technical difficulties

I'm trying to recover my iPhoto library which is now coming up as empty. I have many of my Vanuatu photo's saved elsewhere but I am still frustrated. Will post what i recover soon.

23 babies

So I tallied up my numbers yesterday and I have done 23 births in 2 weeks at Vila Central hospital. Definitely more boys. I have sutured about 5 times, helped a few women avoid episiotomies, managed 12 births with little more than a nod from the staff midwives, consulted the OB's, and given loads of women loving care with mostly non-verbal communication. I am so happy I have come. It has definitely been worth the expense. In the next few days I will say my good byes with lovely homemade meals and get more photos posted.
As for today we are taking a car to go and explore the island so I'm off. More later.

More babies, most of them boys...

4-11-09
More babies, most of them boys. The hospital is going great, did a tour on Friday of all of the different wards with an Ausie nurse who is teaching in the Vanuatu Nursing program. Managed a few births of which I had 4 of said nursing students as observers, and one just about hit the floor. Poor girl I just saw her white as a ghost start to slide down the wall, but my hands were quite busy with baby catching & placenta delivery. I had more opportunity to suture, which I still find distasteful, but I am feeling much more adequate at doing it.

I rushed out of the hospital on Friday to try and catch a few “Couch Surfers” (online travel community) at a bar in town for happy hour but the rain caused delays and I was ½ hour late and they were no where to be found. I wandered to the open market and then got a bus up to the hotel. When I arrived there was quite a lot of cooking going on in the “baby doc lounge” and it was not anyone I had met so far. Turns out a bunch of Peace Corps were in town for the weekend and were bunking up at good old Coconut Palms… they were also having a feast night with Porto Rican food. They invited me to join, which I of course did. It was great having a bunch of Americans to chat with over great food.

Saturday I spent most of the day at the hotel doing homework, then jumped in the pool at 4pm and stayed in until the sun was setting. I didn’t go to the hospital which was weird, but figured I deserved a day off- too bad I wasn’t out enjoying it but did homework. I still have lots to do and unfortunately some of it I can’t do here because my books didn’t arrive in time to bring them with me and I have had internet challenges.

Today (Sunday) we (NZ SMW & Brit from plane) were hoping to head out in a rental car around the island but they cars were all booked so we will do it on Tuesday instead. So Meg & I sat about talking and then wandered down to town, which unfortunately we forgot it was Sunday, it was deserted.

So after making some dinner decided to head into the hospital for the evening. It was a good night, I observed a cesarean section, and then caught a baby from a 1st time mama that was very young (her chart said 13yo, but the docs and I think she is more like 16yo). Her labor went great, but in postpartum she had a cervical prolapse (meaning the cervix protruded from the vaginal opening. It was very shocking to have that happen on someone so young. She had obviously been through some serious abuse in her short life. I then headed home to the hotel and passed out while writing this blog.

More rain...

Let see if I can catch you all up…sorry I haven’t written much, without free internet and with companionship I am opening the laptop less.

My experience at he hospital is going well. The 2 babies I had written about in my last post, the one with the tongue-tie has yet to have been clipped but I did make his mama a syringe nipple extractor, as there are no breast pumps available. With this tool she has been able to express colostrom and get the baby to the breast a bit more, he still does not suck well but with a nipple shield and spoon-feeding he is becoming more active & awake. His sweet mama is become quite my fan, and has even asked to stay in touch via the internet. She was still at the hospital as of last night (day 4 postpartum), and may be heading home today. I still think the baby should have the frenulum clipped but the doctors seem to feel that it will be fine, they say they don’t do that here. The other primip mama I was concerned about, baby did develop jaundice and need to be treated with billi-lights, but has since gone home.



