Grace Chew’s Blog

24/2/2009: Day 13, Kapuna Hospital

Along with settling into the ward and patient
system in the hospital, we’ve been trying to
attend and perform deliveries. Ruth had gotten
the first one, so when we heard there was another
lady going to give birth, I thought I could give it a go.

She was primiparous (it was her first baby), and
had felt her first contractions the afternoon
before. She was progressing slowly but surely,
and to try and speed things up her membranes were
ruptured for her at 10 pm. At this point she was
about 7 cm dilated. The cervix should dilate at
about 1 cm/hour, so she was scheduled to deliver
at 1-2 am or thereabouts, and I decided to hang
around and read a book or two to monitor her
progress and hopefully deliver her baby.

Unfortunately, her progress still remained slow,
and my progress through the book too fast, and at
2.30 am she was examined again and found to be
only 9 cm dilated! By this time my patience and
that of the night call sisters was wearing thin,
and the mother was quite exhausted from the pains
as well. CHW Rita decided to start delivery at 3
am instead of waiting and letting the mother tire
more, and on hindsight it was probably a good
idea as mother was quite uncooperative! She
couldn’t push properly, either being too tired
from the long pain-filled vigil, or not listening
to our exhortations. The situation was
complicated by the fact that she could only
understand her local language which her mother
and only one of the nurses could speak, so to her
whatever encouragements the rest of us gave her was just mumbo-jumbo!

Half an hour into the delivery, she still wasn’t
really progressing so Rita decided to assist with
the vaccum pump (the classic hand-operated
version), but even then, the cup wouldn’t hold
properly and she had resorted to pushing for
several seconds then expending her energy in
crying and flailing about. Instead of bearing
down, she would push her legs into the handholds
of another nurse and I, and arch her back and try
and push herself off the narrow table she was on.
To make matters worse, she had a full rectum and
a full bladder (which both contributed to the
slow progress) and each ineffectual push was
moving the faeces, not the baby, out. What little
sterility we had quickly went out the window!
Once the poor girl got so dispirited she started
jerking her arms about and her eyes rolled into
her head, and we almost thought she was going
into seizures. Thankfully she hadn’t, but by that
time her energy was well-spent and she had to lie
quietly for a few minutes before she could be
roused to start trying to push again.

Finally, with Dr Valerie arriving at the scene,
she diagnosed an OP presentation (unnatural
presentation for the baby, which also explained
the slow progress) and properly sited the vacuum
cup. It was still hard-going, but soon the baby’s
head was out. Meanwhile, a lady had arrived some
45 minutes before and we heard the cries of her
baby in the adjoining room, born by torchlight.
The baby was fully delivered at about 4.15 am,
alive and kicking, leaving 3 nurses, 1 doctor, 1
medical student, and 1 mother quite exhausted.

I got back past 5 am, guided by starlight, but
was awoken by the chickens about 3 hours later.
So much for getting my first hands-on experience for a delivery!