...or the first baby I delivered in Nicaragua since arriving...or the first baby I delivered since becoming a CNM!
I had gone to the hospital earlier in the week. It was a day shift. As I entered the Labor and Delivery suite it was teeming with people. Currently there are a group of 8 Norwegian Nursing students here, three of them were present and accounted for, two third year Nicaraguan nursing students, two midwives, one doctor, two med students, and one adolescent patient be readied to go to c-section. She had arrived at the hospital the evening before after pushing for hours at home. When she came to the hospital she was 3cms dilated. After several hours in the hospital, rupture bag of waters, and pitocin she never progressed past 8cms, so was sent back to surgery. It has started to emerge through my time here and some research in Guatemala that women are instructed to begin pushing as soon as they experience strong contractions. Many women become quite exhausted with the work of pushing up against a closed cervix...and then end up in the hospital being wheeled into surgery. That day there were 4 c-sections and no more laboring patients, so I headed home for the day, deciding that a night shift might be more interesting, and at least less crowded.
So last night I went in to Labor and Delivery to be on shift with my friend the midwife Martina. We had a labor patient already there. She paced back and forth with uncomfortable, yet mild contractions. She was a G3P2 at 39 3/7 (for those who care!) who had been sent to labor and delivery at 5cms at 4pm, at 7pm when I checked her cervix was unchanged. The physician on call decided it was time to augment her labor and she was given pitocin (5units in 1000cc, 8drops/min) 30 minutes later she had a desire to push. I checked her again and she was 8cms with an intact bag of water. I ruptured her membranes to reveal moderate meconium (which came first the oxytocin or the meconium we will never know). 5 minutes later the mother pushed courageously and silently to the birth of her vigorous baby boy. She has two daughters already and was planning on having a tubal ligation, so was quite ecstatic to welcome her son into the world.
All-in-all it was a gentle, uncomplicated delivery. I had been feeling nervous about attending a birth since it has been almost 4 months since my last one...but I guess it’s somewhat like riding a bike, especially when you have all that excellent training behind you! It felt natural to be there supporting the woman, flexing the baby’s head, gently unhooking the two rings of cord that were about the babies neck. It’s also such a great opportunity to work with women in a surprisingly low intervention setting. No electronic fetal heart monitors, no tocometers, no IV pumps...Just a set of hands on a belly and a watch to count contractions, a handheld doppler, and a baby warmer.
One of the things that I love about being in this setting is the exchange of ideas that occurs. I have the opportunity to learn how things are done in this setting: using the partogram, charting in a different language, etc. And the midwives have the opportunity to ask me questions about birth in the U.S. The most recent conversation has been about the position that women birth in the States. Most deliveries at Hospital Nuevo Amanecer are done in the lithotomy position, that is flat on the back with legs in stirrups. I explained to the midwives that women also deliver in that position in the US, but as midwives we are trained to attend women in a variety of positions such as standing, squatting, hands and knees, etc. The nurses were so excited about this, and asked me to bring them pictures that explain how to attend women in these positions...Where is my trusty Varney's Midwifery when I need it! They explained to me that there have been women who have refused to get on the birthing table (yay!) so they have delivered their babies standing or sitting, but they wanted more instruction on this. They also say that ultimately it is the woman's choice where and how she wants to deliver.
