A post by volunteer midwife, Tara Elrod.
The night before last we worked a night shift at Ste. Therese. Glen and I were accompanied by Keri, the doula from Connecticut who we have been blessed to meet and share this trip with, and our translator Shelly.
When the sun sets over St. Therese, the vibe noticeably changes. The unrelenting heat that beats upon the dirt and the concrete, and the thick, heavy stench of dehydrated urine, feces, amniotic fluid, blood, and unbathed, moist bodies give way to the night sky. The scorching sun departs, and the Haitian sky welcomes the moon, which brings a yet still warm night, but one that gives the comfort of an intermittent cool breeze.
The hustle and bustle slowly dissipate as the hours draw by, consistent with the slow but steady drop in temperature. We can feel the difference in the air even in just a couple degrees, and for that, we are thankful. The patients who are here to stay retreat to their beds for not only the comfort of a soft place to lay and potential sleep, but for the protection that the mosquito net brings. Each ward closes its doors, guests and family retreat for the night, and the metal gate to the hospital is shut to the outside world. The moans, yells, and shouts to Jesus of the day no longer occur, but are now replaced with cries that are coming from the new Haitian lives residing in the postpartum unit- the babies that were born today and yesterday.
What I notice for the first time in this sanctuary lull, is the sweet aroma that fills the air. Gone is the invasion of bodily fluids, but now the air is filled with the presence of sweet flowers. It is Heaven on earth. I take deep breaths of the fresh air and I speak to Glen of how beautiful it smells. I wonder why we have never noticed it? Funny how when darkness falls, when your world and heart are quiet, you become more aware of what surrounds you. Beauty is in the little things, yet so often we fail to see them through the busy or the bad of everything else that is occurring. But it’s still there.
Earlier today, at about 1pm, a woman in labor walked into the maternity unit. I took one look at her and said to my translator, “That is a big belly for a Haitian belly! She has to have twins.” I would bask in my observation skills, as minutes later we would find that she was indeed carrying twins. And term twins at that. Glen did an ultrasound and confirmed that Baby A was vertex and Baby B was breech. She would be 5cm then, and when we returned for the night shift, she had not yet delivered. At about midnight, I asked if I could check her and found that she was 8cm, Baby A was nearly +3 station, and a tight bulging bag right inside her introitus. I said to Glen and the Haitian midwife in charge that it was bound to burst any minute and I felt it would be better to rupture it in a controlled fashion, allowing it to leak. I felt the baby would come right away. Seeing as this was twins, Glen was hesitant to do that, and the Haitian midwife said absolutely not, for fear of a cord prolapse. In my mind this was silly at this point, as the baby’s head was filling the vagina. I nodded and said ok. I do not deliver twins, as they are outside of the scope of my care. I was not the primary provider, so it was not up to me anyhow. Just my 2 cents. I then told Glen and the midwife to prepare for delivery, as once that bag broke, we would be having babies. While Glen made sure Pitocin was drawn up, clean instruments were out, and the PPV mask was out, I geared up in delivery garb, to help wherever needed. I stood there, feeling how I imagine new Haitian babies must feel- hot in the stagnant heat, yet swaddled in layers of non-breathable clothing. Within minutes a pop and explosion, a powerful burst of amniotic fluid ruptured 3 feet across the room, followed immediately by Baby A’s head. I was the only one gowned and gloved. I stepped over and immediately caught Baby A. Glen garbed up in the protective gown and gloves and stepped in for Baby B, as we knew this baby was frank breech. Just a few minutes later, this second baby made her way into the world, rump first, to join her sister. Mom would go on to have a postpartum hemorrhage, which would be controlled with Pitocin and Cytotec. She, and her two new girls, would do just fine.
After mom was stable and moved to the postpartum unit, Glen and I would go to lay down to get some rest. Two hours later, we would hear commotion outside in the corridor. Glen said to me, “We better go out there. I think I heard someone say something about a mom pushing in the car.” I grabbed my supplies and ran out to the exterior of the building, Keri and Shelly already two beats ahead of me.
What I see is gut wrenching. There are men lifting a woman from the van, trying to get her into a wheelchair. She is contorting, bucking, violently thrashing, in the black abyss of seizure after seizure. I throw gloves on as I yell over the commotion, “Is she pushing? Did she deliver?!” Shelly says to me that she has already delivered. I yell, “Where is the baby? Is the baby alive?!” I have no idea if she is 24 weeks or 40. IS THE BABY ALIVE?!” I must yell it three more times, as no one hears me, there is such commotion and attention on the violently seizing mom. Finally Shelly says, “Yes, the baby is alive.” She is so calm, almost too calm. She talks and moves in slow motion, and I know that this is because her eyes and ears are acclimated to scenes such as this. Shelly points to a man, still in the van, and I see he has a bundle of miscellaneous cloth in his arms- shirts, scarves, I am sure anything they could find to keep the baby warm. I step to the open door of the van- as mom continues to thrash like a wild animal that the men are trying to tame- and I see the blood. There is a sea of red blood on the floor of this van, spilling onto the dry dirt ground that I am standing on. I grab the cloth bundle and prepare in my mind for what I might see. I have no idea what the condition of this baby will be. I take the bundle and immediately something falls down out of the cloth- the placenta hits the filthy, bloody floor of the van, acting as an anchor in this Red Sea. I have no extra hands to pick it up, and I we are tethered to the van. Keri instinctually steps forward as if to grab it for me, but immediately halts, as if in line with the shout in my head that has exclaimed, NO! She realizes, as I realize, that she has no gloves on and is not protected from whatever lies within that blood. She sees a clean, dry towel sitting on the seat, and uses that to pick up the placenta. Together, stride for stride, we walk as quickly as we can back to the maternity unit. The baby is alive and breathing well, has good color, but feels as cool as I imagine a cadaver must feel.
We remove the baby from the sopping wet garments and clamp and cut the cord, detaching the placenta. I look to see what this baby is…she is a girl. It is the least of my concerns, but as I dress her in what I have brought in my backpack, I am sad that all I have are boy clothes. The scene is stark in my mind- a new Haitian baby, whose mother continues to seize in the background, is getting cared for and dressed for the first time by a disheveled, hot mess of an American who is dressing her in boy clothes.
Keri and I would take turns holding her up against ourselves, with an electric warming pad pressed up against her back. This is how we kept her warm, bringing her temperature up from the 95 degrees it was on arrival.
The following day, the mom would be stable, conscious, and alert. Keri and I would go visit with her and help to get her baby girl latched to the breast. The importance of breastfeeding…it can be the difference between life or death here. To see a woman who I thought may very well die just the night before, now alive and nursing her baby, this was amazing. Even in a room overflowing with sadness and terrible things, this was a beautiful, wonderful thing to see and to be a part of.
There is beauty everywhere. Even when we are in the midst of bad, even when we are too overwhelmed or busy to take notice.