my wednesday-friday in Haiti

I was at the apartment getting ready to go out for Alex and Nicolette's last day in Haiti (they've been in Haiti for a month). We got a text message from Sarah saying that a woman called her saying she was bleeding and that her water broke. As we were getting ready to walk to the clinic, a tropical downpour rolled in. It was raining so hard that our tin roof was leaking. We picked up everything off the floor and put cups under the leaks. We were trying to wait for the rain to pass, but it was clear that it wasn't going to stop for some time. We made the decision to run down the two blocks to the clinic in the rain. I wrapped up my valuables in some scrubs and put them in my backpack. I put the backpack on first and then a big t-shirt over it. 

We were soaking wet and muddy when we got to the clinic. Sarah had already finished the assessment. There wasn't much bleeding and no signs of labor so they decided to monitor her overnight and reassess in the morning. We went back to the apartment after an hour or two of doing vital signs. Sarah and another midwife, Ninotte, stayed with the woman. We woke up early the next morning to go back to see if labor had started. When we arrived, Sarah told us that another woman had called to say her water broke at 3 am and that she was going to stay home for a little while and come in later. The first woman still hadn't started labor. We tried walking, acupressure, nipple stimulation, and herbal tinctures to see if we could induce labor. None of it was working. Sarah performed an internal exam to see if she could see fluid and test it to confirm that her water broke, and to assess the state of her cervix. Her cervix showed signs of infection and it wasn't obvious that her membranes had ruptured or that her cervix was ready for labor. We decided to treat her with antibiotics and keep her for 48 hours for observation. 

The second woman came in early labor and we set her up in one of the birth rooms. Just as we had finished, a third woman called to say her water broke four days ago. She came in and we began IV antibiotics. She also wasn't showing signs of labor. We tried the same natural induction methods on her. They produced some mild contractions and she was 3 cm dilated and soft. Because she was getting prophylactic antibiotics and not showing any signs or symptoms of infection or fetal distress, we decided to wait to see if labor would increase naturally. Meanwhile, the other woman began to shows signs of active labor.

The woman in active labor started to have high blood pressure. Our priority was to vigilantly assess for other signs and symptoms of problems like eclampsia and to try to get her blood pressure down. We gave her valerian root to see if it could help her relax and therefore lower her blood pressure. It did lower is some, but not as much as we would have liked. We did several urine tests and frequent assessments. She did not have any other symptoms and while her pressure was higher than normal, it wasn't so high that we felt we needed to transport. She began to show some signs of transition (opening the last few centimeters), such as vomiting, a change in behavior, bloody show and the shakes. Sarah did an internal exam. She was only 4 cm but her cervix was paper thin and the baby was pressing right on it. A few hours later, she began pushing on a birth stool. At 1:23 am, a 9 lb baby boy was born. His heart rate was good, but he was having difficulty breathing and didn't have good muscle tone. We (mostly, they) worked quickly to stimulate him and give him a few breaths. He pinked up right away but was very sleepy. We put him on his mother's chest and after a few minutes he began to cry. After the placenta was delivered, another midwife and myself went to assess the baby. I had to suction him a bit more. He had a little bit of a rough start, but things resolved quickly and mother and baby are healthy and doing well. 

I went back to the apartment to sleep for a few hours. The woman whose water broke a few days ago was started on pitocin. I came back to the clinic this morning and continued to do vital signs for both the laboring woman, the postpartum woman, and the newborn. Sarah showed me how to do a complete newborn assessment. It was interesting to learn the things a midwife looks for and how they determine how many gestational weeks the baby actually was. With a variety of assessments, it's possible to determine just a week's difference in gestational age. Because mother and baby were both stable, the attention turned to the laboring woman on IV antibiotics and pitocin. Her pitocin was slowly increased because she hadn't made much progress from the night before. If that didn't help progress her in a few hours, it would be necessary to transport her to the hospital. However, her labor became active and she began to respond well to the increased pitocin. She's currently six centimeters dilated and we are playing the waiting game. 

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A 7 lb baby girl was born Friday night at 10:19 pm. The mom worked beautifully at moving and using gravity to help bring her baby down. Birth seemed to come very naturally to her and she followed her intuition. I went into her room around 7 pm to take vital signs and as soon as I walked in, she asked me to give her a massage. She was having a lot of back pain and counter pressure on her sacrum seemed to really help. First, she was sitting backwards in a chair, leaning forward. Her husband was sitting in another chair next to her, as I sat behind her doing hip squeezes and back massages during her contractions. Other than a few breaks to eat and use the restroom, I stayed massaging her for the rest of the birth. She had turned the chair around and I noticed she kept scooting her bottom farther and farther off the chair until she was barely sitting on it. I suggested trying a birth stool which has the middle cut out of it and may be more comfortable since she was feeling so much pressure on her bottom. She began pushing when her body got the urge while the midwives waited quietly and followed her cue. There was no counting or telling her when and where she had to push. Sometimes she only pushed a little, sometimes very hard, but it was up to her to determine what she felt was right. It was a calm, quiet, and peaceful birth. Once the head had emerged, the rest of the baby and a lot of water came out very quickly. The baby was doing well and just needed a little stimulation to get some big, strong cries. The sister in law of the woman said, "The mom didn't cry and neither did the baby." It was true. Mom had stayed very calm throughout the birth and her daughter came out with a similar disposition.