All my births, initial prenatals, postpartums, and newborn exams from Davao are correctly entered on the NARM forms with preceptor initials, and the nine different preceptors who’ve supervised these clinical experiences for me have all signed their notarized statements. I have one more shift — night tonight — and then I will be heading home on Saturday.
Heather asked me to change my schedule yesterday — I was supposed to be on both day and night shift, but she found herself short of hands on swing shift so asked if I’d switch. This worked nicely for me as I had the morning to chase down paperwork but I was rushing around so much that I didn’t really make myself any proper breakfast or lunch, just grabbed a few crackers and a banana on the go.
We certainly were short of hands on swing shift! Besides the supervisor, there was one of the staff midwives, a Filippino student midwife who is still just observing births, one other intern who just got here a few days ago and is still supposed to be just observing births, and me. So only two people who could manage a labor / catch a baby, plus the supervisor. And there was a labor for each of us right away.
My lady was very close to pushing at endorsements, and had her baby fairly quickly about half an hour later. Actually, she pushed for the first time while on hands and knees on the bed and her water broke with a tremendous gush, so I got drenched again. I could see head as soon as the water broke, and the supervisor instructed her to turn over and lie on the bed — I would have been happy to catch the baby in hands and knees. He was quite the chunky little fellow (for here — 7 lbs 11 oz, but very chubby cheeks and broad shoulders) and I had to actively assist the birth of the shoulders — I think if she’d stayed on hands and knees he might have just slipped out without my help and maybe not torn at all (her tear was small enough not to need suturing, but it definitely happened with the shoulders and not the head). His chest circumference was a full cm larger than his head, and the placenta was huge — a bit of a sugar baby, which is perhaps appropriate since having caught all the babies I need for NARM any more are “icing.”
Everything went very smoothly after the birth and after the baby had nursed for a while I did the bath and newborn exam, had mom go to the C.R., got mom and baby all settled in the postpartum room, and finished the charting. I started talking to the other intern about ordering in some dinner — normally, whoever is cooking at the dorm will bring food over for anyone on swing shift, but the students were all going out to a party and we knew no one would be cooking that evening. We were happy to share with our friends on shift with us, and the Philippino student mentioned that she had a friend with a motorcycle (who was just hanging around outside the clinic, hoping the shift would be slow enough for her to hang out outside too I guess) who could go pick up the food for us.
There had been a flyer for a nearby Thai place at one of the dorms so we tried to call. The number on the flyer was incorrect. I looked googled the restaurant and found another phone number in an online newspaper review. There was no answer. Not being so easily daunted, we asked the friend with the motorcycle if he could go pick up a menu for us (and make sure the restaurant was open).
At this point, the other labor — which had been a long and difficult one with a first-time mom and a posterior baby (not so common here as in the States, thankfully — I think the squat toilets might be one of the reasons for that) had progressed to the point where it was time to push. And all hands were needed, as mom pushed for all she was worth with the staff midwife helping to pull her into an upright squat with each push, the supervisor doing “finger forceps”, the student supporting mom from behind, the other intern charting, and me taking heart tones and handing needed items to those with dirty gloves. The menu arrived soon after pushing began, but it was well over an hour before we had a baby out (who had not enjoyed his journey through a tight spot and needed a lot of attention, evenutually being transported for respiratory distress an hour or two later) and even once the baby was born there was plenty to keep us occupied.
It was after 8:00 p.m. when we finally sent the motorcycle boy off with an order and cash, and everyone was pretty hungry by then. But before he got back with the food, we had another, very active labor walk in the door — I was first up again as my birth had been first and the staff midwife was still busy with her postpartum patient. This mama reported ROM at home about ten minutes before and was clearly ready to push. There was time for a quick check to make sure baby was head-down and then I coached her through easing her little boy out over a perfectly intact perineum ten minutes after she walked in the door. The other intern ended up assisting me as another active labor arrived while we were pushing, and the staff midwife needed to go assess her — fortunately, this one waited until the night shift arrived before starting to push!
Baby boy was born covered absolutely head-to-toe in vernix, and the vernix was a lovely shade of old-meconium-stain green (as were the placenta and membranes). So he got deep-suctioned, though I don’t think he really needed it, he was crying even before he was completely out and had a one-minute apgar of 9. The food arrived as we were waiting for the placenta, and the other intern and I cast ocassional longing glances at it as we did our postpartum care. Baby boy number two nursed well, did not appear to be offended by our comments about his green skin (we did tell him he was going to be extremely cute once he’d had a bath), and mom plopped out the placenta easily with almost no blood loss at all.
Finally it was time to endorse to night shift (though most of them were attending on the shift-change baby). The night shift supervisor was not thrilled that so much of the post-care was not done yet for my second catch (newborn exam, bath, injections) but I was not going to detach a happily nursing baby who wasn’t even an hour old yet just so that I could get the charting finished, so I didn’t feel very guilty about it. I did grab him and weigh him right after endorsements, so that I could record the birth in the log book, and then those of us who had just come off swing shift (and another Filippino midwife who’d been hanging around during the shift, and the motorcycle driver) all gathered in the staff kitchen with our long-awaited Thai food.
Puah's Corner 