Long day, short day

It's Tuesday afternoon, Brynne and I finished work a little early today because we stayed really late last night. Anne-Marie finished a wee bit early yesterday to do some work on the donation of some mattresses for the postpartum and labour wards that we are trying to get organized before we leave for Kampala. So she's staying at the hospital a little later this afternoon. What a whirlwind of an evening it was yesterday! The day had been relatively quiet - Anne-Marie had caught a baby with Brynne in attendance as her second. I had attended two C-sections with Cathy to receive the baby - hopes of getting some experience with resuscitation but both babes were born healthy and crying (yay!) so I just did the usual drying, weighing, showing the babe to the mama. I was actually surprised because both these women received spinal anaesthetic rather than a general - most women have a general for a C-section here. I'm not sure why the change but it was so nice for the women to see their babes right away and not to feel so dopey after the surgery. One of the babes was born with extra digits on both hands - just small underdeveloped fingers attached to the side of the baby finger by a thin piece of skin. This seems to be relatively common here - this is the third babe we've seen with extra digits since we started our work at Masaka. Treatment is as simple as using some suture material to tie off the extra digits - they will then fall off within a week or so as the blood supply is cut off. The babes definitely feel a little pain as you tie off the digit but then they settle down quite quickly and seem to do just fine.

Around 4pm yesterday, things started to get quite busy. We had three primigravidas (first time mothers) in labour, all well along. There was also another woman who had been labouring all day but was waiting for C/S. By this time A-M had left, so Cathy, Brynne and I were managing things on the ward. I believe there were still some Ugandan students around for the first part of the chaos. Brynne and I each caught a babe within about 20 minutes of each other. The woman I was attending ended up with a second degree perineal tear. The babe was having decelerations during the pushing stage with slow recovery so we encouraged her to push quite hard...this may have contributed to the tear, or perhaps she would have torn even with a nice slow delivery. It's always hard to know. The babe did need some resuscitation, which Cathy did. I remained with the mother to see her through delivery of the placenta. Babe was fine. We did suture her tear, most of which I did, finished off by Cathy as my frustration and fatige mounted. I still feel pretty sketchy when it comes to suturing. The birth Brynne attended went well, intact perineum, happy mother, no complications. The third woman had been transferred into Masaka from a rural centre. It was extremely difficult to get a clear picture from her about what her situation was - at one point we understood that she'd been pushing for the whole day, later it seemed that it had only been one hour. Though the baby's head was at the perineum, it would not come around the pubic bone. The OB assessed her, felt that there was a large amount of caput with no further descent and decided to do a C/S. Apparently the babe was born alive but resuscitation was not successful.

Somewhere in the midst of all this activity, all the Ugandan students went home, the Ugandan staff were busy elsewhere, and we three Canadians were alone in labour and delivery. How challenging as women just kept walking into the ward, putting their sheets of plastic on the bed, and lying down. Talk about a communication gap - we would ask for their antenatal cards in simple English, rudimentary Lugandan, and our own special "birth sign language" and then try to piece together where they'd come from, what was happening for them, etc. We ended up attending a third primigravida who basically came in pushing. We were going to hand off to our Ugandan colleagues but then the head was at the perineum and it seemed to make sense to carry on and attend her birth. She had a normal birth, though I called her by the wrong name throughout second and third stage - ack! Cathy sutured two moderate labial tears, tears that we would probably not suture at home, but here it's felt that because women often don't have soap to wash with, infection is more likely if you don't suture. As this was happening, another woman walked in with blood running down her leg. Again, there was incredible difficulty figuring out what was happening for her. Eventually it became clear that she was 34 weeks pregnant with a complete placenta previa (placenta implanted over the cervix). She had an antepartum hemorrhage. There were no doctors on site. There was no one in the lab to type and cross-match her blood. The midwife who eventually arrived was trying to call in a doctor and the lab so that we could get her to surgery. They took her off to surgery just before we left. By the time we were gone there was still no doctor. We found out this morning that they did a C/S (babe already dead), transfused her with two units of blood during and just after surgery with orders to transfuse her with two more units post-op. She died on the postpartum ward before they could give the second two units. This was her ninth pregnancy. According to her file she had three living children at home. What a loss. How challenging for the staff here, not to have doctors, anaethetists, lab personnel on site. It is a big blow to have a maternal death, especially at the referral hospital. Such sad news to arrive to today.

It was a much slower day today - two vaginal births, which Anne-Marie and Brynne managed. I attended a dilation and curettage for an incomplete miscarriage with Mickey. I also successfully sited two IVs today on my first go, which was encouraging. It was nice to leave a little early, when all was calm, and have a little time to post to the blog.

Waylaba (goodbye in Lugandan)
Heather