Sexy Underpants

A night at the hospital is always full of surprises. You never know what it will hold. Some nights nothing happens and I will pass the hours trying to sleep on a mattress that we open up on the floor, lying next to another nurse clad in white from head-to-toe while people come and go, knocking on the door, eating fried plantains, and searching for nursing students.

Last night began slowly. An empty labor and delivery room is nothing new to me. I often start my shifts either day or night chatting with the nursing students and midwives. When it is a night shift I often hope for one of two things: that the night will be slow and we will sleep, or that it will be so busy that the 13 hours will fly by.

At 830 still no patients. I spent an hour talking to one of the physicians, and then a friend came by for a visit. I sat outside in the thick night air, watching the moisture create halos around the street lights. We talked and watched pregnant women holding large bellies stream by, but not one of them in labor. Suddenly I heard the electronic samba of my phone ringing. It was the doctor. He needed me to come back and attend a birth. Some how a pregnant mother, cervix completely dilated slipped past me into the labor and delivery suite. I hurried back my clogs clacking against the smooth concrete floor, opened the door to Labor y parto, and approached the labouring mom. One look at her told me this baby was definitely on its way. The other midwife had stepped out, so it was just me, the nursing student, and the physician who was busy scribbling a note, back turned to the patient. I suited up into my surgical green cloth gown and donned a set of gloves significantly too large for me, tugging at the floppy latex thumbs to keep them from falling off. The mother began to push and a bulging bag of waters was instantly visible, black curled hairs from the babies head swaying beneath the membranes. Now, in the majority of deliveries the baby follows a certain dance that I have referred to before as the cardinal movements. The baby descends into the birth canal, flexes his head downward with his eyes pointed towards the mother’s back. When the baby begins to crown the head extends up and out of the birth canal, turning slightly to one side. Following this the shoulders take a turn so that they are parallel to the birth canal and with this a fold at the hip and the baby’s body slips into the world. That is, that most babies are born this way. As this mom began to push I applied my fingers to the baby’s head, creating pressure so that his head would not fly out and tear the mother. To my surprise this little one popped out, sunny side up, eyes to the ceiling, gazing directly into my own. He quickly slide into my hands and up onto his mothers belly. This technically is called a direct occiput posterior delivery, but there was nothing technical about this delivery, it was simply one human being being born staring into the eyes of another supporting his head.

Later that night we had another delivery. A very sweet woman delivering her second baby. She progressed rapidly to complete and we brought her to the delivery table. She was scared, but with gentle support she was able to find her inner strength and bring her child to light.

There are certain things in life that make someone feel like a midwife. One is empowering a woman to birth her baby with the power that she innately has. Another is teaching another woman how to attend a delivery. Last night was when I transcended from student to midwife to teacher. As I prepared myself to attend this delivery the nursing student whispered in my ear, ¨will you let me try this delivery¨. She put her gloves on and laid her hands on the woman’s perineum. She was brave and I noted that her hands were steady and her eyes clear. I felt the fear or apprehension that any teacher must have when the give over the reins to their student as I laid my hands over hers, applying pressure against the mother’s perineum trying to prevent any tearing. It’s very difficult to let go as a practitioner. I wanted the best for this patient, but also wanted to give this student an opportunity to learn the art of midwifery. Together ours hands pressed, flexed, and welcomed this babe. As the head slid forward we both checked for a cord. We both grasped our hands alongside the babies head to ease the shoulders up and out of the birth canal. The student was exhilarated as she placed the newborn up on her mother’s abdomen. I was proud to have had the opportunity to share my skills, although new skills, with this student. We delivered the placenta together, me whispering instruction into her ear. We inspected her perineum and discovered a mild tear that would require suturing. And there I was, a new practitioner instructing a nursing student in how to ease the silver half-moon needle into the red tissue, rounding it up and out. It was an amazing lesson in midwifery to support the growth of another student, and quite a personal lesson in letting go.

