Friday, March 27, 2009

A day off, and that #*&@(*&#$ partograph

On Wednesday we took the day off. We walked into town to get sandwiches to take to the beach, and went to the market. Someone who had been doing labor-support of some sort at the hospital for a relative was at the market. Shamefully, we had no idea what her name was, but she remembered us, shook our hands, and gave us a largish bunch of the itty-bitty bananas they have here. We also ran into one of the midwives there, and paused to take photos of us being not-at-work. It was fun to be recognized. Kicked the day off right.

We proceeded to spend the rest of the day reading in the shade on the beach, the prettiest day here so far. We went snorkeling a couple of times along the effortlessly-easy-to-access reef. And I had entirely too much fun swimming out to the floating thing and diving off. We didn't leave until 5pm, and nobody else was on the beach for a good portion of the afternoon - why, we didn't quite know. We didn't find a bus right away, so we walked to the main road. There, we caught a ride in a very-full bus with much happier than average drivers, listened to "Johnny Be Good" and other classics on the radio, bouncing along the road with the windows down, all packed into the bus. I was unnaturally happy with it all.

We did not go to the hospital on Wednesday.

On Thursday I arrived at 11am and found the hospital in relative disorganization (always somewhat disorganized, but usually in a "but I know where everything IS" fashion). Women were crammed in all manner of odd places. At 11, when the discharge routine is usually finishing up, they were just getting started. A student nurse was walking around in a fog, completely incapable of answering (yes we communicate fine, I've worked with him before) my questions about who was where and why the heck there was a postpartum mom in the store-room, and where on earth was I supposed to take this new admit and where was her chart?

It all got sorted out in the end, most of it by the time T showed up at 1. Women were in actual beds on the actual ward, babies were looked over and given their little blue cards and birth certificates, and things were calming down dramatically.

In this mess, the woman I'd thought I was admitting but in fact had been looked after previously and just not documented, was not dilating very well.

At 3, at shift change, a nurse named Viri who typically works evening shift in the NICU came on. I was roundly admonished for walking home on Tuesday. The hospital has truck drivers that will take you home, something that is not worth it for me because I am staying a whole 5 minute walk from the hospital and the truck often takes half an hour or more to catch. Apparently, Viri and the midwife were worried about me, and made the driver circle the block several times to see that I was home OK. "It was so dark! Didn't you hear the dogs? It's too late to be out!" I feel like the little family groupings sitting up and chatting in the areas I walk through make the lack of danger pretty clear. That, and the friendliness of the people I talk to there. The midwife and nurse, I think, are either living with a little bit of extra caution sunk in from the not-too-far distant past (about 20 years ago).

My admit - the one we were talking about, anyway, continued to dilate slowly through the day. At a little past 4pm, she was 7cm and well past that #*&$@(#*&$ "action" line on the partograph (there are two lines on the WHO partograph: the first, the "alert" line, is the 1cm per hour line, and passing over that just means you should pay some attention; the second, the "action" line, presumably means that should someone pass it, you should do something about it). She was not distressed, her baby was not distressed, we figured breaking her water would set things in motion. The very-senior-midwife on duty, however, took issue (vocally) with our plan, because apparently over here AROM is not "doing something," and chose to also initiate pitocin augmentation without waiting to see if the membrane rupture did the trick on its own.

She had her baby a little after 5pm without issues. Her first three babies had been boys, and she was extraordinarily happy to have a girl. She called for her partner enthusiastic about telling him they had a girl at last, but we couldn't find him. "He went out to walk," said another father who had been pacing the hall with his wife all afternoon. After unintentionally setting several other men in the area on the task of finding the new-again dad, we did a flurry of hospital chores, settled everyone in, and left at a respectable hour. Viri clapped my shoulder on the way out, and let me know that it was getting dark, I should hurry home, but I didn't need to wait for the truck at this hour. Good luck, good night...

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