Thursday, April 18, 2013

Life and Home Stretch Musings.

So praise God! After one week of paperwork and tons of running around by our amazing staff, we are all legal to work in Zambia. This is amazing since in Tanzania it took us 2 weeks to get approved and 3 months to get an actual legal  stamp in our passports. We actually got our stamp just 2 days before leaving Tanzania!! Whew! So this is much improved and we are really blessed to be back up and running in the hospital.  

Just wanted to give you update of the 15 year old hope that was bleeding from a post or 2 before. Remember the young girl who had delivered at home and was bleeding, yet wouldn't let anyone near her? Well I got and update from the doc I was working with that day. They ended up taking her to operating theater because even the senior doctor could not examine her even with sedation.  She ended up having tears throughout her entire birth canal.  Thankfully operation was an option because she would have kept bleeding and not made it.  Today she is doing well and her and her baby were discharged in good health! 
I also heard word about the young 15 yrs old momma who had a baby in distress but was waiting for hours for a c-section.  She was finally able to get the operation and the baby is still in the hospital. I am unsure if the baby will make it but so far it is alive!
It’s good to be back in the hospital this week. I was in the labor room last Tuesday and spent all day with a laboring momma. This was her 5th pregnancy so I thought was gonna be a fast one. She had her first by emergency c-section 13 yrs ago because the baby was 3.9kg and obstructed. Since then she has had 3 normal deliveries so she was in the clear so to speak for her 4th normal delivery. Since her first four babies were large and her first delivery was a cesarean the doctor was concerned and kept asking me to monitor her for signs of shock. This can be a sign that the uterus is actually rupturing. Everything was progressing along fine until she reached about 9 cm and I noticed some active bleeding. I did a quick V.E. (vaginal exam) and although most of the cervix was gone there still remained a segment not dilated and very swollen.  With the bleeding and the mysterious tissue that I deemed was a portion of the cervix I decided to inform the docs. The first doc came in and said the tissue was actually placenta and that she should be rushed to theatre. The second doc said it’s probably just swollen cervix but with the bleeding and her slow progression past 8cm she still needs to go theatre in case of a rupturing uterus. Her vitals had also dropped and labor slowed way down in the last hour. I went with her to theatre and a beautiful healthy chunky baby girl was delivered.
Afterwards the doc was really nice and spent time explaining the risks and signs of a rupturing uterus and some of the signs the patient was presenting. She also said when you’re in a position with limited monitoring resources sometimes you just have to go with your gut and to do what’s best for mom and baby. If her uterus had ruptured with that current amount of staff and supplies there was a good chance that mom and baby would lose their lives.
 In India they didn’t usually even attempt to let moms try for a natural after c-section. Sadly they will even go so far as to let a baby in distress die with the thought, “Once the mom has a cesarean she’s stuck having cesareans for the rest of her pregnancies and if she can’t afford the medical costs she’s better off letting this one go and trying for a natural delivery again with the next pregnancy”.  This was an actual conversation I had with a health professional there during a labor! Thankfully our team was able to spend a lot of time with the staff advocating that every life is worth fighting for and in that particular case above, thankfully a beautiful baby boy was born that day. 
In Zambia and Tanzania they’ve been more willing to let mothers labor after c-sections. This is partly because they don’t have the surgical staff or the after care staff to give every woman a c-section for her future pregnancies. I’ve seen mothers with the vertical incisions labor and do well.  However, this last weekend a woman lost her life because her uterus ruptured (this wasn’t a VBAC) and despite surgery to remove her uterus, and over 7 liters of transfused blood they were unable to save her. This was one of 3 ruptures that happened that week. 
Again, I’ve really been thinking a lot about why I wanted to get this training and constantly trying to make sense of everything I am seeing and experiencing in these 3rd world settings. I came across this statistic this week from the World Health Organization.
“About 1000 women and almost 10,000 newborns die every day due to largely preventable complications during pregnancy, childbirth and the immediate postnatal period. In addition, every year, nearly 3 million babies are stillborn. Many of these lives could be saved if every birth were attended by a midwife.”
I know these statistics seem high but I’ve seen these things. I’ve seen so many babies with heartbeats hours before being born dead because someone didn’t pick up on the baby’s distress early enough. I’ve seen babies not even make it to term because of malnourished or anemic mothers. I’ve seen mothers come close to bleeding to death because their uterus failed to deliver the tiniest portion of membrane (left over from the birth sack) or their uterus was unable to contract from being tired but their life was saved with IV fluids, an oxytonic drug and a staff member with training. Our team has been fortunate not to have lost mothers but mothers have died at these hospitals during our time in these places and we had been monitoring the mother that was in the case above.
I’ve also seen babies born completely flat and God bring them back to life, sometimes through resuscitation, sometimes through straight prayer and intercession. I’ve seen mothers stop bleeding after praying when everything else was failing to stop it. I’ve seen God do things that make no medical sense.
I can’t make sense of everything but what I can say is that God loves life. God wants life to be fought for and he is looking for God fearing midwives and other medical staff to fill the gap. I am so grateful to have had this experience, to have this training and to know that I could be available someday to save a life. God loves people so much and has a special place in his heart for mommas and little ones growing inside them. They are loved. They have value. 
I leave you with a few pics from the past 2 weeks. 

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