that she had been sick during the strike. Aint' no big thing. Just typhoid. Wait...what?! She brushed it off like it were the common cold. Some days I think, "Where am I??"

That same day, a sweet woman was referred to our ward from a local clinic. After a failed augmentation two days prior and an attempted vacuum extraction the day before, she still hadn't delivered despite being 10cm dilated! Yikes. The midwives augmented her again in preparation to vacuum extract again. Poor woman. When they thought she was adequately "juiced", the midwife produced a contraption that I hadn't seen before. It was a power-free extractor made of plastic and something from slightly less frightening nightmares than the metal cup and chain I've referred to before. I was intrigued. The midwife gave it to me to hold while she gloved up which afforded me an opportunity to check it out. My friend and I couldn't resist the urge to snap a quick picture, although it felt like a lie because I wasn't going to get to use it - fortunate for the mother, I'm sure! When the cup was in position, the midwife pumped up the pressure with her hand, watching a small gauge on the back of the extractor. 

And then she pulled. And pulled. And pulled.

I was beginning to think the baby was going to be stuck permanently when slowly, inside the clear plastic cup, I began to see the dark hair of our little one. After much more tugging, me mopping the brow of our champion midwife and an increased drip of pitocin, the baby came. Not in the usual burst as shoulders break free, but in a struggle of pushing and pulling, right up to the end. Hear me: BIG BABY.

He was huge and he wasn't breathing. Out with him came the thickest meconium I have ever seen and lots and lots of blood. The midwife rushed him to the warmer as the pediatric resident came wandering in. He moved slowly to get oxygen (a second tank when he realized the first was empty) and suction before the midwife jumped in and took over. I stood back and watched in awe. She ran the whole show, instructing the resident and other midwives how to care for her patients. She was remarkable. Later, we praised her quick thinking and knowledgable work and in modestly she brushed it off with quiet thank you's and a laugh.

Around the time that the baby was beginning to perk up, the mama started to hemorrhage. The midwife worked quickly, instructing me to find the pitocin tablets in her pocket. I felt like I was moving in slow motion - finally getting my hands on the foil packet and popping out three tablets which the midwife quickly pushed into the rectum of the bleeding mother. It worked like a charm and controlled her hemorrhage enough that the midwife relaxed a little and could turn her attention back to the baby. 

In surprisingly little time, our boy pinked up and cried loudly. A conspicuous hat was pushed over his terrific cone head and he was promptly given to his mama to nurse.  The exhausted mother looked at me and asked, "Do you have a master?" I'd never heard the question phrased this way before. I replied that I am unmarried. So the baby was given the name of my friend's husband! This was followed by lots of pictures and sweet conversation.

At the end of the day, it's hard to walk away from such scenes - the mama and baby, safe and doing what comes so naturally. I have run into one of these mamas outside of the hospital only once. And one sent me an e-mail (Can you believe it?!) and a picture of her 6-month old that I had helped welcome into the world. But the rest are never seen or heard from again and I wonder what becomes of them. 

Most babies aren't named until several days after their birth but following the tradition of a doula friend who used to work with me, I name the sickest babies, just to give them some kind of identity should they not survive. I don't tell anyone. I just use their name in prayer. And of course, I don't know whether or not they live but when I walk out of the ward at the the end of the day, baby {blank} is still breathing. 

The ward never fails to surprise me and I'm so thankful to be back in the swing of things. 

C-Sections and Selfies

My friend and I were working with a mama who had started feeling labor pains 4 days prior. Her first baby was delivered via C-section and when this labor stalled, she asked for another. If only it worked that way... It took hours for the doctor to even assess her and then even more time before the OR staff came for her. 

As usual, she was asked to stand and change into the army-green OR gown and answer a number of questions before walking herself down to the operating ward. I was holding her IV and catheter bags and she kept looking at me and saying, "Let's go!" and walking away in the general direction of the OR. She was, however, tethered by her lines and I had to remind her several times that we couldn't leave until we had permission. She was so frustrated and to make things more difficult, she continued to contract while waiting for the tech to prepare the paperwork. She also refused to sit down. I'm sure this would have seemed like a step backwards and a move away from being done with the whole nasty business that her labor had seemed to become.

When the tech was finally ready to go, I walked a step ahead to keep her from getting tangled in her lines. My friend came third with the OR tech following last. When we reached the door into the OR, my friend and I stopped and I tried to hand the bags off to the tech but the mama said, "I want them to come with me!" I looked at the tech and then at my friend (who's face said that she was doing everything to hold back a squeal). The tech said he'd ask and disappeared. In the meantime, the mama was passed off to another staff member who, without missing a beat, muttered, "You can come."

We stepped into a small room with a tall cabinet of powder-blue surgical clothes. We picked out something that looked like it would fit and then draped a sheet over ourselves - I suppose to keep germs from jumping, willy-nilly onto random surfaces as we walked by. Last but not least, we slipped off our shoes before leaving the room and then walked the full length of the OR to the women's dressing room at the other end. I was too excited to think about what I was stepping in with my bare feet or the fact that they say the pores on your feet are bigger than any others on your body. 

We changed into our scrub dresses (yes, you heard right), tied up our hair in army-green bandannas and borrowed two pairs of bumblebee-yellow galoshes. When I slipped my foot in the first boot, I felt something and jerked my foot back. Why the owner was storing dirty plastic bags in her boots is a mystery.  *shudder* 

We donned our masks and followed the nurse into the operating theater. Our mama was being prepped and given an epidural. Normally, they like to completely sedate the patients for c-sections but the baby was showing more and more signs of distress so they decided it wasn't worth the extra time. 

Once mama was prepped and ready, the staff let my friend and me stand at the foot of the bed. It was the perfect vantage point and there was nothing to obstruct our view. The doctor made one smooth incision and then he and the scrub tech pulled, leaning back to utilize their body weight, to stretch the opening to make room for a baby. 

It was barely 15 minutes and he pulled out a very, very large baby girl! She was partially engaged in the pelvis and so he had to pull her back up towards the mama's chest and then out through the incision. Had the baby been further down, a c-section couldn't have been possible and the labor ward staff would've tried using the vacuum extractor. As much of a bummer as a c-section is, I wouldn't wish vacuum extraction on my worst enemy! I was thankful when I heard our big girl start wailing. She was carried off to be given a once-over by the nursery staff.

Lucky for us, there was a med student watching too and he was happy to answer all of my questions as I watched in complete awe. When the doctor was ready to stitch the mama up, he pushed on her abdomen until her uterus popped out and was sitting on top of her belly for easy access. Yes. It reminded me of being 8 years old and learning about homesteaders using pig bladders as balloons and 19th century water bottles... 

The doctor was amazingly fast and had mama stitched up in a short time. We waved our goodbyes, thanked everyone profusely and slipped out. After taking a number of fun pictures of us in our super awesome outfits, we reversed the process, ending with retrieving our shoes from the first room and heading back to the ward. It felt like coming back from the land of Narnia and trying to figure out why no one has been wondering where we've been. 

"But we've been gone for hours!"

It was really only about an hour and half but it was so neat to be allowed a peek into the mysterious interior of the OR. I've watched plenty of women disappear behind the doors and have always wondered what happened back there. Now I know. I've worked in some beautiful, 1st-world operating rooms and I was worried about what I'd find here. I was grateful to see the theater, relatively clean and to the best of my knowledge, adequate for the procedure. 

At the end of the day, my friend and I visited our mama and her new baby in the post-natal ward. Both looked great and after congratulations and some newborn snuggles, we headed home for the day.