Don't forget to breathe!

Hi everyone, this is Natalie writing with Quinn from Mbale! Yesterday was a crazy, crazy day, so take a deep breath and...

Quinn, Angela and I arrive on the maternity ward around 9:00 and are told we have someone in second stage. Quinn quickly throws on her gloves and receives her second baby! This baby is born limp and not breathing, so Angela helps me with my first neonatal resuscitation....for 60 minutes. The baby has a great heart rate the whole way, and does start breathing on its own. We quickly do some charting and are told another mom is at 8 cm. This mom is someone we had seen before: she had come in the night before with severe bleeding at 28 weeks. She was diagnosed with placenta previa, and while the mom was stabilized, unfortunately, her baby had died. She seems to be progressing, so we leave nature to take its course for a while since she is stable. Then...another mom in second stage! Quinn gets on her gloves and receives another baby! As I spend some time with the other mom, Quinn diagnoses twins! Then, Angela is called. A first time mom with a footling breech (when the feet come first. In Canada, this would be a c-section) in second stage! But as Angela assesses, she discovers not only is it a footling breech, but also a cord prolapse (a cord prolapse can be very dangerous as the cord falls through the cervix, it gets compressed and the baby doesn’t get all or any of the oxygen it should). We get the woman to push as hard as she can and the baby is born in less than 2-3 minutes. I take the baby for another resuscitation, and it comes around really well. We quickly eat our lunch, and Angela calls me to assess another woman who was sent to the hospital for a footling breech (ok now, really? 2 footling breeches in one day?), but as her birth unfolds and I examine her, I don’t find a foot, but...a very cute hand that grasps my finger. The baby comes out easily like superman, with one hand and arm in front of its head. It’s already 7 pm, but we want to stay to see our ladies through- Quinn, the twins; and myself, the woman with the previa from the night before. The woman with twins is so stoic and quiet that its only when Quinn decides to check up on her because she was scrunching her face that she saw she was pushing. The mom pushes beautifully, and the twins come out without a hitch. Angela and I have to hold Quinn down so she doesn’t take the twins home, they are so cute. And did I mention all intact perineums (no tears)?

The mom I had been following was developing a fever despite antibiotics, and because her uterus was getting bigger, we suspected she was having an abruption. She was quickly taken for a cesarean section. At first it seemed like she had lost too much blood and her condition did not look so good, so I was thrilled and relieved when I came in today to find out she made it through the night and is now doing well.

I’m very sad to write, though, that when we arrived this morning a mother had passed. She had been very sick. Her husband is a school teacher, and she left several children at home. It made us all sad to think that had a few things been different in her care, perhaps she could have lived.

Adjusting to Ugandan life both warms my heart and makes me take pause. I love the  warm culture, the traditional hand shake ( a combination normal handshake, followed by  closing your hand in each others, and another handshake), the dancing hugs (hug side to side three times while simultaneously patting each other’s back), the bustling market, the red soil that’s everywhere and stains the ankles of all your pants, the bright coloured dresses, the babies wrapped around their mother’s back, and the at least 5 year old I saw nonchantly standing up and breastfeeding. I especially love the care taker, who has the most wonderful ear to ear, eye squinting smile, who every morning tries to teach us Lugandan and laughs as we try to imitate. I love that I can see that babies are so resilient; and that births many people would be fearful of back home, despite little technology, can be normal. But Quinn and I have struggled with other aspects, such as some of the treatment of women, differences in practice management, and how to communicate our knowledge of evidence based practice in a way that builds relationships, and lack of technology when it really can make a significant difference to the mother and baby’s outcome.

For me, its only my third day and I have learned so much. And the more I learn, the more I realize the less I know. I am so appreciative to have a great friend, and an unbelievable mentor to guide me.