Friday, August 30, 2013

Excited for the Pain

Excited about pain? It may be a foreign concept to some, but for "Jackie" her pain meant the end was near!
For the past few months, I have been privileged to care for "Jackie" a woman in her early 30's with 2 boys and a baby on the way.
About 2 weeks ago, "Jackie" started to have regular contractions, regular, but painless. While this is a normal part of labor preparation that the body undergoes, for a 3rd time mother she knew that pain would mean true labor. So she waited..... And I kept my phone turned on.......
I had that midwife's instinct that when true labor hit, baby would soon follow.

I was just heading to the clinic for swing shift when I received a text. "Jackie" had arrived for her prenatal exam. We had to reschedule from the day before as it was her 2nd son's birthday. 
As I arrived, "Jackie" was full of smiles. Her sweet bubbly face told me that something was going on. At our last visit, she had been nervous of impending birth, but after a long discussion and prayer, she felt much more at ease.

All was normal during the visit and "Jackie" excitedly shared that after weeks of braxton hicks contractions, she was starting to have pain! And on top of that, she had lost her mucus plug that morning... She confided that she felt baby would be in her arms soon... Perhaps tomorrow, she thought aloud...
I smiled and told her to text me at any time. I would be at the clinic all evening anyway. She laughed and said that she would see me soon.
As she left, that feeling that is beginning to become more familiar arose inside of me. She would be in labor... soon... within the next day....

Shift picked up with postpartum visits and a laboring mother. Soon I was caught up in an impending birth. I charted for the midwife... baby born at 7:37pm...
I heard my phone buzz in my pocket, but at the time I was quite preoccupied and dismissed it from my mind.
About 20 minutes later, I was finished with my tasks and went to warm dinner for some of us midwives. As I went to head to the kitchen I saw "Jackie" standing there, hands on hips, nodding. "I'm in labor now" she said, trying hard to smile as the next contraction hit. Well, dinner for me would have to wait! I glanced at my phone... ayuh, there was a text "I'm on my way now"...

While checking "Jackie's" vitals, she abruptly stopped me. I looked at her as it was completely out of character... then we both looked down as her bag of waters trickled to the floor. "SROM, clear fluid" I alerted the head midwife.
Baby's heart beat sounded good and "Jackie" did not have the urge to push yet, so I finished checking her status. At 8:30pm she was at 7cm with steady contractions every 3 minutes, lasting about 60 seconds. My instincts told me she would progress very rapidly...

We labored together with her husband nearby. She was so beautiful and strong! With each contraction she calmly breathed and moved as her body dictated. For one she would stand and sway back and forth. Reminding me of the strong trees surrounding my home. For the next she sat and rolled her head, breathing deeply through the pain. The next she laid on the bed and curled into a ball, tensing and releasing her muscles. Finally she sat up on the bed, looked at me and said... "I am ready now. I need to push."
I looked and saw a large amount of show. I knew she was ready and asked for the head midwife to come. It was time.

"Jackie" was so calm. She pushed and rested as she needed. She listened to her body, and I listened to her. At one point she started to panic, but I advised her to relax and slowly she did as the baby's head emerged.
Beautiful baby girl was born at 9:31pm... "Jackie's" first girl...

Krystine Angela
A few hours later I leave the clinic. Mother and baby are both doing well and resting in the continued postpartum area. "Jackie" only had a slight tear that was quickly repaired. No sign that she had just given birth to this big girl (7lbs 6oz) a few short hours ago aside from her exhausted, smiling face.

2am and I climb into my bed. Thankful for the blessing of birth. Thankful for my friends who are ever helpful. Thankful for my blossoming midwifery instincts.Thankful that I can turn my phone off and sleep as it is the first time in 2 months that I will not be on call. Thankful that God has given me the privilege and opportunity to serve Him.... Thankful for my life!



Thursday, August 29, 2013

Blessed Birth

I am tired as I swing my heavy backpack down and begin to unload its contents... the empty container that had housed a salad for my dinner, my emptied water bottle, and a bag of soiled laundry. I place the laundry in my hamper and grab some clean clothes... after a cold refreshing shower I look around the kitchen. There on the table is a plate with my name on it... I heat the soup and my friend who had also just returned from shift joins me.
Over the bowls of warmed hamburger soup we recount the evening's events.....

Early in the afternoon shift we witnessed a beautiful birth. This was the mother's 7th baby and things progressed quickly and smoothly. No tear, no problems, perfectly lovely....

Following this birth a few hours later, another laboring mother arrived. This was her 5th baby and her bag of waters had broken in the taxi on her way to the clinic. I helped to check her in and evaluated her contractions. She was pushing and not breathing well.
I checked. She was only 8cm and her cervix was beginning to swell from the extra pushing. I explained the need to stop pushing, but she would not listen. With each contraction, there was another gush of clear fluid. A check of her abdominal size and I suspect polyhydramnios (extra amniotic fluid).
After a little while, I was able to help her move to her hands and knees to help reduce the cervical swelling.

