So...the past 2 days have been very interesting...yesterday, there were 2 situations that were pretty intense. Firsst of all, in the delivery room at St Therese hospital, women are coming in all the time. So many women, all the time. All different situations are happening in there all at once. Women coming in with incomplete abortions or in the midst of spontaneous abortions, women in early and active labor, women coming on for labor checks, Drs doing D & C's, somen coming in with high blood pressure...there was one night I worked a few weeks ago where in addition to several births and other women in labor or there with high blood pressure, I swear there were alteast 20 other women sho walked through the doors that night, for labor checks. So, basically, there is always someone walking through the doors.
Ok, so yesterday, this woman is brought in by a Matron, a community midwife, and a man, from another town. She had actually birthed in a hospital, the day before, and had had eclamptic seizures. She still had a floey catheter in, and an IV with mag sulfate (anticonvulsive med) and apresoline (antihypertensive med). Well, they had cut a huge right mediolateral episiotomy, and had not repaired it. The matron also reported that she had bled alot. So, they had brought her in for sutures. I ended up doing it. Her tissue was just gaping open and since it was one day later, the only way for it to heal together was to scrape it and make it bleed and then suture it. I used a single scalpal blade and just scraped and scraped until all of it was bleeding enough. I sutured it in 3 layers. I had to--it wasn't 3rd degree but it was very deep. I was suturing it and even though I had given her lidocaine, it was really hard for her. It was so hot in there...you always sweat so much here...towards the end of the repair, I guess the sweat must have been dripping off my face, because a couple of the students started fanning me and wiping off my face and neck. They are very sweet with me.
So, another situation that was going on all day yesterday was that there was this woman who was very, very sick. She was near death. She was a 35 year-old 8/7 (8th pregnangy, going to be her 8th birth). She had high blood pressure (160/110, not as high as alot of other women I've seen here) and other obvious signs of severe pre-eclampsia. Her entire body was swollen. Her face, hands, even belly. Pitting edema. She also had preexisting asthma. So, she was having all of these signs and also started having respiratory distress. She was having air hunger. She was breathing erally fast and shallow. Her lungs were filling with fluid. Marthonie and the Cuban Dr (I'll write about him sometime---he's a character) worked on her, gave her several different drugs to stabilize her. Also her bb was breech. The plan was to do a c/s and then a tubal ligation. To prevent another pregnancy, which could kill her. Eventually she had the c/s, and then a little while later had a massive hemorrage. She soaked an entire sheet with blood. When I saw her after this, she was intubated and on oxygen and on a ventilator. The only one they have in this hospital I'm sure. I watched Marthonie work on her the whole time and watched her communicate with this woman, who was so comprimised, so close to death, and I was so impressed and touched by Marthonie as a midwife. She is very skilled in managing eclampsia---she has seen it so many times. But she stayed with this woman and kept talking to her and reminding her about her baby. I stayed with her and we walked away from the hoepital together. She said that she was thinking about this woman's other 7 children.
Today, this woman is doing well. She is present. She can talk, eat, breastfeed, etc. It was amazing to see people working together and saving someone's life--they literally saved her life--with such incredibly limited resources and materials.
Another woman's baby died yesterday--she was postdates (43 weeks) being induced with pitocin; no one listening to fetal heart tones...the baby died.
That was yesterday. Today, when I arrived at the hospital, someone had died (not the first time) and there was a crowd and their covered body was being put into the back of a pickup truck.
We had 4 births today--all were nice, normal. I caught one of these babies. I decided to forego my lunch break to stay and catch this woman's baby. It was really nice. While I was with her, this other woman was carried in by several people. She was severely preeclamptic. Marthonie, who had also stayed, started her on mag sulfate (to prevent convulsions). It was hard, she was really resisting, everything; her IV got pulled out twice; after a little while she started having convulsions. This was my first time actually seeing this. She got somewhat stabilized, and the OB came in--(we had to call him in)--and he did a sono h=on her and said she was around 29 WEEKS. I had thought her belly seemed term. I don't know. I'll see tomorrow how she is doing.
I am understanding more and more Creole. I can't speak it well at all but I can communicate alot better than I could. Even if it's not correct.
I wish I knew more about pharmacology. I just never had needed it before. Here, it would really help.
Ok. That's all for now...