The labor ward has been pretty quiet since Sunday, we have had a few C-sections, a few born before arrival (BBA), and I have caught 1 and assisted with a vacuum extraction. There was one more fetal demise, for which I was not present, the baby crashed and mama was rushed, as quickly as possible in Vila to have a cesarean, but it was already too late. The mama that had the breech demise came in to have her tubes tied but I was not present. I hope she is coping well with her loss. I ended up working quite a bit with the intern doctor who handled the breech, and it has been hard on me. I am moving on but still feel the loss deeply. I know that I am doing a lot of good here and that it wasn’t really my fault but I still wish I could change it. Yesterday I stopped the midwives from cutting 2 episiotomies, for which I did a little dance of success. The midwife said she finds them easier to repair and I passed on the wisdom that I have been trained about that if you put two pieces of perineum together they will heal. Both women had mild 2nd degree’s that needed very little suturing.

The new hotel is going quite well. I am enjoying having company and the “Baby Doc lounge” is a nice place to prepare meals and socialize with my fellow New Zealand student midwife. Yesterday was lovely but rainy, we went down to the market and had lunch with the locals, and then M and wandered down the water-front with plans of heading to the arts 7 craft market area to do some tourist shopping, but ran into some friends (another intern & the brit from my plane) and didn't make it. We stood about talking for a good hour before wandering down the road to show the brit the yummy sandwich place(for his lunch) and M and myself got ice cream cones. We made tentative plans to rent a car for the 3 of us to head out and explore the island, and parted ways.

Today we had the other volunteer NZ Midwife Christine over for lunch, I made a coconut curry with eggplant and the mystery greens served it over ginger rice. It was great to have time to debrief with an experienced midwife who practices similar to those of us in the US. Then I did some laundry, which with luck will be dry tomorrow, since the rains just don't seem to want to stop for much time though it is supposedly the dry season it continues to be quite wet. Unfortunately it’s not too great for getting out and doing stuff. I will likely head into the hospital soon to see if any mama’s are ready to have babies, if not I‘ll prep supplies & clean.

Tomorrow I plan to meet with some "couch surfers" (online web community of travelers) at a local bar for happy hour. That's it for now.

Later on easter night

4-4-10 5pm

Trip to the hospital went well. I missed a lot of mamas & babies as most had already gone home. It could be the midwives took pity and let them go early as it is Easter. There were still a few of my babies there that needed a little more help. One was my 2nd catch from yesterday they kept her because she hadn’t pooped- oops that was my fault. I showed them how to do belly massage & bicycle to help with belly fussiness but also checked her chart to make sure I was remembering correctly, this little girl had pooped right after she was born all over her mama, and I didn’t chart it. I’ve gotten so lax at charting over here, they really chart so little but terminal meconium will not be left off one of my charts again. They also asked to name the baby Adrianna for me. That’s actually two baby girls born yesterday that will be named for me, what an honor.

I then went on to check in with the other mama’s whom were still there … One was still in because her little boy had yet to breastfeed, I had helped in her care early when she was admitted but she didn’t have her baby while I was there. I worked with her for about 20 minutes, I really think the baby is tongue tied, which when the baby’s frenulum is too short which prevents the baby from sticking out its tongue and often causes them not to nurse/ or nurse well. In the US this is often corrected by snip the tissue with surgical scissors, it’s quick and baby usually nurses immediately after & recovers quickly. Fortunately the pediatrician was in the ward so asked her to evaluate and talked to her about the procedure. I don’t think it is something they do over there, but I hope they do it. His mama is worried about him not going titi, as they call breastfeeding, and there is really nothing to lose. The doctor seemed sympathetic so I am hopeful, she may ask another doctor their opinion. If a different midwife had been on I may have talked to her about doing the procedure.

Next was one of my last mama’s it was her first baby and I am worried that she will not breastfeed often enough. I do feel for her though as she is probably quite sore, she was bleeding heavily and I was afraid she had a cervical tear since in Vila we practice active-management with pitocin (syntocin), and then they get a dose of methergine, so post-partum hemorrhage is very rare. The doc checked her with retractors to hold back the walls of the vagina, and after a 10 minute evaluation announced that it was just uterine bleeding. So she then got an IV drip of syntocin over the next few hours. Her baby was nursing fine but had a shallow latch, I showed her how to help encourage a better latch and how to take him off when he stops, but all in all I’m afraid she’ll have a lot of nipple pain.

