Patience and trust in the face of the unknown

Greetings from Jinja! We are well rested after our lovely relaxing weekend at the Kingfisher with the rest of our class and we are happy to be back at work at the Jinja Hospital. The nurses and Midwives were glad to see us back to help out. This morning they greeted us with choruses of “ You are welcome” and ‘ Well done”. It feels so good to see all their smiling faces. Yesterday I had a small cut on my hand so to be safe I worked in the antenatal ward.  Wow, over 200 moms waiting to be assessed and cared for. So I spent the morning doing countless BP’s. They giggled every time I tried to call out their names, often mispronouncing them.  I also had the chance worked with the local doctor. Mother after mother came parading in with their sheet of plastic and hopped up on the table. I palpated all the mom’s bellies, listening to babies and the doctor asked them questions about their current state of health and pregnancy. In the afternoon I worked solo assessing many moms and thankfully the Sister (midwife) in the ward was there to translate to make sure everything was communicated appropriately. Liz and Grace worked on the ward and spent many hours supporting a first time mom. Her cervix took time to completely open and the doctors were convinced she would need a c section but with patience, support and lots of position changes she finally birthed on hands and knees (very rare) with an intact perineum! We had a delicious lunch at the TASO HIV support centre where we had the pleasure of enjoying a drumming and singing group performing. Their songs were all about prevention of HIV and the music gave us all energy to complete the day.

Today started off doing rounds with the doctors.  There was an 18-year-old first time mom who had been in labor all night.  She was fully dilated however the docs decided that her labor was obstructed and she would require a “ceasear” (c - section).  We sat with her for the next couple hours monitoring the baby, whose heart rate showed some signs of stress and provided what comfort we could, while continuing to assess the other moms in labor.  The grandmother was distraught and prayed over the laboring young mom. All the beds were full of women being induced for various reasons. When our mom as ready to go to the OR, we both had spidey senses that two people would be helpful, so decided to accompany her to the c-section as a team. Once we were in the OR and she was being prepped for surgery we started to see the baby’s head poking around the perineum. After an in depth consultation with the OB intern, the OB and much monitoring of the baby and progress with moms pushing efforts, the OB intern agreed to let us postpone the surgery. We wheeled our young mom into the hallway where we prepared to deliver the baby. Liz went to inform Grace what was going on and I encouraged the mom to keep pushing while coaxing the tissues to stretch around her baby’s head. Liz returned to help out and we continued to advocate for the mom to not have an episiotomy. Liz explained to the OB the benefits of letting the perineum stretch and if it had to tear then the healing process would be speedier than if we cut. We had a close eye on the heart rate and the baby was doing very well. Soon, the baby was born in the hallway outside of the OR over an intact perineum.  The beautiful baby boy required a little bit of a resuscitation, which we did before clamping and cutting the cord. The mom was grinning from ear to ear. Grace showed up to help me tuck the cervix, that was causing a bit of excessive bleeding, back up under the pubic bone and we were good to go. 

Upon return to the labor ward we found three other moms awaiting “ceasear”. Liz stepped in to assist Sister Margaret on a quick delivery of one of the moms on an oxytocin induction. Several moms were still awaiting admitting. I went to receive a baby after a surgery and provide some resuscitation. One of the interesting things about c sections here is that the OB prays before the surgery, for low loss of blood, skilled hands of the surgeon and for the mom and baby’ s health. At the ward, Liz admitted several moms in early labor, one of them only 14 years old.  Then we switched places and Liz went to the OR and I admitted moms. 

At the very end of the day, a mom came in carrying a baby that had passed following a road side delivery. I gave her a head to toe and checked that her fundus was firm, perineum intact and that she was generally ok.  Upon unraveling the baby from it’s blankets, we found that the little one had died on route after bleeding from the cord. A sad end to a good day.

Now we have returned home to scrub our scrubs, enjoy a little salad and reflect on the day. While Jinja has not being super busy with deliveries in the last week, we have enjoyed the diversity of care we can provide at all stages and the excellent opportunity to provide support and manage difficult labours.  Through patience and trust in the face of the unknown, everyday we are learning many new skills to put in our midwifery tool belts and a new humility that is a precious gift.