 I labored with her. She was not very happy with me, but that is ok... as a midwife I know that it isn't really the mother who is mad at me, but rather the hormones that she is experiencing... I don't take it personally... A few minutes after, I notice that there is baby's head visible. we offer for her to turn to her back... no response... we try to get her attention, but she is in her own space.

I know this baby is coming in this position and there is no time to turn back. I had only seen one birth in this position before. A friend leaned in and softly said "Its ok, just do it upside down"... I did. The mother would not listen, she would not breathe. Baby came fast with the next contraction.... a beautiful baby girl was born at 7:46pm.... Following baby was a huge gush of fluid... I tried to avoid it, but was not fast enough.... 'this is why I keep an extra pair of scrubs on hand' I thought to myself.... mom tore a little, but not as badly as it could have been.
Baby was named Hannah and weighed 8lbs and 4 ox... super cute baby!


I learned so much. I learned to not take things personally, to think fast, to adapt...
I sipped my soup and looked at my friend... "I love my life" I said...
Tired as I was I was so thankful. I am blessed to be in a place where I can learn so much, where I can go from a good and  busy shift back to my dorm and find a bowl of dinner waiting for me. I can sit and share my heart and learn from others all around me... granted, it is not everyone who would be able to discuss polyhydramnios while sipping soup... but this is my life. This is who I am... I am a midwife... and I am so very blessed!

Sunday, August 25, 2013

Skill #8

My skill for the month of August was... creating a new recipe (or at least, new to me!) from a combination of cabbage rolls and a sauerkraut roll recipe my friend gave me... Toss in the traditional meatball style and voila :)
I made sauerkraut & pork balls...


 They were so DELICIOUS! (All the girls at my house gave their thumbs up approval! So I decided that I would share this wonderful recipe... When I cook though, I often "guestimate" with my amounts, so please adjust as you'd like!
This made enough for 14+ people...

1.5 kilo pork (3 lbs ish)
3 c. uncooked white rice
2 onions chopped
chopped garlic (bout that many cloves)
Salt and Pepper
Other Random Seasonings (I think I added some Cayenne Pepper, Thyme, Tumeric.... Use what you like and what you think smells good with it :D )

2+ Heads of Cabbage
Some Vinegar
Salt
Water

Can of Sauerkraut

*Mix first group of ingredients well 
*Form into meatball size portions... keep in mind that they will swell as the rice cooks! 
*Chop the cabbage into fine strips and place in the bottom of a large pan... I used a Wok...
*Cover the cabbage about 1/2-3/4 with water, add some vinegar (1/2-3/4c? use your judgement) and sprinkle with coarse salt.
*Place the pork balls on the cabbage... the water may rise to the bottom of the balls...the balls should cover the cabbage.
*Evenly cover the layer of pork balls with the Can of Sauerkraut and juice
*Cover and cook on medium-low heat for 1 1/2-2 hours or until the rice is tender and the pork is cooked!
*Serve warm/hot with Mashed potatoes (Or I used squash and potatoes mashed together)
*****ENJOY!!!!!!***************

Any thoughts or comments? Please comment if you have tried this and what you thought about it!

Friday, August 23, 2013

A Touch, A Smile, and A Prayer

You can not always alleviate a mother's fears with words alone... often a touch, a smile, a prayer is needed...

What was it about this woman. She entered the clinic as any laboring mother does. She told me this was her 3rd baby... that she had some contractions, no bloody show, and she just wanted to know her progress. Though her mother was with her, she was anxious... her 2 young children were waiting outside for her... how long would this check take... I look at the chart as she heads to use the CR (comfort room aka. bathroom)...

After scanning through the prenatal progress notes, something jumps out to me... Suspected Abuse... "Pt reports going to doctor for 'accidental'.... medicine given"... and another by a 2nd midwife "Pt reports bruising on face from accidentally being hit"... and a 3rd "Pt is living with her mother now, separated from bana".... *

She finishes in the CR and we move to the cubicle. I look into her eyes and begin the check in. We talk about baby...
Vital signs are normal-Check...
Her GA (gestational age) is good and is near her EDD (estimated date of delivery)-Check....
Measure growth of the uterus, it is good- Check...
Positioning of the baby... I am not sure... I feel again... I second guess myself, unsure of what I am feeling... I try to find the heart tones and don't hear them where they "should" be according to my position... The thought "Better to be safe than sorry" flashed through my mind... though I have been here a year, I go and ask the head midwife to come and reassess the baby's position... LOA (Head down and body on the left side, towards the mother's front)... good... same as I thought... I try again to find the heart tones. The other midwife stands to watch. I hear them, sporadically, is that them, no, to slow... wait... count... 90, as midwives we exchange glances... I check with another doppler... 90... not good....