So as it turns out I went to the hospital for baby checks, I was there for just over and hour. I escaped without getting wrapped up in admitting or catching babies. I’m proud of myself, as that is a challenge.

I then came back to my superior room at the Coconut Palms Resort, relishing in the air conditioning, and the mindlessness of cable tv. I proceeded to fall asleep for that nap I needed. I had planned to wake and splurge on dinner downstairs in the restaurant. The hours posted in the room were 6-10pm, but when I arrived at 9pm they had stopped serving, so back to my room for curried rice & lentils.

The entrance to the maternity ward- and me.

One of my Saturday Mama's


"Baby Adrianna with her sweet mama"

"And my sweet little toungue-tied boy- named Jaden"

The superior room- my easter treat!

4-4-10 2pm

I arrived at the new hotel, which is a modest resort, but they cater to you more here. I was greeted with a nice cold glass of orange juice, which reminded me that I left my nalgene water bottle in the refrigerator at my old motel- so now I must remember to go and pick it up tomorrow. It’s nice to see other travelers. Though my old hotel was nice enough, it was not on the tourist destination list. I felt I was the only expart there, it was mostly occupied by Ni-Van and the Ni-Van hotel staff. There is also a pool here, which I plan on getting into as it is not surprisingly very hot out today.

For tonight I have their ‘Superior room” which includes air conditioning, which is heavenly, a private bathroom, and a balcony- Happy Easter to me. Tomorrow I will move to the shared rooms- which are nice but more like a hostel/dormitory like. I requested to be roomed with the New Zealand Student midwife that is also at Vila Central hospital.

My plan for today is to settle in for a bit then walk to the hospital and get baby & mama pictures from yesterdays births, as they will all be discharged home by this evening, assuming everyone is doing well. Then when I return I will likely nap & enjoy the rest of the day in the a/c.

6 babies, and 14 hours at the hospital

So yesterday was very busy day. I caught 4 babies, and assisted with 2 others. The theme for the day was "Meconium" and there was lots of it. That's baby poop for the non-midwife, and it's concerning when the baby passes it while still in the uterus as it can be a sign of distress, and in rare circumstances the baby may have inhaled it and it can cause pneumonia. 2 of the babies needed oxygen and in Vila that means a o2 line is run into a clear plastic box which is put over the babies head. They both appeared to recover from their birth just fine. The other interesting thing I noticed is one baby had growths in his mouth, I will do some research and see what the pediatrician sid about it when I head in today.

The other exciting thing to note is that I am moving to a hotel closer to the hospital, which is great considering my 14 hours I put in yesterday was mostly due to not having a ride all the way across town at 130 in the morning when I was finished. I ended waiting till 3am to leave when the hospital driver finally showed back up, there was some thing going on involving a splene, a rupture I would assume.

The bad thing about the move is that I will not have free wireless internet so many of my post may be delayed, and I may not be able to put up as many photos, as I have to pay by the hour for access.

Ok well off to the new digs. Happy Easter!!
(which in Vila - means No one is around, feels oddly like a ghost town out there)

The board - how we keep track of all the Mama's, and yes it was almost 3am.

Nurses Station- where we do all the paper work, and there is lots.

The Birth Log- my name is in there attached to all the babies that I caught!

The new hotel- Which is literally around the corner from the hospital.

Not the post i thought I would write... :(

So I had thought I would come home from the hospital today and write about how wonderful yesterday was- the rare occasion of an over staffed maternity ward. Only one birth and all of the volunteers (3 today) missed it. The silliness of the whole affair, if you hang out any where in the maternity ward talking, don't do it at the nurses station- you might miss something. Hang out in the nice cool air conditioned delivery rooms so the midwives can't sneak in and deliver a mam without you knowing it.

