Thursday, July 9, 2009

Oh wow ... there's a foot

I (Michelle) was back on the labor ward today. It was very slow when I arrived and I assumed that I might be transferring to another unit for rounds or scrubbing in for surgery. Thus I did not immediately gown up in delivery attire. That was a mistake.

I was just talking to the physician on duty (Dr. Mkamba) and a women walked in and spoke to one of the nurses in swahili. I heard the words "second stage" in there somewhere and then the nurse told me to go deliver her (some of them haven't quite figured out despite my explanations that I am not qualified to do unassisted deliveries yet). I asked the physician for assistance and we headed over the assess the situation. When we got there the head was almost out. The physician just walked me through things, but I did each and every step myself for the very first time! It all happened so quickly and a healthy 3.2 kg baby boy was born!

I was excited about my first unassisted delivery and I just about to go get officially gowned up when I was directed to assist another woman. I again brought Dr. Mkamba with me, but he did not bring gloves or gown up either. We assessed the woman, ruptured her membranes, and I prepared for another delivery. And then, we saw a foot. Oh no ... this baby is breech and it is WAY too late to do a C-section. Okay, Dr. Mkamba gowned up and got more assistance and we prepared for a breech delivery. The baby came within a minute and a healthy 2.6 kg baby girl was born!

Breech deliveries are a three person effort and are very different from normal cephalic deliveries. I am so happy to have learned the skill of a breech delivery. In America, every woman who presents in a breech position goes to C-section, so physicians never learn the skill of a vaginal breech delivery. But what happens if a situation like this presents where it is WAY too late for a C-section?

Hailey worked in the HIV childrens clinic today where she saw a few mothers who didn't even bring their kids with them to the appointments. They just brought their child's medical record and left him/her at home to work in the house. The physician that Hailey was working with was frustrated and just kept saying "I treat kids, not cards!"

Lindsay was in the theatre today and saw a few hernia repairs. There were many observers in these rooms, and because they are more crowded than C-section deliveries it can be difficult to see and/or learn much from these experiences.

Another great day at Mt. Meru!

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