wishing I was a waitress at Denny's

when i was in midwifery school we had a class one day where vic was teaching us about complications. she mentioned that seeing some of these things in a delivery was about the time that you started wishing you had become a waitress at dennys. now is that time for me. remember those two labours i had, where i wasn't sure if i would be awake all night or not? well, it's 5:04am and i just got home from the hospital and all i want to do is go home (really home) and be a waitress at dennys. tonight was the worst night i have ever had as a midwife, and i have had some crappy nights as a midwife before.

this story has nothing to do with the situation here, i'm going to use medical terms and not bother explaining them and it probably won't be of interest to everyone so feel free not to read it as it sucks.

i ended my email last night because i heard my radio. it was miriam, one of the village midwives, telling me that one of the girls was ready to deliver. i headed to the hospital to watch the delivery and help out if any complications arose. they arose. the girl had a long pushing stage and when the head finally came out, it stopped right there. i tried to use it as an opportunity to train the tba how to handle a shoulder dystocia, but it soon became obvious that it was a real dystocia. none of the million women in the room spoke any english and weren't able to understand anything that i was asking them to do, so i finally just had to physically move the tba out of my way and take over. the baby finally came, but she was flat and had thick meconium staining. i tried to bag her but the mask was too big and i couldn't get a seal, so i did mouth to mouth, which is really disgusting when a baby is covered in meconium. meanwhile her mother started to completely try to bleed to death. she was hemorrhaging everywhere and i was trying to resuscitate a baby while trying to tell the women who don't speak english what to do. the baby started to breath, but was still in rough shape so i radioed for carmenza. she didn't hear me so i asked my driver to go to the house to wake her up and bring her to me. by the time she got there the baby was doing better and i had the hemorrhage under control. the delivery room, after the hemorrhage, looked like a murder scene. i, covered in blood as well, looked like i was the perpetrator. i won't go too into detail because they were, in hindsight, funny moments and the night ended up being so unfunny, but i did also have two other things happen during the hemorrhage. one was that a huge bug flew up my scrubs and started to bite me on the butt, and i was wearing sterile gloves so i couldn't get it out, so instead i jumped around yelling "bloody hell- there's something in my pants!" (forget not that none of these women understand english). the other thing is that, obviously, one of those spiders decided to make an appearance. thankfully by that point in the evening i was just like "not in the mood for you AT ALL" and he met an untimely end at the bottom of my shoe.
as soon as mom and baby were settled in bed, the next girl decided that she was ready to push. i went home for a minute to change my bloody clothes and get a drink (no, not that kind of drink. not that i couldn't use one of those) and carmenza decided to join me for the next birth. to make a very long story short, the girl was a total rockstar. it was an amazing labour. at one point she let out a groan, then got up off of the delivery table and walked outside. we followed her outside and found her kneeling in the sand, pushing. we spread out in the sand around her and just let her labour under the stars. we stayed like that for awhile, until she decided that she wanted to go back inside. the baby was coming slowly, too slowly, and when the head finally came out it pulled back immediately (the turtle sign). all i could think was that there was no way i was getting two dystocias in one night. wrong...it was another dystocia, another case of pea-soup meconium and it was worse than the first. thankfully carmenza was there so when the baby boy was born limp and blue, i cut the cord and tossed him to her. the mom was alright, so i left her with the midwives and joined carmenza at the table with the baby. he was exactly like the baby girl that had been born a few hours before, and she had been ok so i wasn't particularly worried. babies are always so easy to resuscitate, unlike adults. carmenza did some mouth to mouth until his heartbeat started to slow down too much. she did some compressions and i took over the mouth to mouth. slowly he started trying to breathe. it took a long time for him to come around, and even then his breathing was laboured. he was cold and we had no way to warm him up (surprising that someone can feel that cool to the touch in this heat) so i held him close to me under the intense suturing light while giving him breaths when his breathing slowed down. finally he stabilized and leimona, one of our village midwives, really wanted to hold him, so i motioned for her to keep him close to her and wrapped up, and to keep stimulating him (for the midwives who are reading this, i don't know why i didn't kangaroo him. at first i wanted to be able to give him breaths easily, and then afterwards i thought he was stable). carmenza agreed to suture the patient because i hate doing it and told her we would be done a lot faster if she just did it for me (bring back any memories of davao, jones?). i watched her suture and every few minutes i went over to check on the baby. the last time that i went over, his lips were pale and he was limp. he wasn't breathing and his heartbeat was painfully slow. i put him on the table and started chest compressions and mouth to mouth again. carmenza came to help me and she took over the compressions for me. i don't know how long we tried to save him, but it seemed like hours. the room was full of people but somehow it was just him, carmenza and i there. the suturing light hung over him, improvising as a heatlamp and my only awareness was of every detail of his still face, his white lips, carmenza counting in spanish as she physically beat his heart for him, and me begging him to breathe. there were times when we thought he would make it....his heart rate would speed up towards normal and he would try so hard to breathe. each time it was only fleeting. finally carmenza listened to his lungs again and told me what i already knew... he needed more medical intervention than we had to offer. we kept trying, knowing that the nearest facilities that could save him were two days away. finally he made the decision for us and his heartbeat slowed down and wouldn't speed up again. when it reached 20 beats/minute, carmenza took a piece of gauze and opened his eyes. she touched the surface of them with the gauze and he didn't react. she sighed and said "he's dying". then she looked at me and said "i think it's time to stop". i started to cry and nodded. i wrapped him up and took him to his mother who lay in bed waiting. i handed her to him forgetting, in the moment, the ritual ("who gave you this baby?" "God did") and no one bothered to remind me.