Gwo Tet Un

I was getting impatient.  I had woofed down about a half portion of my evening meal.  The eleven year old that swings by the clinic to mooch actually scoffed at the amount of food on my plate.  Talk about being made to feel like a punk.  But I had done this because the last two of our laboring women were theoretically about ready to deliver.  The first was a primip who was term and being helped very gently along so she could just go ahead and have her baby at the hospital.  The other was a G3 who one might think would be a pro at this stuff.  They both took forever.

Maybe it’s because I didn’t get to go to La Fite.  Maybe it’s because they kept saying something to me about the ‘blan’ but I had no clue what it was.  Or maybe I was just ready to get some more food, but I’m sure I was wearing my impatience on my face.  And my co-workers can attest that I would never do that at Wesley.

We deliver the multip, finally.  I can only imagine what the heart tones would have been doing because she came out swimming in thick meconium and a cord around her neck.  Baby transitions okay and we actually do some skin to skin.  A full hour is too much for them to handle here, but I tried my hardest to institute a change.  Ten minutes in and I see that they’ve already pulled the baby off mom so they can tie the cord and clean her up.  And forget about four hours of recovery time in the delivery room because she was immediately told to walk back to the back “post-partum” room where two other new moms had already claimed the best beds.  No Jacuzzi.  No flat screen TV with touch screen, on demand movies, and food ordering service.  I’m not exactly sure how the ServeHaiti can compete for these pregnant women when they aren’t getting pampered properly.

But now we turn our attention to the primip.  She had come in yesterday during clinic, but hadn’t technically hit active labor until about 3 pm today.  But when they live miles away over a couple mountains and a terrain that even a moto can’t traverse your only option is to keep them around till they deliver or basically guarantee that they deliver at home and you hope to see mom and baby within the first week.  So she got to “maché” around the compound all day and night.  But now, she was our only remaining pregnant patient and she was close to active labor.  The pit is running.

Keep in mind these women are unblocked.  There is no epidural taking the bite out of their pain.  They scream, they pray, they sing and squirm in every way possible to try and distract themselves from the pain.  Because of this though, I have to fight every urge to check her and figure out where the hell we’re at.  Do I have time to finish my meal?  Ugh.  It’s painful.  And normally I’m one who is hands off of my laboring patients.  I finally get up the nerve, or lose the battle to my impatience however you want to look at it, and check her.  Complete and +2ish.  Perfect.  Let’s ‘pusse’ this baby out.  Yes.  That is Creole for push.  And yes.  That is said repeatedly, at louder than playground voices, during active labor.  #KeepAStraightFace #IDareYou

She seems like she should be a good pusher.  I feel like all Haitian women seem like they would be good pushers.  I’m not sure why and I’m not sure if that’s racist.  But I feel like that’s a compliment?  My apologies if someone is offended by that assumption.  Making good progress.  Baby is crowning.  Finally, I can see the end of my work duties.  I mean, I’d hate to violate hours. 

Then he’s still crowning.  Still crowning.  She’s unblocked but damn we’ve been at this for a long time.  I apply gentle stretching forces with my gloved hands to try and facilitate the path.  With the next push I insert my finger into her rectum.  Gross, I know.  But I was going to try and hook the baby’s jaw and pull him forward.  I couldn’t reach it.  This kid’s head was huge.   We try and doppler for heart tones, but she waves us off as another contraction hits.  She’s running out of gas. 

At this point the Haitian resident and I discuss our options.  We have no surgeon, or operating room, or sterile surgical supplies.  We have no vacuum or forceps.  Alright then, good talk.  It’s either we push him out or we send her on a four hour drive in a massive downpour to Port-au-Prince.  We talk episiotomy and get the scissors to the bedside.  I try and offer some push coaching, but who the hell am I kidding.  My botched attempts at Creole probably add to the confusion.  Fortunately for me the Haitian resident speaks a little English and she and I have been practicing languages with one another throughout my time here. 

With the next push I reach as far as I can.  I find his jaw and thrust it forward.  Every OB in the world is probably like, wtf are you doing.  And they’re probably right, but in the situation it seemed like the most reasonable recourse.  He comes out.  And, yeah, massive tear.  And he too is followed by a pile of meconium.  I pass him up to the patient’s abdomen so we can start cleaning and skin to skin.  I take a peak at the tear we are gonna be repairing still waiting to hear a cry.  

I hear nothing.  I take a peak up to her belly.

He doesn’t look good.