As I gather supplies and start to check her progress via internal exam, the head midwife prepares to start an IV and calmly asks others for more assistance, I feel reassured by her calmness. One midwife rushes in, provides the mother with oxygen, and starts to recheck the heart tones... Another picks up the charting... She is 6cm... As the head midwife inserts the IV, I glance up and notice scars slashed across her wrist... my heart breaks for her...

I hear the tock-tock of heart tones rise, baby's heart tones pick up speed... 130, 140, 136... normal, safe, good... We smile and breathe a sigh of relief... Oxygen is discontinued... heart tones remain stable...the other midwives disperse as I explain to the patient... her mother calls for a neighbor to come and stay with her laboring daughter so she can bring the young ones home. My patient looks away... she is silently crying... I hold her hand. She turns to look at me... We are alone in our little world, though her bantay and another midwife stand in the cubicle... we gaze at each other... she cries, I place a hand on her rotund belly and I pray... I pray for a safe delivery, for peace, for this new life...
 I pray, and she cries...
A few minutes have passed.... I check the heart tones again, they are good... As I talk quietly with her, she talks with me... she soon seems more relaxed, but is still tense... I can sense that she is holding back... I leave for a little while to give her space...

When I return she is standing and rocking her pelvis between the contractions... a good sign that she is moving.... I observe a contraction and check the heart tones...my gut tells me that her body is wanting to progress, but that she is still holding back.

I again talk with her... she bites her lip... "just let it out" I whisper... "Just let it go... it is ok to cry, no one needs you to be tough right now, I am here to be tough for you"... she looks at me and the tears begin to flow... She rocks more aggressively. After a few minutes she is doing better... baby seems to be fine... I give her some space...

Within 10 minutes I hear her cry out, I rush to the cubicle and smile when I discover that her response to the contractions is no longer the stoic glare, but a laboring woman... one who has allowed herself to let go and let her body work...
Though it is time for endorsements to the next shift, I monitor heart tones one last time... they are still stable... all seems well... I thoroughly explain the situation and need for extra TLC to the new midwife on duty... She smiles and introductions are made... I know she is in good hands....

My Friend returns from shift and reports that her cute baby was born less than 2 hours after I have left... music to my ears!

What was it about this woman? I have seen similar cases before... but for some reason, today, today it just all seemed that much more real to me... to see the power of prayer... the power of a gentle touch... the power of a caring calmness... the power of emotions... the power of your gut feeling, the power of midwifery, the power of God....

I am so thankful that the Lord was able to use me as a channel to show His love to this woman... To share with her that I truly cared, and that the Lord did too... This is why I am here... it isn't always about welcoming that new life personally into the world, but about sharing Christ's love and drawing them to HIM... through a touch, a smile, and a prayer

*Please note that some details have been changed, but the basic idea is here...

Monday, August 12, 2013

Surprise! Its a.....

I was very privileged to witness a beautiful birth the other day. The mother was younger and expecting her first baby. When I met her, she had just come in to the clinic thinking she was in labor. She had applied an oil that is known to stimulate contractions and they were strong, fast, and painful. Evaluation showed that she was only 3cm dilated though. After washing off the oil, the contractions subsided she went home to rest and wait for labor to progress.
After only 2 hours, she had returned. Her entire body showed that she was in true active labor. Her breathing had changed and the contractions were strong and true. She reported her water breaking 20 minutes before. No need to recheck progress, she would stay now. I labored with her and she handled the contractions well. She tried various positions for relief, but I could tell labor was quickly progressing. Her contractions had started at one in the morning and it was now 9. We would wait. We would be patient...
I monitored her frequently between a prenatal check up and a post partum exam. "Just breathe, you are doing wonderful... good job"... simple words of encouragement, but they made her face light up with pride... her baby was coming soon!
I sat at the edge of her bed and talked with her as she smiled and breathed through each contraction. I asked if she thought it was a boy or a girl... "Oh, it is a boy ma'am". The ultrasound tech had told her a boy and she was thrilled... "Just my boy and me then I am done with babies... this is so painful!" I looked at the young woman in pain, and alone. For all intents and purposes she was single. She had a bana, but didn't want him in the room or on the birth certificate... her bantay was an elderly neighbor. No mother there, no sister or aunty... just a kind neighbor and her midwife... She clung to her hope in her baby... a little baby boy...
It was then that I shared a story... of another mother who was told to expect a boy... but when the baby was born the doctors were as surprised as the parents to see a beautiful baby girl (Me!)... She just laughed as I said "well, I don't look like a boy, do I? So doctors can be wrong at times"... "I know" she replied, "but lalake sya (He is a boy)"... I smiled as labor rapidly moved on....
The time came... The time mothers look forward to and dread... Let me show you in pictures...
*Please note... below are some pictures of the beautiful miracle called birth! While I tried to withhold any graphic photos please be aware and proceed as desired... you have been warned!