Unfortunately today took a turn for the sad. I lost my first baby. To be fair to myself i wasn't managing this one but was called in by the pediatrician to help with a breech birth. It was a surprise one, a mama who had been with us for 18+ hours with PROM (premature rupture of membranes), whom we were told not to do any vaginal exams on due to infection risk.

Well she was suddenly pushing and out comes a but...
As the other student volunteer and I come one of the staff midwives was managing the birth, then in comes the 1st Call Doc and he takes over. At this point the baby is born to the belly button. There is spontaneous movement of the baby and the loop of umbilical cord is still profused and beating. The baby is born to the shoulders but no arms are coming- which of-course means the baby need help because they are above his head. At this point I am telling the Doc that you need to get the hands, the staff midwife is standing back- so I am assuming that this Doc knows what he is doing. He keeps support the baby, and waiting for a good push from the mama who is not having regular contractions, they get a pitocin drip going (this is when I'm screaming inside) and I keep calmly saying to the Doc get the arms (and holding myself back from jumping in front of him and doing it- Which I should have done!!). It goes on for a 10 more minutes before Doc # 2 comes in, it was too late at this point. He sweeps the arms out from above baby's head, there was no real response from baby. Mom then get's her first contraction in ages, and pushes out the head of a completely limp baby boy. I cut the cord, and they sweep him away to the pediatrician. We all knew it was too late. I delivered the placenta which was already separated, when the baby was born. My heart was screaming, I wanted to cry. The head Doc explains what happened to mama- the blood flow to her baby stopped before he was born. This was a very healthy full term baby boy (3400kg/ 7#8oz) He would have been the last for his mama who already has 4 other children the youngest is 8 years old. It's a shame that he was lost. I feel horrible. I know that this a problem because of the system I am part of, I will not bow down and assume a doctor knows best again, if I see non-management of a breech I will move to action- who cares if they get their pride hurt. I may have been able to save that baby if I had just done what i am trained to do- I failed.

I did what I could for the mama in the time following the doctors leaving, I brought her family in, her sister in-law asked me to dress the baby for them, which I did. Shortly after I moved them to a private postpartum room, which was soon filled with family of all types to help mourn the sweet baby that was lost. All afternoon I watched people come and go. I removed mama's IV, and we weighed the baby. A death certificate was filled out.

The other volunteer midwife went home (off to find her own way through the loss) I stayed past the shift change knowing that the best medicine for me would be to watch the family mourn, and wait for another birth to help fill the void. Shortly before the afternoon shift change I got my wish, a sweet little girl was born into my hands at 2600kg (5#12oz, which is average weight for the Ni-Van's). While I'm doing her paperwork sitting at the nurses station, the family of the baby boy bring out his coffin adorned with flowers, and they all follow it out of the hospital, the mama was discharged with the procession.

I then caught another baby boy who also weighed 2600kg, and decided after cleaning up it was time to head home to my room. I saw the doctor (#2) who finished the delivery of the breech, and asked him about the other doc's breech experience. Turns out he was an intern. I was shocked...they vaginal breech's, twins, and VBAC's regularly in Vanuatu. This was the reason I sat on my hands (figuratively speaking) and just told him to get the arms instead of doing it. I told the Doc that I was trying not to step on toes, so I told the other doc to get the arms instead of doing it, he said if something needs to be done, just do it everyone has something to learn.

I am positive that midwifery is the right thing for me to be doing, today definitely affirms it. I will not be a well behaved woman again and stand by while someone else makes bad decisions for a baby & mama, not on my watch.

I will end this hard post with some beautiful photo's of my first 2 birth mama's & babies, and the gorgeous sunset from last night.


My first catch in Vanuatu! Baby boy named Chasely.


The first baby I witnessed being born in Vanuatu (baby boy from Day #1)


Sunset starting- Staring the random boat!


Sunset finishing- with the same random boat!