Last Day in Vanuatu (I think)

I went to what should have been my last day at the hospital today.

Only we were so busy that I didn't get all my papers signed. "Come tomorrow, first thing, we'll get it done right away" the nurse in charge said, working on her 3-o-clock report at 5:30pm. I went to say goodbye to the ladies working evening shift, and they gave me hugs and handed me a wrapped package, which (curiosity got the better of me, that and the certainty it wouldn't stay wrapped through customs) turned out to be a lava-lava. If I ever get a chance to wear it, I'll remember both them and all the laboring women walking the halls in their lava-lavas here.

I did two births today. Shortly after I arrived, I did a CTG strip for someone who had been at the hospital overnight already, and found some pretty significant late decels (with every contraction). I took her off the CTG for long enough to put a new admit on and seek consult (which turned out to be less than helpful).

The first birth was the mom with the decels, which hadn't improved but hadn't gotten terribly worse over the 5 hours since I first saw her. The student nurse who was supposed to be assisting me totally disappeared ("I wen lunch," he told me, unhelpfully, later). I grabbed a newcomer from Australia who shared my name (Niki and Nicki), and who, had she come earlier, would probably have been a great friend. I have done births solo here a few times (maybe 5 or so?), but the slow labor for a 3rd baby, the mec, the late decels...I wanted someone else there. The meconium got heavier and heavier until it seemed like it must be coming straight from baby out without any dilution at all. The decels got worse with pushing, eventually not recovering and hovering at 60 even between two contractions. Oxygen to mom, I ordered (easier said than done...). Some recovery. Not back to baseline, but up into the triple digits. Baby was born, thankfully, less than 10 minutes later, and did not require anything more than a little suction and stimulation to come around.

So many moms here have meconium. So many babies are totally fine. My feelings are now pretty thoroughly mixed on the subject of meconium, after managing so many births with meconium that it just doesn't seem significant anymore. I know that this isn't acceptable in the Washington-State-out-of-hospital type practice, have no fear. I'm just not scared of it anymore. Neener-neener.

The second birth of the day looked to be pretty easy. 42 year old 2nd time mom, who had her first baby 17 years prior, but seemed to be laboring along nicely all day. She got to complete and wouldn't push. "Tired!" she cried at us, over and over. "No push, me no save push! Me no wantem push!" When the midwife-in-charge came in and authoritatively ordered her to stop whining and start pushing, she made a disgusted face and solidly ignored the commands. Four hours later, three of which she spent rotating her baby from OP to LOA to OA, her baby was born with the aid of a vacuum. Shitty last birth for me, really. She was also the first to be visibly disappointed to have a girl. "Thought it would be a boy," she sighed, and turned away. "Yufala sure?" she rejoined, moments later. Yes, we were, that was a little girl that was dragged reluctantly from her body. (Hopefully this doesn't sound too harsh. I spent a large part of that labor rubbing her back, her shoulders, her legs, speaking encouraging words and waiting for her to get down to business and push out a baby.)

Shitty last birth, maybe, but I'm leaving knowing that I'm far, far more ready for practice than I was when I got here. This is a good feeling.

We'll see tomorrow, I suppose, if I get dragged in for another "last day," since I don't actually leave until 2pm.