by Joana
It was a cold and windy morning.. Not the kind of weather that I usually enjoy, but it would end up to be a unique and special day. The busiest I had ever yet seen at Mbagathi District Hospital; the day I would deliver my first little baby.
On this particular morning, 6 woman were in labor all at once. It was a sight and sound to make you begin to pray, and indeed, praying was something of an addiction to me when I worked here. Everyone was running around. It was too early for the usual nurse in charge to have decided to show up, so we scrambled to make some order out of the chaos. The nurse interns had a pile of files and were working on gathering patient history and some basic observations. The interning doctor on shift was Calvin. Since the morning that we tried for hours to cannulate an extremely overweight patient, him and I had become good friends. He was also very good at deliveries, I had always learnt a lot from him. Now he was preparing each and every mother for the birthing and I was his assistant. And that s just the team that we were: 3 nurses, another CO intern , Calvin and then me.
Each of the mothers in labor had a unique way of expressing their pain and apprehension; some howled and some muttered meaningless nonsense, others just hit their beds with unexplainable strength and energy.
I was setting up an Iv solution for a young mother in her early 20s. She was freakishly thin with dust and grime covering her little body and her swollen stomach. Her contractions were coming fast and strong..i could just see the bulging around her opening each time at the peak of a contraction. A quick examination confirmed that, yes, the time was near. I started calling for Calvin, ‘it is coming, it is coming!!’ he was very calm but also very preoccupied, “I can t be there right now,” he told me, as he slowly drew medicine from a vial into a syringe. ‘you know what to do right?’ I knew I had the basic idea, I had practiced with big plastic dummies in class and I had observed countless births since my very first shift in maternity. A wave of confidence suddenly swept over me and I agreed that, yes, I could do it.” “ok, that s good. Remember to support that head and those shoulders,’ and that was that, left alone with no time to lose, that baby wanted to come out, and come out NOW.
I tore open the delivery pack and began preparing the birth site, while supporting the perineum with a heavy wad of cotton. The young mother was holding onto my coat and at times tugging at me ferociously, unnerving me that I might lose my balance. It was not her first child and she was a great pusher, she panted and moaned and shrieked .I encouraged her that with each mighty contraction the baby was slowly being revealed. Suddenly the head popped out. It took me a second to react and start wiping the airways of the little head…there was more pushing and shoving and then the shoulders came out, one at a time. I caught it just in time as the whole infant spurted out with a considerable force. It was so small, warm and slippery, I had a terrible thought that it might slip form my trembling hands.. But that didn’t happen…I placed the baby on mommy s stomach and she gave it an intense look, as if she couldn’t’ t decide what to feel. It was a baby boy..pinkish brown all over with little scrunched up face and large lumpy head covered in dark thick curls. A quick rub on his back and his screams filled the room along with the all the others, like a symphony of wails. It s was the sound of new life. Little souls protesting their reluctance to enter this world. And yet all I wanted to say was, ‘welcome! welcome to existence!’ The cord clamps were attached and I cut the filmy cord that had stopped pulsating. A quick glance up at the clock on the wall to my right to note the time: 9:15. I was feeling elated and out of control. The nurse ran over to whisk the baby off to the resuscitation machine: to be suctioned, dried, oxygenated and so on and so forth.
Joana EMT ready..
Blood was oozing out slowly and steady out from the mother. I had a gag reflex as the scent of everything suddenly seemed very strong. I inspected the site and was incredibly relieved to note there was no tear, (as I dread little else more than having to suture). After a few minutes the placenta was ready to be delivered. I massaged her uterus until I felt it contracting into a grapefruit sized lobe beneath her navel. Giving firm and even pulls on the protruding end of the cord with one hand and applying downward pressure on the uterus with the other, I know that this will help the placenta to move down and then out. As it was slowly proceeding, the cord would be wrapped more and more around the forceps that I had used to clamp the cord at the mother s end. Eventually the whole thing slipped out in a smooth’ swoosh’. As it came out it was caught in my two hands and turned gently until all the membranes were twisted. It was very important step to then thoroughly inspect the placenta to assure that it was all intact and no pieces were left behind which would be a potential source of infection. Then there was the final work of cleaning out the clots and cleaning up the mother. I felt she worked so hard and I could imagine her relief. I went and made her a huge cup of hot chocolate. There was a big smile on my face and all the tension was melting away and converting into a deep feeling of joy and satisfaction. The mother and I shared a small moment of silence and exchange of smiles. I respected her deeply as she got up from the cot, wrapped her blood soaked kanga around her hips and limped off to collect her child. This was definitely an experience I could not forget.
