Asha

I did the pelvic exam while the doctor stood back.
“Doctor, this baby is not cephalic, its breech. Meconium stained liquor and she is fully dilated. Will she be able to have a normal delivery?”

(Meconium stained liquor means that the baby has passed feces already which indicates there could be fetal distress)

Asha, my first African momma

the twins

“Check the fetal heart rate, if its ok then she will deliver normally, if not we will take her for a cesarean section,” he responded.

There were four of us in the Intensive Care Unit today. It’s only my third day in the hospital, and my second day in ICU I am still figuring things out here. And I didn’t expect deliveries (Oh, how I have learned this week though, to always expect deliveries.) We searched for the heart rate of the baby. It was more difficult than normal to find. At first we heard a weak, slow, pulse but checking several minutes later it was 120 beats per minute. That’s good. We reported to the doctor and he ensured us that she would be fine to deliver normally.

“Will you conduct this delivery, please?” He looked at me.

Of course I will. I began to monitor the mother and my team and I continued to check on the baby. The heart rate stayed strong but after giving birth to 4 other children and being fully dilated, the baby should have been progressing better down the birth canal. The mom had little to no contractions. It wasn’t normal, but the staff, as loving and gentle as they are, we uninterested in her case. We patiently waited for the bub to arrive. After about an hour and a half momma started with some pretty strong contractions and the little bum began to come out. Sina, my instructor and a Medical Doctor from Germany, assisted me with the birth. I knew right away that something wasn’t right. The little bum was so small, too small. We lifted her out of her mom and placed her up on her mother’s tummy. She didn’t cry. She didn’t breath.

She didn’t make it.
And it didn’t take long for me to notice she wasn’t alone.

“Twins! I think there’s twins!! I think there’s another one,” I cried out.

This is when I am so grateful I work in a team. I have a baby who I am pretty sure is dead lying on top of her mother’s belly, a mom who has no idea she has another baby coming out of her OR that her first baby isn’t breathing and I need to somehow resuscitate the baby and be with the mom to deliver the next one ALL AT ONCE. Stress and panic try to take control in this situation, and they would, if it weren’t for incredible teamwork but I manage to stay calm. We search through the woman’s birth bag to look for something to cut and clamp the umbilical cord with. We must get this baby oxygen. She has nothing. (The women must bring their own supplies for a delivery) My instructor remembers she has a clamp in her bag. Someone runs to get it. When she comes back with it, Sina cuts the cord and takes the baby. A teammate of mine follows and together they fought for the life of that baby. Unfortunately, the first African baby that I welcomed into the world didn’t have a chance to be apart of it. She was pronounced dead minutes after her birth.

I can’t cry. I’m in the middle of another delivery here. I am working alone now and I am with a woman who doesn’t speak a word of English. I hold my index and middle finger up to her, making a “two” sign. I have to tell her she's not finished yet.
“Two, mama, there’s two.”

She shakes her head no. I can hear her thoughts, “It cant be. I’m 8 months pregnant here. I would have known I was having twins. I had prenatal care, I’ve seen the doctor, and someone would have told me.”

Between me insisting and the fact that her contractions weren't subsiding, she was finally convinced that she would be having another baby. She shook her head a few more times in disbelief.

the sweet baby boy, twin 2

This is my first twin delivery. I haven’t studied or learned much about the procedure. How quickly should the baby come out? Do I need to intervene or shall we let the baby come out in its own timing?

I have a lot of thoughts happening right now. I just lost a baby. And I have been monitoring this baby and I had no idea there were two. I missed it. I don’t have a scanning machine and I’m still a student, learning. Shouldn’t I have known, though? But she has a doctor. How did no one, at all, catch that she had two babies inside of her? This is reminding me of India. How did no one know she had a breech presentation and meconium stained liquor? Why am I the one to tell the doctor all these things? I monitor mom and baby while mentally processing. 15 minutes pass and there is no progression.

We check the fetal heart rate again. Its dropping.

“Doctor, I think we need to give her oxytocin,” I say. (But who am I to tell the doctor what drugs to administer?)

“We cannot,” he says. “You cannot give oxytocin to a mother with twins. Check her cervix and see if it’s closing,” he tells me.

I don’t know if this is right or not. I really don’t. But I have no option but to trust his word. Even though he just missed a lot of crucial things on the first baby, even though I had to correct a lot of his findings, I still can’t override or think I know more than him about what drugs to administer.

