Tuesday, April 24, 2012

First catch!

Pink Torch Ginger

I’m no stranger to being up at all odd hours of a night.  It has largely been the story of my life over the last handful of years.  Birth is not a 9-5 job. Pregnant women do not just wander into labor land after her midwife has had the luxury of a full night’s rest, a tasty & fulfilling breakfast, and a hot shower to top it all off.

It’s rarely ever on the nights where you’ve gone to bed early, prepared to rise before the birds even begin to think about singing the sun up. No, they come calling just after you’ve crawled into bed (later than you should have), clicked your light off and your head has hit the pillow with gratitude for the end of the day.

Here at VH, with the exception of nights, I have had the opportunity to observe some variation of crazy busy on each of the “incorporated” shifts.  So, last week, I took a leap-ready for some action by the light of the crescent moon.  Isn’t that when most babies come calling, after all?

Perhaps babies here don’t love the dark of night?  Maybe the light of such a small sliver of moon isn’t enough to draw them from their warm, watery bliss?  Whatever the case may be my first night was full of anything BUT birth.  I busied myself with finding any measure of expired item I could find.  Much like an Easter egg hunt, however, without the usual anticipation of dark chocolate delights that await the eager egg huntress! 

I thought long and hard about tackling the storage closet.... and decided that it was not a battle that I was prepared to “fight.”  Bags full of questionable items, boxes filled with smaller boxes, shelves dripping with supplies of a medical nature that I have never encountered... It would have been something akin to playing hide and go seek and I feared I would not be the victor, but left to wander into perpetuity trying to make sense of it all. 

So, after sitting and staring at the Oxford Handbook of Midwifery for a couple of hours while the midwives were having a heated conversation in Patois, I decided to take my leave and “retire” to the PET room to rest my head.  They reserve the PET beds for employees who have had babies or have had some procedure as well as people of greater import than the regular admissions off the street.  I left the ladies with instructions to come gather me if there was any sign of new life on the way...

The cacophony produced between the incessant dinging alarms of the “NICU” down the hall accompanied by the occasional confused roosters, Castries rabble-rousers, and the “animals of the night” I, somehow, drifted off into some kind of slumber. It was easily the most disjointed thick paste of consciousness somewhere deep in between waking & dreaming I have ever experienced. I was all to eager to withdraw and detach myself from its grip.  That sandman can take a hike! It was with great delight that I was greeted by the beaming grin of one of my favorite midwives about the same time all the roosters were stirring & eager to begin their premature oral address for the day.  She came to let me know that there was an admission; she was at 4cms, they had already administered the customary “douche.” She was a first time mother moving very expeditiously through labor. I washed the sand out of my eyes and joined them.

“She’s a sickler.”  (Aka sickle cell disease-SCD).  Everyone is tested here for the sickle cell trait and disease (as well as the routine battery of “prenatal” tests).  The disease can complicate a pregnancy significantly with sometimes-tragic outcomes.  Women with SCD are at increased risk for things like UTIs, gallstones, and further complications of anemia leading to heart enlargement and heart failure.  The risks to the fetus are significant as well and inlcude miscarriage, poor fetal growth (IUGR), pre term birth (which has its own host of complications and long term implications), low birth weight, stillbirth and neonatal death. Some women in St. Lucia receive little to no prenatal care (even though it is free) and even fewer receive genetic counseling for SDC or Ultrasounds to follow up on fetal well-being. 

This young woman was given IV fluids to prevent dehydration (which can elicit a sickle cell crisis) and was placed on EFM for the duration of her labor. As it turns out, we didn’t have to wait long.  We got her settled into a labor room and the midwives (yes, ALL three of them) set to watch me set up for my first catch here at VH.  I’m used to having one set of eyes on me, sometimes two (clinically speaking).  To have three midwives chirping various bits and pieces at me was somewhat overwhelming, especially for what turned out to be a very normal & uneventful delivery.   (For the record, I like “boring” “normal” and “uneventful”-all things that make for longevity in my work and a smile at the end of the day for all parties involved.  None of these qualifiers take away from the beauty and richness in the process of birth.  Excitement in birth is something I neither require, desire nor invite.)

We all have “our way” to go about doing things.  What works for one, may not necessarily suit another.  These ladies all had different pieces of “advice” for how to proceed on the same thing.   I am reminded, again, that I am here to “learn” not to “teach.”  However, I trust my hands to help usher these little souls earth side.  I’m finding it is a thin line to walk along in these moments.... to listen with an open mind and, at the same time, not offend if I don’t heed their bits of wisdom.  I deeply admire how some of these women go about birth.  There are juicy morsels that I will bring back with me and into my practice as a midwife, just as there are a number of things that I will happily leave behind.  (One of the midwives said, with enthusiasm, that I should bring back strong encouragement for routine “douche” in labor. Interesting to consider how that informed consent discussion for routine enemas will go over with clients.)

Amidst the hoots and hollers from the peanut gallery (In all sincerity, truly my dream team-those three were a total delight to work alongside!!!) a 3.20 kg, healthy baby boy was born into my hands.  Pink & screaming he was given to his mother for a brief moment before heading to the warmer for the routine NB ritual.  While I wrapped up the rest of her third stage and got her all tidied up, one of the midwives made it very clear to this young woman that, under no circumstance, should she become pregnant again.  The midwife pointed out that, she selfishly, had already put herself at great risk and has potentially passed the SCD (or at the very least the sickle cell trait) on to her infant... The precarious balance between the bliss of having a healthy baby & the reality of some particular piece of an individual’s story here is palpable.  I want, so desperately, for these women to have many uninterrupted, blissed out moments marinating in the smells and sounds of their sweet, delicious babies.

A girl can dream....  In the meantime, the baby biz is pickin’ up again at VH & I have had the pleasure of welcoming several other sweet souls since my “first catch” here.  Stay tuned.

Les Pitons and the town of Soufrière

On a not-so-covert Cacao mission...

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