On my third shift in the hospital, I worked with an American nurse-midwife named Cathy. I helped with a couple of deliveries as she labor-sat with a 9th timer who was almost complete. It was unusual that she wasn’t just spitting her baby out. Her contractions were short and far apart. We had her up and walking but she became a spectacle in the labor ward. She has gray hair and thus, many people, waiting in the hospital for other loved ones, started staring at her and following her around. They wanted to see how this “gran moun” (old lady) would deliver. We finally gave her a private space in the maternité so that she wouldn’t be the object of such gawking. The labor (or non-labor) was going on for hours.
Finally, it was decided that her labor would be augmented with pitocin. I didn’t think that this was a bad idea, seeing that she was a hemorrhage risk and that the weak labor pattern would make that worse. Within an hour or so of receiving pitocin, she was screaming her baby out. Again, a little unusual. I would have expected a 9th timer to be an old-pro. Anyway, the baby came. But, it didn’t breath. There was meconium staining and the student midwife on staff was slow and clunky with her aspiration of the baby’s nose and mouth. As I saw that the baby was not breathing, I asked for the ambu bag and began the resuscitation. The baby was still unresponsive and apneic (not breathing). Within a minute, we had also begun chest compressions because the baby’s heart rate was low. Cathy did the first shift of chest compressions as I bagged the baby. I began the mantra of neonatal resuscitation. One and two and three and breath and one and two and three and breathe and…… Over and over. The baby, a little boy, was not responding. He most likely had meconium in his lungs and the, ultimately, quick delivery did not allow for enough squeeze to get it all out. Most people believe now that meconium aspiration is the result of an in utero distress. In the U.S., we deal with it often in the NICU and the babies live.
This little guy, though, was not going to have that advantage. We resuscitated him for 30 minutes, which is a long time for that kind of thing. He was finally breathing on his own, but he never took a full cry and he had the rhythmic agonal gasping of one who is desperately trying to receive air. Miss Genette offered that we could try to find a pediatric doctor to help. I thought that was a great idea and so I carried him out of the maternity ward and across the courtyard to the largely, ill-equipped pediatric unit. The baby boy was breathing on his own, but was still limp and unresponsive. Cathy and I would continued ventilating him with the ambu bag which seemed to be offering him more support. Miraculously, the doctor somehow came up with an oxygen machine. So, we put a nasal cannula on the baby and observed.
He definitely seemed to be doing better with the oxygen, but I still felt that this baby needed more care. Could we transfer him to Paul Farmer’s hospital 45 minutes away in Cange? The doctor agreed that this was a good idea and said that he would make the arrangements. I left the hospital about an hour and a half after this birth, having stayed with the baby the whole time. I felt that he was doing a little better. He had a little better muscle tone, but he still hadn’t cried and most of the time, his eyes were closed. He was receiving the oxygen and was now under the care of the pediatrician. I was adamant with them that this baby needed to be watched carefully until he was transferred to Cange. Miss Genette left the hospital 3 hours later and the baby still had not left yet.
The next morning, back at the hospital for another shift in Labor and Delivery, I asked about the baby. Miss Genette did not know, but we finally found another midwife who had the news. The baby had died on route to Cange.
I felt numb. This baby would have lived in the U.S. But this is Haiti, and the hospital does not have a NICU, does not have good suctioning equipment, does not have endless supplies of oxygen. I don’t even know if the baby had medical support on the drive. All I know is that a family member accompanied him.
I saw the mother in the postpartum ward and told her how sorry I was. She was resolute and quiet. I also knew she was about to pick herself up and go on with life. There is no time in Haiti to mourn the loss of a baby when you have 8 other hungry mouths to feed. Death is sorrowful and yet, not unexpected. The town of Hinche has at least 3 or 4 coffin shops where the wood workers display their hand-made boxes along with school benches and tables. We saw a coffin being carried down a dusty, dirt road by a procession of pall-bearers and community members. Out in the middle of nowhere, obviously they were headed to a burial spot. Death. This is Haiti.
-The above story is an excerpt from a blog post by Maria Iorillo, LM, CPM, who travels annually to Hinche to volunteer with us. Check out Maria’s blog for more stories from her. Since this writing (about a year ago), Ohio State University has built a NICU at Ste. Therese Hospital. Maria will be returning for another volunteer trip early next year.
-Photo by Cheryl Hanna-Truscott