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Friday, 9 April 2010

Emily Denness - November - Impressive midwifery skills reach ECHO

The European Commission for Humanitarian Organisations (ECHO), one of our biggest donors, is arriving today to assess the clinic. We also receive word that a woman from a community in Tabasa, about an hour and a half’s drive away from here, is in labour and is coming to the clinic.

She has been in labour for two days and it’s her first baby. There is thick, thick meconium (a tar-like substance that lines a baby’s intestines during pregnancy and usually excreted through bowel movements after birth) in the waters.

The presence of meconium during the labour can be a sign of fetal distress. The baby isn’t happy and the woman is 7cm dilated. She just needs a little push with a drip, but I insist that we rehydrate her and give her something to eat first. Once born, the baby will need resuscitation, I’m certain of it.

Dipping heartbeat

The baby’s heartbeat is dipping. It takes the mother a while to master pushing, as it does with most first timers. Finally we see the baby’s head. The resuscitation equipment is ready, and the adrenalin starts pumping. The baby comes out but it’s not responding, breathing or moving.

We start resuscitation even before the cord is cut. I’m not sure if this one will pull through. We cut the cord on a flat surface. It’s a girl. The heartbeat is good, but there’s still no breathing so we have to do it for her.

Dr Eoin and I take turns in resuscitation. We use suction to get loads of meconium from the lungs. We keep going, and just hope that she makes it. It feels like we’re not breathing either.

The mother is watching with baited breath, as is the grandmother. Ten minutes pass before the baby takes a gasp. She’s still unresponsive and still not breathing by herself, but there’s hope! 

Sigh of relief

Another five minutes pass before she starts breathing. She’s breathing! Yes! She’s not opening her eyes and is still a bit floppy, but she’s breathing! Everyone breathes a sigh of relief and we keep watching her like a hawk.

After ensuring that the baby’s not going to suddenly stop breathing we hand her over to her mum. Babies always recover so much better when they are held by their mothers. After a while she even opens her eyes.

The placenta still hasn’t come out yet, so I give the mother an injection to help. She coughs and the placenta pops out! She wants to keep it, so we seal it up in a bag, otherwise there will be a trail of blood following them home.

The woman starts bleeding. The uterus is high so I press on it but there’s more blood. I remove some large clots which are stopping the uterus from contracting. She has lost a lot of blood, more than half a litre, but the bleeding is starting to settle. They could have both been close to death if they had stayed at home.

Reputation intact

We tell ECHO the good news and they’re all relieved and amazed by the story. My reputation as a midwife is intact. So what if I’m not good at big speeches, I can do my job as a midwife and that’s why I’m here. Dr Eoin is very relieved, because I was in Feina the last time there was a case like this.

The team from ECHO is having a long meeting with the general coordinator and the desk coordinator who’s visiting from Paris. They seem very impressed, and we’re pushing for more donation money to support and help grow the mission for next year. It looks promising!

In the morning we wave off ECHO in the helicopter, and EID, a national holiday lasting five days, begins. It sounds like a nice break, although I know that there’ll be more on days when I’m off! I plan an afternoon nap to help prepare for the days ahead.

I love this job.

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