Diving back in...

I woke up this morning with fear and trepidation beating a drum in synchrony in my stomach. I was nervous about returning to Masaka Hospital - worried about what we would encounter and my ability to respond to urgent concerns with grace and skill. As we walked along under the eucalyptus trees on the way to the hospital, I felt my anxiety grow and found myself a wee bit teary-eyed as we changed into our uniforms in the 'Sister's Room'. I knew that I needed to face these fears and anxieties, to just walk back into the labour and delivery room, take a breath, and be in the present moment, be with women, be calm, caring, and available for them. So that's what I did and it was okay. I did okay. We had a relatively good day, in terms of our management of cases. Two women went to C-section, one for failure to progress and the other for "CPD" - Cephalo-pelvic disproportion. The surgeon reported that both cases were managed well and he felt that both sections were appropriate. Moms and babes were healthy following both surgeries.

Anne-Marie caught her first Ugandan baby today! For various reasons, she had not yet been the primary midwife at a birth. A baby boy, born to a first-time mother who pushed for about 45 minutes but popped that babe out unexpectedly quickly at the end. The babe needed a little help getting going with his breathing - resuscitated by Cathy and Brynne - but was doing just fine after a few puffs with the bag and mask.

We had a second vaginal birth today, of a 23 week fetus that had died some time ago. It was distressing, but Cathy managed the birth with grace and skill and I think we all learned some important points regarding managing the birth of a macerated still-born babe. We were sure to have an IV line placed as hemorrhages are often associated with stillbirths and we wanted to prevent a major bleed. The mother did well, though it took about 15 minutes for the placenta to deliver. I think because the birth was so unexpected, the mother didn't have any cloths to wrap the babe in. Cathy had a wee cloth, stitched by Heather Wood many years ago when she and Cathy worked together in Saskatchewan, which we used to wrap up this tiny baby boy. When we left the ward this afternoon, this woman was doing well, with no unusual bleeding, stable vital signs - we felt really positive about how we managed the situation and hopefully she won't have any further complications. It's hard to know why this babe died, but Cathy thought perhaps the mother had contracted malaria in the pregnancy, which can cause fetal death.

Brynne, Anne-Marie, and I all successfully sited IV's today, a skill that continues to be somewhat nerve-wracking for me, though I am feeling better about my ability to do this following today's success. I have a goal of putting in at least one IV every day this week, more if they are available.

On Wednesday, we are heading out into a rural area for the day to meet with some Traditional Birth Attendants (TBAs). We will be bringing some supplies - boxes of gloves, soap, and small bottles of bleach, to give to each TBA. We're purchasing these supplies with some of the money collected by Anne-Marie and myself from our generous friends and families - it feels like a really worthwhile use of donated funds. These women attend many births in rural areas which are far from hospitals and health centres and are often the only people available to assist birthing women. Some of them have taken basic training courses. We will be talking with them about what normal birth looks like and when they should refer women to a hospital or health centre. For example, if the baby is in a transverse or breech presentation, if the woman has already had more than 5 babies, if she is very young (less than 18 years), if the labour is prolonged, if there is active bleeding, etc. It should be a fun day, with an opportunity to meet with the midwives at the rural health centre as well.

Must run as it's getting dark and it's time for me to head back to the Zebra.

With love and light,
H