On Saturday, I was witness to "the miracle of life." A baby was born about two feet in front of me. It was quite the experience, but only read on if you have a strong stomach. Baby-birthing is NOT pretty.
I went into the hospital at 8am, like always. I've decided to show up seven days a week because there's literally nothing else to do in Huarmey. The hospital itself typically has few patients, but sometimes I get the chance to talk with the health workers while waiting for someone to come in. When I arrived on Saturday, there was already a gestante (pregnant woman) in the bed. She had been in the hospital since the night before, slowly, slowly progressing. She was dilated to 7cm when I came in, and since you need 10cm before starting to push, she had at least a couple more hours to wait. I was surprised, however, at how calm she looked. Her contractions, when they came, were mild and brief, which is unusual with a woman in that stage of labor. The obstetrician on duty and I sat with her off and on for the next couple of hours, but by 10am she was only at 8cm, still dilating too slowly. The obstetrician gave her an injection of oxytocin in order to speed up the contractions.
This particular obstetrician, Heidy, is friendly and really wants to teach me things. While sitting with the pregant woman (Nelly), Heidy takes out a book of common obstetrical emergencies and flips to the appendix entitled, Receiving the Newborn. She then starts talking to me about where to place your hands when the baby's head is coming out, to make sure to check that the umbilical cord is not around the neck, and to push the baby down, then up, to get each of the shoulders out in turn. I start to get just a little nervous. Surely she can't think that I'm going to receive the baby, right? I've seen one other birth a few days earlier, but that almost didn't count because it happened dramatically fast (in less than 5 minutes) and I didn't get to see anything. I know the people here are willing to let me learn, but shouldn't I see how things are done at least once before trying them myself? Holy crap.
My fears are not alleviated when Heidy takes me into the next room and starts showing me videos of "epistomias" (sp?) on YouTube. ***DO NOT continue reading if you have a weak stomach*** Epistomias are a commonly made incision into the vagina, opening it up so that the baby has more room during the birth. Heidy demonstrates how to make the cut, saying things like, "make sure to guide the scissors with the fingers of your other hand," and "make the cut at 45 degress." She then takes a couple of pieces of spare gauze and shows me how to do the stitches that one uses to sew the vagina back up once the birth is over (this is done in the room with Nelly, whom Heidy assures that I am learning fast). I still don't know if I'm actually supposed to do any of this, and am giving myself a monster headache while trying to concentrate on Heidy's Spanish.
A couple more hours pass, but still Nelly's contractions are too far apart. She is hooked up to a fetal monitor, which we watch for a while, and then the doctor comes in to give her an epidural. I'm a little mystified as to why the epidural was needed, because it is a sophisticated procedure, nonessential (in a place where the patients, always poor, pay for their own meds), and Nelly doesn't seem to be in much pain. But she readily accepts the injection into her back after she is given the promise of a "painless birth."
Finally, around 1pm, Nelly is deemed ready for delivery. The epidural has made it impossible for her to walk, so she is wheeled into the delivery room and gets comfortable in the stirrups. Everything is done very slowly; no one is in any rush to get this baby out. I had thought that as soon as the woman reached 10cm, it was game time and everything happened at once. Alas, no. I am instructed to tie small plastic bags around my feet (surgical booties), and then to put on a plastic apron. I then wash my hands in soap and water, and, now sterile, put on a clean surgical gown over the plastic apron. Heidy puts my hair in a hairnet and attaches a surgical mask over my face. We walk into the delivery room and I put on sterile gloves. I look around the room, and no one else seems to be similarly attired. Nervousness threatens to bubble into panic. Why am I the only sterile person in the room? I do not want to receive this baby!
Thankfully, finally, another obstetrician shows up and dons the gown, hairnet, etc. It's a shift change and Heidy is leaving, and the new ob is much less a learn-by-doing teacher. I could not be happier. It's about 85 degrees in the delivery room, and with the surgical getup I feel a touch of dizziness as sweat begins to collect in the small of my back. Of course I can't sit down or touch anything, because I need to remain clean.
Some instruments are laid out on a table before me and named. I look at them skeptically but am unable to determine their purpose. Now we are ready to deliver the baby, and with each contraction, Nelly is instructed to "puja!" (push). This is the part that I've been waiting for, but like everything else today, it happens so slowly. The new ob, Joel, examines the position of the baby every once in a while, and invites me to do the same. I put my hand in and feel gingerly around. All of a sudden I hear a pop! and some fluid explodes on my feet. Crap! I broke the baby, and it's head exploded and it's all my fault! is the first thought that enters my head. But the doctors just laugh and tell Nelly that I was kind enough to break her water for her. Um, you're welcome.