I insert my hand to feel for the baby. It’s coming out headfirst but its not far enough down. The cervix is starting to close. We need oxytocin. I am learning a lot about medication and drugs and I know, when I practice, I want to be as natural as possible-but I have also learned what a gift medication can be. How it really can save someone's life.

My instructor, who is also a doctor tells the African doctor that we should administer the drugs. We see him second guessing his initial reaction. We see he is unsure of the situation. I can't be working with a doctor who is unsure. I need someone confident in this situation. I need him to be sure in this moment. I need him to be the doctor and make the right call. I want him to have the solution.

“the heart rate is dropping, doctor we need to get the baby out.”
He comes to listen to the heart.
90 then 80 beats per minute. This is dangerous.

“I have called my superior doctor, he will decide,” he tells us.

the heart rate goes down to 60 beats. We’re losing the second baby.

The four of us begin to pray out loud, we are crying for the life of this baby now. The doctor hears us and doesn’t stop us. I feel the thickness in the spiritual realm. Its weird to say this and hard to explain but there is tension in the air. Darkness is trying to take over, death is winning.

Sina says, “doctor, this baby wants to come out.”

“Ok,  you do whatever you think you should. Give her oxytocin if you think its best.” He says. He’s placing his trust in Sina. He doesn't know what to do.

We search through her belongings. She didn’t know she was having two babies so she’s lacking in supplies now. Thank God, she had some leftover oxytocin. One administers it while the rest of us continue to pray.

“This could distress the baby,” Sina warns me. “It needs to come out quickly”

We keep praying and listening to the heart. It’s beating faster, it’s getting stronger. A miracle is happening. It’s back to 120. And within minutes his head pops out. He is born and with a beautiful cry I place him straight on his mommies belly. He’s here. He’s alive. He’s healthy.
He is a miracle.

We all gave a sigh of relief. He is okay. The doctor comes back to see and he laughs with joy.
“Congratulations,” he says to us. Like we were the ones who just birthed a baby. But I understood what he meant. Congratulations for making the right call, for making the right decision and for saving this baby.

“You prayed. You prayed and the baby lived, “ he noticed. And we all knew we just saw a battle unfold before our eyes. We fought for a life and we won.

Just then the senior doctor walks in. He laughs as well and we hear the first doctor telling him what we did. They smile in approval.

I think for the first time in an hour, I take a breath. Have I been holding it all this time? My back aches and my heart hurts a bit. But we survived. We did it. Thank you, Lord.

It took the mom a few minutes to remember she gave birth to two babies. Now she holds her two fingers up to me and speaks Swahili. She’s reminding me she had two babies. Like I could have forgotten.

“1 baby, Momma.” I say as I just hold up one finger now. No one that speaks her language is around to tell her that she lost the first twin. And although we have a huge language barrier, it becomes my job to tell her.

She continues to try and remind me she gave birth to two babies. She’s persistent in showing me both of her fingers. Two. Two.

I shook my head no. “One baby now, mom.”

I see the lines on her face change. She understands. Now I can cry. It’s okay for my heart to break with her. I tell her in Swhahili I am very sorry.

“Pole sana mama, pole sana.” She looks back at me with consolation on her face. She lost a baby and yet somehow she consoles me?

And just for a brief moment she let herself feel grief, feel the loss of a baby she didn’t even know she was having- and then she recovers. You recover quickly here. Fetal death is normal. So it might hurt, but mom knows to expect it and then to get over it. This is the life they live. Your lucky if your baby lives. I get her cleaned up and she thanks me a multitude of times. Her and her new son are doing great. And my workday is coming to an end.

Momma, resting after the delivery of her son

And this is has become my first delivery story in Africa. It might not have been what I was expecting, but hey, they never really are. I wonder if I would have been able to catch that there were twins fror her abdominal exam would I have been able to save the life of that first baby girl. It’s possible. It’s possible that she had already died before I even arrived today too. I don’t know the answer to that. Today, I was forced to learn in the moment and I did learn- but I lost too. Today, I left the hospital feeling gratitude towards my teammates, joy for the victory, pain for the loss, and exhaustion from the week. It’s a lot of emotions to carry but again,  I am so grateful I don't carry them alone.