Have birth-bag, will travel...: 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.