Sunday, March 22, 2009

Sunburnt on Saturday

On Saturday, off to the beach at Hideaway. The day looked dreary and we settled ourselves out in the open, where the light was enough to read by and just slightly warmer than the wet/shade. The sun began to shine brightly, I did some snorkelling (although the water was somewhat murky, the fish were abundant and the corals very much alive - Hideaway is definitely the place for easy snorkelling), and then headed into dappled shade under a tree.

Somehow, my forehead, one thigh, and a particular portion of my back became dramatically sunburnt whilst the rest of me remained pretty much fine. And yes, I did apply sunscreen to the entirety of the exposed all-too-white surface of my skin.

The effect of the sunburn on the flushed appearance I managed to work up last night on shift was incredible. Anyway, we left the beach at around 1:30 and were at the hospital at around 3pm, which is when the afternoon shift starts.

*following portion concerns stillbirth and is not for the faint of heart, please stop reading here if easily disturbed and skip past the indented portion of the post, or to the next post entirely if you'll be tempted*

A woman whose baby had died in utero (this had already been established the previous day) appeared at the hospital in what looked like early labor, and then left again, only to reappear a couple of hours later in roaring labor. T volunteered to catch after a bit of encouragement from midwife Tamanu. The woman, an 18 year old primip, disassociated heavily while she pushed. Her macerated baby girl came out weighing 1k, with the cord wrapped very tightly around its neck three times. T had to exit the room while Dr Robin and MW Tamanu examined the baby; in the meantime, I attended to third stage, which Dr Robin encouraged me to hurry along with cord traction but I was reluctant to do because I wasn't sure about the heartiness of the cord. All was well there. The baby was carefully wrapped and arranged and brought to the family outside; there was much crying, and at one point T and I walked by to see the dad with his whole body draped over the bassinet, just sobbing.

Meanwhile, another woman was laboring up and down the hallway, and although she paused to stroke the back of the grandmother for a moment, appeared not to be upset by the mourning family, nor them by her.

After the hour was up, we moved the mom out onto the floor. Mercifully, the patient load was light, and she got a room with four beds (normally fully occupied) to herself, but her family was nowhere to be found. She continued to essentially stare off into space and interact with us minimally. Almost an hour later, her family reappeared. I'm not sure I've ever been so glad to see such a crowd of people show up postpartum. She sat up, reached out, and sobbed into her mother's shoulder...and sobbed, and sobbed, and clung to her aunties and to her boyfriend, and each time we passed for hours there she was, clinging to a relative and crying.

Meanwhile, the laboring woman appeared to have been deserted by whatever much-older man had brought her to the hospital, and was having difficulty dealing with her labor. I walked with her for a while, rubbing her lower back during contractions (it seems that this is most often what labor support consists of here) and essentially just being present. She decided to lie down in the admissions room as another mom came in with some sort of early labor going on, and started sounding transition-y, which for a multip is cause for some sort of action. Off to the labor room we went, but when I checked her she was 7 and not yet ready to push.

She seemed most comforted at that time, unfortunately enough, to drape her arm over my shoulder and flex her hand right against the spot on my back that was sunburnt. Attempts to rearrange the situation failed. I feared for my ability to break loose and catch her baby when the time came; fortunately, she got more used to T and began to switch up her routine a little bit.

About an hour later she was actually ready to push, and out came her 3.5k (7 and a halfish pounds, large for here) baby, with linebacker shoulders and looking huge for this small mama, over an intact perineum with a push for the shoulders, a push for the chest, and a push for the hips. Baby came out floppy and blue, and her APGARs were 2/5/7, which is misleading in that because her heart rate was over 100 the entire time, and she was attempting to breathe by 2 minutes, the situation was not particularly panicked. MW Tamanu had been in and out of the room in this time, while she was giving report to the midwives during shift change. Baby improved, mama delivered the placenta without major incident, we got baby set up and nursing, and we left to stagger to our room just after midnight.

1 comment:

Morag said...

Lots of love to you both... Only 4 of us showed up for onsite (K8,W,P and I) and and you were missed.
Xx L