By Jennifer Gallardo
It is 12:30 in the morning and I bring my computer to the birth room to write about my day in Haiti, as I sit with the eighth momma in labor today. We came home from the beach a few hours ago to find three mommas in the postpartum room with their babies next to them, and four mommas in labor. We only have three beds in the labor room, and one is broken, so one momma labors in the postpartum room and another laboring momma walks in the hallway until Fernando fixes the broken third bed. I put up a screen so he can do so while two other momma’s are in labor in the same room.
No sooner is the third bed fixed when the momma in the hallway comes in and gives birth in it. The fourth momma has her baby too and I get to catch while she births on the birth stool. She is really cute with her hair up in two buns and a beautiful smile. It is her fourth baby and she doesn’t moan or make loud labor sounds, but just smiles at me and grabs my hand to rub her belly and back. I take her picture after the birth and show it to her and she is delighted and says over and over again, “Belle!” The way she reacts to how she and her baby look in the picture makes me wonder if she has ever seen herself in a picture.
Seven babies have been born and we are waiting on baby number eight. Rose Edith is on call tonight and I tell her to go to sleep and I’ll take care of the momma in labor. She says no, but then finally agrees to sleep in the prenatal room next door as long as I promise to wake her up when baby is coming.
As I labor sit and try to write about my day, I only get to type for a few minutes before the momma says to me, “Shitay” (sit) pleadingly, and points to the chair beside her birth stool. I go over and sit by her and hold her hand, and then she commands, “Chante” (sing). I sing every hymn I can remember, in English or Spanish. She sings along in Kreyol as she lifts her hands to the heavens and pleads with God to have this baby. She has watched seven other babies be born today, and each time she breaks out in sobs and wails, not understanding why her labor is so difficult.
Her belly looks bigger than the other mommas who have come in, and I think of all the spaghetti she may have eaten to sustain herself. I remember when I went to the Haitian orphanage the children ate two meals a day of breakfast and dinner. Both meals were spaghetti. The reality in Haiti is that food is hard to come by, and while the majority of women who come through our gates are too thin from not enough caloric intake, some are overweight because of a diet too high in carbs. The ultrasound she had says she is having a baby that is 3,900 grams, which is almost 9 lbs and quite big for a small Haitian woman. This is her first baby. She has been pushing for an hour.
The next three hours are a blur of feeling oh so sleepy but fighting to stay awake, singing and massaging momma, encouraging pushing on the birth stool and in different positions, and checking progress and baby’s heart tones. I have asked the momma’s sister to come in, and she helps with labor support. Baby’s head continues to move down, though ever so slowly. Heart tones are good and strong. Finally, I feel the birth is close enough for us to awake Rose Edith. She comes in sleepily and watches. She checks the baby and says it is taking too long and we should consider going to the hospital. The momma hears the word hospital and pushes harder. The student is in catching position. Momma is so tired and is done with the birth stool, so she pushes while on her back. I am feeling that midwife intuition that I need to be ready for anything. I can tell Rose Edith feels it too. I don’t want to cause an emergency though, so I am just extra vigilant and I eye the oxygen and ambu bag incase it is needed.
The head is finally is born after much encouragement to momma. No rotation with the next contraction. Nothing budges. The student checks for cord and there is none. Another contraction and we encourage momma to push. Again, nothing. I check to see where the anterior shoulder is, and it is behind the pubic bone, in the vertical position rather than diagonal which is the way it needs to be to fit through the pelvis. I try to fit my two fingers in by the anterior shoulder to do the cork screw maneuvers needed to turn baby into diagonal position, but the pubic bone is low and flat and the baby’s shoulder is so tightly pinned against it that my fingers won’t fit. We try McRoberts with corkscrew and suprapubic pressure, to no avail. I ask mom to turn onto her hands and knees and Rose Edith translates. She does so, but puts her head and arms down, which is more like a child’s pose, and the position is making it difficult for me to get the posterior arm out. I can reach it but I can’t get it out. I feel like I am fighting gravity, as I try to deliver it again and again. I try to rotate baby with mom in this child’s pose, and it feels like I am attempting to move a piano by myself that won’t budge.
I have delivered over 1,300 babies, and have had my share of shoulder dystocia’s I have managed and delivered, and in this moment I am thinking of positions that I want momma to get into, but the language barrier is too great. McRoberts didn’t work well for her. Runners pose on hands and knees would be amazing, but how to explain that? I try to get her to stand, and I remember the word “ kanpe” but she and the midwives look at me confused. I have had a lot of success getting a shoulder dystocia out with momma standing and me delivering the posterior arm. Maybe they haven’t witnessed standing births? OK, I have got to get this baby out! Let’s just shoot for getting hands and knees done right! I get on the bed, and get into hands and knees myself, saying, “OUI! OUI!". Then I do child’s pose and say, "NO! NO!” Please tell me they understand? It is ridiculous that I am in the middle of an emergency and I can’t communicate and am resorting to showing them positions when time is of essence. I am at that point where I know if I don’t get baby out quickly, he might not make it.
I watch the student and Rose shout orders to the momma and get her into standing position leaning over the bed. Not what I was asking, but I think it will work. I reach in and deliver the posterior arm with some difficulty, then rotate the baby and pull him out and towards the front of momma, onto the bed as she leans over him. He is white and slippery and floppy. I dry and stimulate him, fully expecting that I will need to resuscitate him by now, as it has taken longer than usual to get him out. I am surprised when baby sputters and takes his first breath before one minute of age. I listen to his heart and it is below 100 beats per minute but rising. I am flooded with relief.
Now to work on the placenta birth. After a long hard labor, momma is gushing blood. We lay her on the bed and give her a shot of pitocin. The student does gentle cord traction as we encourage momma to push, and the placenta is delivered and bleeding is under control. We check for tears and Rose Edith and the student prepare to suture her. This is the first vaginal tear we have had the entire time I have been at MamaBaby this trip.
It is so hot in the birth room that we are all dripping with sweat as if we were in a sauna. I am holding this little warrior baby that I wrapped in an army blanket when I notice my arms and shirt are soaked with blood. I take off my shirt and see my bra has fared no better. I take that off too and hike up my skirt and tie the drawstring around my neck. I wash my arms and hands with soap. There. That’s better. I take a picture, ecstatic that I am holding a living breathing baby and so happy for this momma that she has finally finished with a long tough labor.
It is 6am when I am able to go upstairs and take a cold shower and scrub myself clean of all the blood and sweat. Once out of the shower I stand on the porch, enjoying a gentle breeze, wrapped in my towel. By now the sun is up and we will be leaving for the airport soon, so I decide not to bother with trying to sleep. I head downstairs and can hear the auntie of the little warrior baby chattering to others who are waiting. She keeps saying my name and when I walk down the three men and women in the waiting room stand up and warmly congratulate me and thank me for saving the baby. I take pictures of all the momma’s in the postpartum room and birth room. Nine babies today. We have done a good work today. I feel content.