Today on swing shift I was endorsed an active labor. Her name is Leizel, a first time mom. She had been dilated to 9cm for several hours, so we decided to do AROM (artificial rupture of membranes). After AROM, Ate May who was supervising, helped apply pressure until the head was freed from the behind the pubic bone. We then had Zel change her position to the antipolo. There she pushed well. Her bana, Mark, was there supporting her. With each contraction she pushed a little and we quietly encouraged her to breathe the baby forward. She had incredible control. The head crowned and the baby’s head slowly came out, slightly bluish. I felt for a cord wrap - and there was a cord coil, wrapped once around. I loosened it and waited for the rotation of the baby. But, the baby wouldn’t rotate, so I reached in to guide the shoulders. Everything loosened, and Zel continued just breathing the baby slowly out. As 3:17pm came, I somersaulted the baby out through the cord wrap and onto Zel’s tummy. She and her bana looked to find out if it was a girl or boy… and it was a girl. We began all the welcoming and Zel breastfed as we waited on the placenta.
Almost 30 minutes later, the placenta came out duncan (maternal side first) and without 80% of the membranes, but with several hundred ml of blood. (Part of which went into my shoe) Arg. I was thinking a manual removal may be impending. I grasped the still visible membranes with a hemostat and twisted as Jenny gently massaged the fundus to help it come. I ended up with about a foot and a half of stringy membranes and finally it was completely out. All in all she bled about 600 ml at least. She continued breastfeeding which helped the uterus clamp down and stop the bleeding. She rested for a while, had an energizing snack, and felt ready to go the bathroom. I felt she should wait a while longer before getting up. About an hour later we made our way to the bathroom… she wasn’t dizzy. I had her sit in the bathroom, but when I came back she was standing.. whispering “chel, I feel dizzy”. I had her sit back down and close her eyes. She recovered without fainting. She wasn’t dressed so I couldn’t get her back to the bed easily.. Her bana and I tried to dress her quickly, but she was fading fast again. (Picture Asian bathroom in regards to size and ‘flooding’) I told Mark to be prepared to support her in case she faints… and she got the look in her eye. We lowered her to the floor (in the ‘flood’) She came to and by this time we had her clothes were on good enough to carry back to bed. We basically made a run for it.. and it was successful.
Alot of our mommas have been malnourished their entire lives. A lifetime of damage done to their bodies is difficult to address in nine months of pregnancy or less, depending on when they come to us. Many are anemic, and hemorrhage at birth. In the States, blood loss is often considered to be of hemorrhage magnitude with a loss of over 400 ml. I’ve seen so many women lose a thousand and some even over two thousand. If our women lose less than a couple hundred, we are pretty excited. I know I mention placentas pretty often.. but one of my favorite things is examining the after birth. A beautifully developed, healthy placenta with its strong, fat cord is gorgeous. I love healthy babies and mommas. They make my heart nearly burst with happiness.
Mark went to get Zel something to eat. Zel rested and breastfed. I did paperwork. A couple hours passed and I prepared everything for the baby’s bath, exam and to give injections. Everything was going well until Zel went back to the bathroom and was dizzy again when she stood up. We decided to give her an IV which I inserted (my 3rd time!) to help her re-energize. Their birth cost about US $15.00 (to replace medical supplies). For many families who don’t make that amount in a couple weeks of work, it is difficult to come up with. Having their baby in the hospital would have cost them between US$30-50 which is less than what we in the West are used to paying for one full tank of gas. Quite thought provoking.
Mark, Zel and baby Pheobe are a super amazing family. I’m looking forward to their postpartum checks.
