3 Beds, 3 Babies, 3 Hemorrhages...(by Tanya)

After a wonderful relaxing weekend at the King Fisher Resort with our classmates in Jinja, we were bound for a busy day back at work…..

The morning and afternoon felt evenly paced and semi- organized, and we actually felt like we were getting a system down…the labour ward was quiet and tidy so we considered leaving early…

Our labour room: beds #1, 2, 3....

Babil charting the chaos!

but as quickly as we thought it, our beds filled up. Babil had bed number one, Jo had bed number two, and I was going to second assist both of them (second assistant assists the primary birth attendant, she monitors fetal heart rate during labour, administers the oxytocin injection after delivery,  notes time of delivery, and ensures baby transitions well etc. The primary birth attendant directs the management of the labour, delivery of baby and placenta).

Babil’s mom delivered slowly and gently and the baby was fine. As she was delivering the placenta the woman began to hemorrhage. As Cathy rushed to insert an IV into a tiny little vein to start a bag of normal saline, Babil did bi-manual compression of the uterus, and I drew up and injected ergometrine…. a few minutes later the uterus regained tone and bleeding stopped….

Just as this was happening, Jo was called to bed number three as a woman came in from our first stage labour room with a baby who was suddenly crowning….

Jo putting in an IV

And as fast as she could catch that baby, the mom in bed number two, pulled back her legs and began to push her baby out. I grabbed the closest pair gloves to put on just as her water broke with a big splash; baby’s head was also crowning. The baby’s head was large for an African baby and didn’t restitute. I felt a big shoulder wedged behind the pubic bone. I called Cathy for help with the shoulder dystocia, and after a couple of maneuvers (that we just finished teaching at the workshop in Jinja) the baby came….but not without another postpartum hemorrhage! So Cathy and I performed the same steps that we had just finished with Babil’s mom….

Just in time for Jo’s mom (who appeared to be recovering well with baby on her chest) begin to have a hemorrhage as well, which was brought under control by putting up an IV with another 10 units of oxy and suturing her perineum…

Our tidy, organized, quiet labour ward was no more, and we definitely didn’t leave early, but despite the chaos and litres of blood lost, our moms and babes were all fine.



Making a fake PPH at a workshop

Postpartum hemorrhage (PPH):  Defined as a blood loss of more than 500 mls of blood is an obstetrical emergency that can follow vaginal or caesarean delivery and is a major cause of maternal morbidity. According to the World Health Organization, PPH accounts for 25% of maternal deaths per year.  Anemia can be one of the contributing factors in postpartum hemorrhages, and is extremely prevalent here in Africa. With a diet low in iron, limited access to prenatal care, lack of iron supplements, high rate of malaria,  HIV, and short intervals between pregnancies, anemia is hard to avoid. The physiological increase in blood volume throughout a woman’s pregnancy enables most woman to handle this loss during delivery, however, woman with anemia in Sub Saharan Africa can become hemodynamically unstable with a blood loss  less than 500mls.  Detecting anemia in our moms is a skill we mastered quickly. And as a result, we have learned to be prepared for a PPH and to act quickly!