hello...well it seems that my internet access is more stable now...yes! and each day i have had things to write about. today, i stayed late (till 8pm) because i didn't want to leave this woman who was laboring...also i was concerned about her and about this other woman, and no one there listens to fetal heart tones so i figured maybe i would wait until the students and american midwives arrived for the night shift and then i would leave.
so, i caught this woman's baby...this lovely lady, having her first baby. she was hypertensive, actually she had mild pre eclampsia (B/P around 160-170/100-110) and + 2 proteinuria, but no other signs. she had been on mag sulfate but now was just on B/P meds (hydralazine). anyway, she had appeared to be in active labor last night, when i left, and had been 4 cms BBOW 0 station. then in her chart it was documented that at 6pm last night she was 8cms. well, today in the afternoon, when one of the midwives checked her, she was 6-7 cms. she lad been laboring for awhile. she stayed the same dilation for awhile so we gave her an IV with pitocin (10 IU in 1000 ml). also, we started B/P meds again. there was no more of ANYTHING at the hospital pharmacy, so we couldn't give her the B/P medicine in IV fluid. there was no IV fluid, no IV tubing, no angiocath (to put the IV in the arm--like an IV needle), and also no medication (hydralazine) for B/P. so, basically, what happened after this, was that around 5 pm or so, the american MW's left, and maybe about an hour later i checked her, to see what was going on...hoping that she just had a cervical lip...well, i find her to be only 4-5 CMS. after the night before being 4 cms, then 8, then today being 6-7. the first time i check her, and she is 4-5. her pelvis feels roomy enough...also, she is pushing and can't stop. so, i thought we should call the OB in order foro him to come in and eval her, or atleast for him to know. there was also a VBAC laboring there, her 1st vaginal birth, and they don't usually do VBAC's at all. she was in active labor. i couldn't leave with both of these ladies there. the grad MW's don't monitor fetal heart tones AT ALL. i told them a few times that they should listen to the VBAC lady's FHT's every 15 minutes, because she was in active labor, and they never did. i also told them that we need to listen to the 4-5 cm lady's FHT's atleast every 30 min, because she was on pitocin, and because of her labor progression and her high blood pressure. well, i ended up staying and monitoring them both myself. we called the Dr, who I guess was busy because he said just to continue normal care on them, and didn't say if he was coming in or not. well, my lady, she walked around and squatted and pushed with contractions even though she was 5 cms, and after awhile, she was complete and pushing!!!! so i stayed with her. it was awesome! she was totally present, connected, doing really great. her 2 family members were with her. the cleaning lady came in and tried to kick everyones family out, but i told her we should let them stay because her bb was almost here. so, she did amazing, and had a beautiful birth. a beautiful slow head delivery. here everyone tells the mom what sex her baby is, which is not what i do--i like to let them see and tell us. i asked her what sex her bb was and held her baby up for her to see and she told us all it was a girl, and there was this climactic moment of joy, that i saw in her and in the 2 women with her, that i used to experience all the time in birth with families at MLL, but had never seen here yet. they had tears in their eyees! and she was happy! normally what i see is moms just totally checking out after the baby comes. she was happy! what a joy to experience that again. she had a tiny nick, i gave her 3 stitches. well, while she ws pushing, the other lady who was there, the VBAC, also started pushing. i helped to get stuff ready for her birth, and encouraged the MW to listen to FHT's after each contraction, which she didn't do because she just isn't used to doing it at all. i listened a couple of times. this lady had her baby, all was fine. the cleaning lady kept telling them both how to push, and finally when she said something to my lady, i told her to stop telling her what to do and what not to do, because she was doing great on her own and the bb was coming. geez! people want to help, but they end up taking away peoples' confidence by telling them what to do. my lady, i was just so happy for her. i had been worried about her. i had thought that maybe she did need a c/s. she was so appreciative for the help. it was really special. after all of this. Dr Celestin, the main OB here, he arrived, and saw that they had both birthed, and was really happy and left.
It was great. Another great thing from today was my meeting with Marthonie...things are just getting better and better with us. We are becoming better friends, learning together, trusting eachother more. I am so thankful for this. I never thought that this would happen, at the beginning when I first came, and there was not this openness, this collaboration. Man, the beginning was so hard. I am so glad to be 3 months into it.
Now, if we could only get our graduates to listen to fetal heart tones...