Nelly's contractions continue but the baby is descending too slowly. To help her along, two doctors press on her stomach each time she pushes. One even climbs into the bed and literally puts all of his weight onto the top of her belly. Everybody is sweating profusely. Also, during each contraction, Joel at Nelly's nether regions opens up her vagina and stretches it, hoping this will help give more space. He is the one who does that awful slicing thing (anesthetic first) to give even more room. About half an hour of intermittent contractions go by, each with Nelly pushing the baby, two doctors pressing on Nelly, and Joel widening her vaginal opening. Considering all this, there is remarkably little blood, and I'm able to watch from about two feet from the baby's area of expected entrance.
The baby is just about out. We can see the head in the vagina but Nelly is still unable to make that final push. A third doctor instructs me, as the only other sterile person in the room (actually there's a nurse in sterile garb as well, but her job appears to grab the baby and whisk it away as soon as it emerges), to first hand Joel this instument, then this second one, then a third. I have no idea what any of them are but pick up the first two, ready to go.
With one last push, baby arrives! It comes with a gush of fluid and is completely blue. I hand Joel thing 1 and then thing 2. I attempt to hand over thing three but he motions me to do it myself. I look over at the baby and see that the first two things were clamps for the umbilical cord, spaced about a half inch apart. Thing 3 is apparently a pair of surgical scissors used to cut the cord. So I cut it. It's all over in less than ten seconds but I feel like I've accomplished some major surgical procedure. What's even better is that the baby starts crying right away. He's still blue, but I think the most dangerous part is over.
We have to wait a few more minutes for the placenta to be delivered. It's this large, blueish bag that looks absolutely disgusting. I know it's full of nutrients and even that some people eat it, but that seems unsanitary beyond comprehension. Joel patiently sews up Nelly's vaginal tears (she's been given a shot of local anesthetic) and she soon stops bleeding. It was a difficult birth, apparently, but the baby and mom appear to be all right. I finally get a chance to take off that awfully hot gown and apron and booties, my shirt sticking to my back and my hair plastered to my face. I leave the hospital to go home for lunch (its now 3:30pm), thankful that I never threw up.
I went into the hospital at 8am, like always. I've decided to show up seven days a week because there's literally nothing else to do in Huarmey. The hospital itself typically has few patients, but sometimes I get the chance to talk with the health workers while waiting for someone to come in. When I arrived on Saturday, there was already a gestante (pregnant woman) in the bed. She had been in the hospital since the night before, slowly, slowly progressing. She was dilated to 7cm when I came in, and since you need 10cm before starting to push, she had at least a couple more hours to wait. I was surprised, however, at how calm she looked. Her contractions, when they came, were mild and brief, which is unusual with a woman in that stage of labor. The obstetrician on duty and I sat with her off and on for the next couple of hours, but by 10am she was only at 8cm, still dilating too slowly. The obstetrician gave her an injection of oxytocin in order to speed up the contractions.
This particular obstetrician, Heidy, is friendly and really wants to teach me things. While sitting with the pregant woman (Nelly), Heidy takes out a book of common obstetrical emergencies and flips to the appendix entitled, Receiving the Newborn. She then starts talking to me about where to place your hands when the baby's head is coming out, to make sure to check that the umbilical cord is not around the neck, and to push the baby down, then up, to get each of the shoulders out in turn. I start to get just a little nervous. Surely she can't think that I'm going to receive the baby, right? I've seen one other birth a few days earlier, but that almost didn't count because it happened dramatically fast (in less than 5 minutes) and I didn't get to see anything. I know the people here are willing to let me learn, but shouldn't I see how things are done at least once before trying them myself? Holy crap.
My fears are not alleviated when Heidy takes me into the next room and starts showing me videos of "epistomias" (sp?) on YouTube. ***DO NOT continue reading if you have a weak stomach*** Epistomias are a commonly made incision into the vagina, opening it up so that the baby has more room during the birth. Heidy demonstrates how to make the cut, saying things like, "make sure to guide the scissors with the fingers of your other hand," and "make the cut at 45 degress." She then takes a couple of pieces of spare gauze and shows me how to do the stitches that one uses to sew the vagina back up once the birth is over (this is done in the room with Nelly, whom Heidy assures that I am learning fast). I still don't know if I'm actually supposed to do any of this, and am giving myself a monster headache while trying to concentrate on Heidy's Spanish.