Baby Born at 11:47 am

Momma's First Glance at Baby
Momma discovers she has a baby girl!


 After much surprise and deliberation, momma settled on Kyzee (American pronunciation Kacie) for her baby girl's name... for some reason, she didn't want to name her what I suggested... Sarah Jo... (her boy name was Joseph)... Total of 10 hour and 55 minutes from first contraction until arrival of the placenta...
Another busy day volunteering... another beautiful miracle... another surprise!
Welcome to the World baby Kyzee!


Thursday, August 1, 2013

From Tears to Triumph

About time to share another birth story! This one starts with tears....

A few months ago I started to help provide care for a 19 year old girl... "Lara". She was pregnant with her 3rd baby. Her first, born when she was 17, was a healthy little girl. However, her last baby was born preterm at 20 weeks in the hospital. "Lara" needed a blood transfusion and the baby did not survive.

I spent a lot of time with "Lara". I prayed with her. I talked with her. Slowly, over time, I saw her emerge from the shell. I saw her open up to me. I saw her smile.

And then I got a text... "Mam Sarah, I am having contractions that won't stop. What should I do?"... she was 36 weeks and 5 days... PRETERM!
I advised a warm bath and other labor relief, but still the contractions came. 
Finally I had her come to Mercy.

Her contractions were strong. They would not stop. One after another, 2 minutes apart.... After consulting with the supervisor we explained the need to transport to the hospital.
She cried. I saw her slowly withdraw back into the shell. There was a blank look. She did not want to go back to the place where she lost her first baby... she was scared.... I was too, but I put on my brave face... I knew this was best for her and the baby.

When I said goodbye at the hospital I prayed with her. I asked her to text me to let me know how she was. I waited all night... no text. When I was alone later, I cried as I prayed for her.

The next morning I again texted her.... and Praise the Lord! The doctors were able to help stop her labor. She felt ok now and would be seeing me soon!

Wednesday I saw her during prenatal clinic. She was doing well. We talked for a while and slowly her smile returned. She said contractions had started at night, but left during the day. They were slightly painful now, but she was term... she was "safe" to deliver at the clinic... we prayed and looked forward to seeing when this baby would come into the world....

I awoke to my cellphone ringing... text message... I knew as I reached for my phone... "Mam Sarah, my water broke. I am on my way to Mercy"
Quickly climb down from my bunk, dress, brush my hair, throw scrubs into my bag and dash for the door... then run back to grab a banana and my water bottle... time to go!
I make it to the Clinic shortly before she arrives. Things rush through my mind... "would she be in active labor? would this birth go ok?" I prayed and drew a breathe as she walked into the clinic... here we go!

8:20am labor check in. All Vital signs normal... Upon examination, "Lara" was 4cm. Time for castor oil and exercise to help labor get moving!
9:30am "Lara" wants to start pushing... I encourage her to breath... we continue to monitor the baby and all is going well.
At 10:30am "Lara" is getting agitated and wants to push badly... At 10:55am I check again... only 7cm....normal progress, but she is not happy....
I offer various positions to help relieve the pain... she refused. I try to help calm her... she thrashes with each contraction. She is finally sitting at the edge of the bed.... She wails and moans with each contraction... At times, she digs into her bana's wrist... Then she bites down... His eyes widen and look at me pleading... I try to calm her....
"I can't do this any more Sarah... Sakit Kaayo... Daghan... NOOOOOO.... I CAN'T Anymore!!!!"
I try to help her breathe... I try to help calm her... she looks at me with fire in her eyes... She is DONE being pregnant... she just wants to push this baby out now.... reasoning will not help...
11:20am She throws herself down on the bed wailing.... I do a quick check... well, the baby's head is now visible... time to push!
The rest was a breeze... a few short minutes of pushing and breathing...the head emerges... tight nuchal cord, somersault, baby out... 11:25am
Welcome to the World Baby Dleanrain!

The tears again flow, but this time in triumph... baby "Rain" is a handsome baby boy who appears fully term and healthy... Another precious life enters the world!

Baby "Rain" -- 2600g/5lbs 12oz 49cm long


So Peaceful!

Sweet Family!

One Proud Papa!


Another sweet birth! God is so good to me! Every birth is such a miracle! I am always amazed each time I see a mother go from frantic to calm in just seconds... the tears of the terrified to the tears of the Triumphant.... God definitely had His hand in this birth! I am so thankful for all He does!
Praise the Lord!

(oh, and if there was any doubt.... I LOVE MY MINISTRY!!!)