Babies having babies

We have finished our first week of work here in Mbale, and it is hard to believe so much has happened in 5 days!

Thursday was a very busy day- between us we caught 7 babies! The day started out slowly, and began getting busy around lunchtime, when most of the local midwives needed to leave the ward for a hospital-wide meeting. I got back onto the ward after a 5 minute lunch break just in time to be sent to deliver a woman who had arrived already pushing. I got her up on the bed, and was about to examine her to make sure she was ready to push, when I saw 5 adorable toes at the opening of her vagina. Another footling breech! I called over Natalie and Angela for help, and within a few minutes had caught a little baby boy. As I put the baby up onto his mother's stomach, we realized that it was not yet empty- twins! When I examined her I felt another little foot, with a little bum right behind it. Another footling! Natalie caught this baby, and he needed a little help to breathe, so I took him away to resuscitate for a few minutes. It was pretty amazing for us to realize that this woman would not have delivered vaginally in Canada. It really made us question some of our own ways of thinking about things at home. It seems like some of the things we think of as abnormal at home could actually be just another version of normal.

Other cases made us really miss some of the bells and whistles from home. A woman came in who wasn't able to walk. Her vital signs were poor, and she had very bad abdominal pain. It seemed that she was suffering from a ruptured uterus (this is rare, but more common among women who have had cesareans with previous babies, particularly when the uterus is stitched back together in a single layer- which seems to be the norm here- instead of a double layer). We put in an IV, and gave her fluids, but she needed to have another surgery as soon as possible. Unfortunately, there is only one operating room at the hospital, and there were two other women who also needed emergency cesareans ahead of her. When she finally got into the operating room, they discovered that not only had her uterus ruptured, but she had a placenta percreta (the placenta had implanted too deeply into the uterus- also more common when women have had a caesarean before), and she had to have a hysterectomy. Unfortunately, the power went out at that point, and although the doctor borrowed one of our headlamps, he wasn't sure that he had properly closed the blood vessels. (The following day this woman was returned to the operating room due to internal bleeding, and has since stabilized.) It was difficult to just wait, providing support and monitoring for this woman between other deliveries, not knowing how much she had been told, or understood, and knowing that at home she would never have had to wait for an emergency surgery. Another woman we attended had a baby with a cleft lip, and some other abnormalities. At home, we would have been able to access a pediatrician, and other sources of support to help this woman care for her baby. Here no one could tell us when they would be able to get a pediatrician to see the baby, and it was clear that there was no support available for her mother.

Before we arrived, we had all thought about the fact that there may be some experiences here that would challenge and upset us. I have been surprised, however, to find that it is often something unexpected that will catch me off guard. The thing that has upset me most is how many very young mothers we see, often abandoned by their partners, and with no real options. Thursday night the last mother I attended was 15 years old, and terrified. From her behaviour I suspected that she may have a history of abuse. Unfortunately, she had a tear that needed to be sutured. In an attempt to be helpful and stay out of our way, I'm sure, her mother stepped away with the baby, and left us to work. The poor girl seemed even more terrified, and then the electricity went out again (luckily I had a headlamp on), and she was crying for her mother and afraid. Natalie provided some great support to her, but it was hard to know how much she was able to understand. I left that evening feeling very sad and wondering what had happened to this girl. Things here seem to happen in waves, and the first girl I attended yesterday was also 15, and also afraid.  In a bed nearby, there was a 14 year old who would curl up and lean into us or hug us and cry with her contractions. In the waiting room yesterday there was a girl who looked to me to be no older than 12, although she told me she was older. I thought she was there as an attendant for one of the other women until a midwife asked me to take her blood pressure and I looked down to see her bulging belly. (The doctor who assessed her thought that her pelvis was not developed enough to deliver vaginally, and it was decided to send her for caesarian section.)

This week has been full of learning experiences and the great privilege of helping many brave mothers and their beautiful babies. We are taking the weekend off to integrate our learning, recuperate, and get ready for the next week!

-Quinn and Natalie in Mbale