I have 2 more weeks before I am home and I feel like a long distance runner nearing the end of the race and getting that final burst of energy to make it across the finish line. In these last few weeks, aside from all of my tasks here, I managed to get in a podcast interview with Blyss Young, midwife and Stuart Fischbein, OB. They have a podcast called Birthing Instincts. Amazingly, the internet cooperated and only went out once the whole time! I had a lot of fun chatting with them even though there was a slight delay and a few people have messaged me asking if I was ignoring Stuart’s questions on purpose! LOL! No, I was not. Here is a link to the episode in case you missed it: https://podcasts.apple.com/us/podcast/245-birth-stories-from-south-sudan-with-kristine-lauria/id1552816683?i=1000550543216
Today was not a busy day in terms of volume but what we did have was eventful enough to keep us on our toes. The first patient was one sent from another facility because she needed a transfusion. She was 20 weeks pregnant with her first baby and had a hemoglobin 3.1. Our goal is to get the patient to at least 6, which is a very low bar but is all we can hope for in this environment. We knew she would need at least 2 units. We tested her for malaria, HIV, syphilis – all the standard things, and everything was negative. We have no idea what is causing the anemia but she will likely need more blood as her pregnancy progresses and her blood volume expands.
After the first unit, her hemoglobin went up to 3.4, not impressive. We gave her another unit and it came up to 4.1. We are still awaiting relative that will donate more blood so she can have another transfusion in the coming days and then hopefully have some blood on hand for her in the future. She will likely not get through her pregnancy without more transfusions. Will we ever figure out the cause of her severe anemia? Not likely.
The next patient came in preterm labor at about 26 weeks. She already had given birth 3 times but those babies had all been term. We tested for malaria and UTI, the usual things that cause preterm labor here, both were negative. There was no abruption and the fetal heart rate was strong, so it wasn’t a demise.
These preterm cases are always difficult when there hasn’t been a demise because the babies are usually born alive and because there is really nothing we can do for them, they just get wrapped in a blanket and stay with the mother until they die. It is always difficult to watch.
Preterm labors are usually quite short and we were watching this mother closely. She didn’t tell anyone that she wanted to go to the latrine though, so that is how I ended up in the doorway of a latrine with a mother squatting down and holding a micro premie between her knees.
This tiny girl weighed in at 750 grams and in usual fashion, we wrapped her and kept her next to her mother for the short time she was with us.
In the bed next to the preterm patient, was a mother having her 5th and 6th babies. The first was presenting head down and the second was breech. The labor was active when she arrived so I knew she would birth within hours. Both babies sounded good when I listened. She was 38 weeks in gestation so I wasn’t anticipating any issues. This was the second time she was having twins.
When she finally shuffled back to the birth room, without much effort she pushed the first baby to the perineum and then the head was out on the next contraction. It was 3:59PM. That baby was a boy and weighed in at 2.73kg, a nice size.
I listened for the heartbeat of the second baby and the mother seemed surprised there was another baby in there. I asked the midwife why she was surprised and she said, “she thought maybe you were joking about twins”. Just a few minutes later she started to bear down again. A bag of waters came down and out and then exploded as amniotic sacs are known to do! The fluid was clear and there was a butt cheek and a foot coming down so I knew the baby was complete breech. In one push she brought the baby down and out to the shoulder blades, then the arms came simultaneously and then the head popped out and the baby fell right into my hands. It was 4:03PM.
Both births seemed fairly effortless from where I was standing and the placenta, an enormous thing as big as any placenta I have ever seen with twins, came out before we even had a chance to give her an oxytocin injection!
The second twin, also a boy, weighed in at 2.17 kg, so slightly smaller than his brother. The placenta was beautiful and looked very healthy and when we examined it, was saw it was complete and there was 1 chorion and each of the boy had their own amniotic sac.
With both babies doing well, we did our newborn things and then wrapped them up and tucked them in with their tired mother. As happy as we were for her, it was bittersweet. The juxtaposition of the mother with the premie that had just died, in the bed right next to the woman who had just given birth to not one but two babies, seemed like a cruel twist. But this is how it is in South Sudan, and places like it. There is tragedy next to joy around every corner.
***For more photos from the field, you can follow me on IG @globalmidwife64 ***