A couple more hours pass, but still Nelly's contractions are too far apart. She is hooked up to a fetal monitor, which we watch for a while, and then the doctor comes in to give her an epidural. I'm a little mystified as to why the epidural was needed, because it is a sophisticated procedure, nonessential (in a place where the patients, always poor, pay for their own meds), and Nelly doesn't seem to be in much pain. But she readily accepts the injection into her back after she is given the promise of a "painless birth."
Finally, around 1pm, Nelly is deemed ready for delivery. The epidural has made it impossible for her to walk, so she is wheeled into the delivery room and gets comfortable in the stirrups. Everything is done very slowly; no one is in any rush to get this baby out. I had thought that as soon as the woman reached 10cm, it was game time and everything happened at once. Alas, no. I am instructed to tie small plastic bags around my feet (surgical booties), and then to put on a plastic apron. I then wash my hands in soap and water, and, now sterile, put on a clean surgical gown over the plastic apron. Heidy puts my hair in a hairnet and attaches a surgical mask over my face. We walk into the delivery room and I put on sterile gloves. I look around the room, and no one else seems to be similarly attired. Nervousness threatens to bubble into panic. Why am I the only sterile person in the room? I do not want to receive this baby!
Thankfully, finally, another obstetrician shows up and dons the gown, hairnet, etc. It's a shift change and Heidy is leaving, and the new ob is much less a learn-by-doing teacher. I could not be happier. It's about 85 degrees in the delivery room, and with the surgical getup I feel a touch of dizziness as sweat begins to collect in the small of my back. Of course I can't sit down or touch anything, because I need to remain clean.
Some instruments are laid out on a table before me and named. I look at them skeptically but am unable to determine their purpose. Now we are ready to deliver the baby, and with each contraction, Nelly is instructed to "puja!" (push). This is the part that I've been waiting for, but like everything else today, it happens so slowly. The new ob, Joel, examines the position of the baby every once in a while, and invites me to do the same. I put my hand in and feel gingerly around. All of a sudden I hear a pop! and some fluid explodes on my feet. Crap! I broke the baby, and it's head exploded and it's all my fault! is the first thought that enters my head. But the doctors just laugh and tell Nelly that I was kind enough to break her water for her. Um, you're welcome.
Nelly's contractions continue but the baby is descending too slowly. To help her along, two doctors press on her stomach each time she pushes. One even climbs into the bed and literally puts all of his weight onto the top of her belly. Everybody is sweating profusely. Also, during each contraction, Joel at Nelly's nether regions opens up her vagina and stretches it, hoping this will help give more space. He is the one who does that awful slicing thing (anesthetic first) to give even more room. About half an hour of intermittent contractions go by, each with Nelly pushing the baby, two doctors pressing on Nelly, and Joel widening her vaginal opening. Considering all this, there is remarkably little blood, and I'm able to watch from about two feet from the baby's area of expected entrance.
The baby is just about out. We can see the head in the vagina but Nelly is still unable to make that final push. A third doctor instructs me, as the only other sterile person in the room (actually there's a nurse in sterile garb as well, but her job appears to grab the baby and whisk it away as soon as it emerges), to first hand Joel this instument, then this second one, then a third. I have no idea what any of them are but pick up the first two, ready to go.
With one last push, baby arrives! It comes with a gush of fluid and is completely blue. I hand Joel thing 1 and then thing 2. I attempt to hand over thing three but he motions me to do it myself. I look over at the baby and see that the first two things were clamps for the umbilical cord, spaced about a half inch apart. Thing 3 is apparently a pair of surgical scissors used to cut the cord. So I cut it. It's all over in less than ten seconds but I feel like I've accomplished some major surgical procedure. What's even better is that the baby starts crying right away. He's still blue, but I think the most dangerous part is over.
We have to wait a few more minutes for the placenta to be delivered. It's this large, blueish bag that looks absolutely disgusting. I know it's full of nutrients and even that some people eat it, but that seems unsanitary beyond comprehension. Joel patiently sews up Nelly's vaginal tears (she's been given a shot of local anesthetic) and she soon stops bleeding. It was a difficult birth, apparently, but the baby and mom appear to be all right. I finally get a chance to take off that awfully hot gown and apron and booties, my shirt sticking to my back and my hair plastered to my face. I leave the hospital to go home for lunch (its now 3:30pm), thankful that I never threw up.
i think this goes without saying.. but WOW
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