One of the most midwifery related actions that we do at Hospital Nuevo Amanecer is dress our patients after the delivery. We carefully bath them with wiry gauze that has been hand folded when there is nothing else to do in the labor and delivery suite. We remove the dried blood and streaks of amniotic fluid. We then help the mother to cross her legs together and slip on her undergarments in which we have placed several absorbent kotex pads. Our patient had been sobbing through the delivery and was still weeping as we cleaned and prepared her. As we pulled the underpants out of a green plastic bag that her husband had brought for her she began laughing hysterically. We all broke down, laughing like crazy as she said ¨of all the underpants, this is what he brings me? I have a mountain of underwear and he sends me back these? These sexy underwear?¨ And we all laughed until it hurt as we helped her slip on the chocolate brown, satin panties with a large cut out key hole and silk bow in front.

Birth and Death

The saddest moment of a pregnancy must certainly be when a woman hears that her baby has died. All of the hopes and dreams that she had for this unborn and unknown being lost like grains of sand slipping through ones fingers. Part of the psychological transition into motherhood comes when the woman feels the first flutters and twirls of the growing fetus within her womb. She identifies at once that this creature is of her, but is its own unique life coming to being. With this acknowledgment she begins to wonder, will she have my curly hair, will he bear the family nose, will she be kind, will he be funny...and just like that, before the child is even born the parents have cultivated a garden of hopes for their little one.

I can't begin to understand the sadness that my patient felt when she went to the clinic, concerned that her baby hadn't been kicking within her for the past two days and discovered that her baby had died. Surely the nurse or doctor applied cold gel to the plastic tip of the hand held doppler and searched in vain for the quick click-click-click of the baby's heartbeat. They probably told her that they were sorry, that it was too late, that her baby hadn't made it. After this heartbreaking news they must have informed her that she would need to go to the hospital to have her labor induced.

When I met her she was 5 centimetres dilated in labor with her first baby who had died. She was exhausted, her golden skin looked sallow, her eyes sunken with a far away look. Sweat beaded on her forehead and upper lip. She grasped her IV pole from which a bag dripped oxytocin into her veins. A cruel twist of fate this labor. Normally a labor of love and pain, women know that on the other side they will greet their long awaited baby. In a developed county this woman would be offered pain medication or an epidural to ease her through the difficult labor. Here it is not an option. With each contraction she reeled in pain. She moved from sitting to standing, to lying, lacking the strength or will to move gracefully between positions. She could not find comfort and cried out to God to see her through as each contraction surged through her. I sat with her and tried to calm her, knowing that her suffering was deep.

When her cervix was completely dilated we brought her to the delivery suite. She lay on the table, forlorn. She pushed bravely. I guided her, my hands fearful, never having delivered a baby that would not be alive. The delivery was difficult. Normally a baby rotates into the mother’s pelvis in a dance called the cardinal movements. The head flexes, then extends as it’s born, followed by a 45 degree turn at which time the shoulders align vertically before the rest of the body is expelled. But a baby that has died does not know the movements. The head does not gently extend, the shoulders do not rotate. The baby's body would not deliver. I found myself stepping aside as one of the doctors with more strength moved in to extract the baby. I had wanted so badly for the delivery to be gentle, to offer this woman just that small kindness after so much suffering, but it was not meant to be. I stood at her side as the baby was lifted to her abdomen. I wrapped her in the sterile green surgical drapes and carried her to the neonatal warmer, gently placing her onto the bed. It was overwhelming that she did not breath. Her right arm curled up towards her tiny mouth, left arm over her belly. Her small legs were pulled upwards in a tuck. She looked ready to take her first breath, ready to startle and fan her arms up and out into the world. She was perfect.

I moistened some gauze and began to wipe her face, eyes, hair, trying to make her as clean as possible given the conditions and lack of running water. She had been expecting a little girl. Her family passed back a rose pink princess dress with puffed sleeves and layers of sparkly tulle. After measuring and weighing her I fitted her white cloth diaper on. I smoothed the pink princess dress down over her little body, placed the pink hat over her moist black hair. I pressed her left foot onto an inkpad and placed a foot print on a piece of paper for the family to take home, then slipped on her pink socks. She looked like a newborn Cinderella.

One of the nurses brought her daughter over to her mother, whose eyes welled with tears. The baby was brought out to family waiting in the hall.

I wanted this blog to be a tribute to this brave woman. A remembrance for her daughter.