But back to my laboring patient. I just had a feeling about her. She seemed strong and I've found very few ladies that complain here about labor pains. And 24 hours already seemed long. But FHTs were good, BP was good, I had no reason to be concerned and chalked it up to first pregnancy worries. But it didn't surprise me at all when they called me at 10:00 pm asking if I could please come and help them. I arrived in the village and had a terrible time assessing her as it was really dark and my flashlight quit. They lit a candle for me but when I suggested we just go to the hospital everyone was quick to agree. They got all of their stuff together and we set off. We arrived just before 11 and discovered the ward was overflowing (20 beds full and people sleeping on the floor), there were 5 ladies pushing, three babies in the lone incubator and one stressed nurse (and a partridge in a pear tree) . It was obvious my patient didn't take precedence. The nurse did a quick exam while I monitored her other patients (HA!) and declared her dilated to 3 and fine. She was to go walk around outside and she would be checked again in 4 hours. As there were no open beds anyway it didn't seem to matter that it was 11:30 at night. I checked that Winny (the laboring mom) and Johnathan (the soon to be father) and Dina (their very young attendant who was 16 and brought along to fetch water, cook, and do the wash) didn't need anything. They discovered they didn't bring any mats to sit outside on and didn't have anything to eat. So I ran home and grabbed some things for them and brought it all back. At this point I decided there was little I could do for them so headed back home to bed. At 7 the next morning (Christmas) I stopped back in the hospital hopping for a baby. But no luck. Johnathan didn't have a phone so couldn't call me but they had never been checked again. They had been waiting outside all night. I got a bit assertive and asked the nurse to pay attention to my patient. She did an exam and told us she was to 4 cm. She also broke her water at that time which I thought was a terrible idea but did it before I knew what she was doing. I checked FHTs and they were still good but it was very obvious Winny was exhausted. Contractions were few and far between and externally felt much weaker than 24 hours before. We were sent back outside and I tried to get her to lay down and sleep for a bit.
|Winny in a "labor room" at the hospital.|
But back to Winny, She looked terrible. I went and got a gurney and loaded her up myself and headed over to surgery. It took him an hour and a half to finish the first patient (sections are NOT quick here!) and it was 10:00pm that he finally took her back.
30 minutes later we had a 5.8 pound baby. He was clearly full term and healthy but tongue tied (ankyloglossia) and small! No indication of why the terribly prolonged labor. By 11:00 she was back on the ward and in bed. It was a really, really long day leaving me wishing for some midwifery training in the not so distant future.
Anyone want to weight in with things I could have done better, ways to help the patient, any ideas for next time? I'd love to learn from this...