Huarmey hospital attends to about 18-20 births each month. I would like to be able to see all of them, but many women go into labor during the night and it's not safe for me to walk in the dark by myself. As a result, I haven't been able to see as many births as I would like. One day I was extremely frustrated to walk into the hospital at 8am to see two women in the delivery room, both having given birth within the last ten minutes. I just missed them!
However, one of the benefits of shadowing here for so many weeks is that, every once in a while, a gestante will be obliging enough to 'dar a luz' during the day. Saturday featured just such a woman. She was admitted to the hospital around 7am, 3cm dilated with her second baby. (The second baby part is important to me because it often means that the labor will go more quickly. First-time moms are more likely to have labors that last 12 hours or more.) Within a couple of hours her contractions were coming every minute or so and she was howling in pain with each one. There is only one doctor at the hospital who knows how to give epidurals, and he was busy. Thus she felt the full force of each contraction. It was painful just to listen to her scream.
The doctors here want me to practice giving internal exams. This involves inserting your (gloved) hand into the vagina and measuring with two fingers the diameter of the dilating cervix. It's extremely difficult to do. For one thing, you can't see your hand inside the woman and have to estimate how far apart your fingers are spread and compare it to a dilation chart. For another thing, the cervix is not rigid, and it's easy to spread it open a little bit as you open your two fingers. And then sometimes the woman cries out in pain as you try to examine her. So I give my best guess with this gestante, somehow managing to do the exam in between the contractions that force her to writhe and twist awkwardly in the stirrups. I'm only off by 1cm, which I'm proud of.
By 10am the gestante is brought into the delivery room. She is progressing too rapidly for the staff and me to properly scrub in, but I throw on a gown and gloves and feel semi-clean. As the obstetrician, Margot, starts talking and showing me various instruments, I realize that I have graduated from the umbilical cord-cutting stage of my apprenticeship. She mentions things that I should hold when the baby starts crowning, and keeps asking me to examine the gestante and monitor the baby's descent. This becomes more difficult than I have seen before, as the poor woman (in more pain than I've seen the other women here) is screaming bloody murder and keeps trying to swat my gloved hands away. At one point she aims a kick at Margot, but can't get much force behind it with her legs in the stirrups. Amidst the din I understand Margot explaining to the woman that she's trying to get the baby out faster, and thus is helping to ease the gestante's pain. But the explanation falls on deaf ears as the gestante screams louder and her eyes glaze over.
Thankfully, the baby descends rapidly. I'm told to pick up this one piece of gauze and put it at the base of the vaginal opening, then take my other hand and put it at the top. Margot puts her hands on top of mine and guides me as we push the baby's head out by forcing the vaginal lips away from the curly damp hair that is emerging. And then all of a sudden the head is out. You have to turn it like 90 degrees to orient it properly, then push down to get one shoulder out, and then pull up to get the other shoulder out. The rest of the baby emerges with a gush of fluid. I place her on top of a towel on the mother's belly and within a few seconds it starts to cry (HUGE sigh of relief on my part). I clamp and cut the umbilical cord, a task that seems ridiculously simple now, and after a few minutes I pull out the placenta. It's large (I can barely hold it with one hand) and purple and warm, in case anyone was interested. Margot then takes over and makes sure none of the membranes are left inside the mother, which could cause dangerous bleeding. The gestante looks half dead, eyes still glazed over, limp, and minimally responsive to questions from the doctor, but I think she's just exhausted. She did not have much tearing and did not need any stitches.
Afterwards, I take off the gown and plastic apron and realize that my entire shirt is damp with sweat, both from the heat and my nerves. One doctor goes out to the nearbye tienda and buys me and Margot cold Cokes, for a "job well done." I'm not entirely sure if I did a good job or not, but at no point did anyone shove me out of the way and start yelling angrily, so I know I didn't do terribly. Dr. Meza says that next time, I will do more of it by myself. I just hope this next birth is normal and without complications.
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