Today I was in the Labor and Delivery ward that was run my midwives the midwife obstetrcis unit (or MOU for short). I went with the idea that I was just going to be obnoxious and follow people around, make them let me help, and basically just make a nusence of myself. Unlike in India, mifiery here is a three year degreee and they can (and do) deliver low-risk babys alone. The unit has six beds, and women in early labor sit in the waiting room until they are deemed ready to move to a bed. Mother's deliver and then are moved to the recovery room (with ten beds) for six hours. Then, assuming they and the baby are ok, they go home.
I started by learning all of the midwives names. They talked to me a little about their work, my schooling, and how I would have to go to school for six years to be midwife (the whole accelerated thing is hard to get their heads around...its easier to just say that I'm finishing my four-year degree). They were shocked. But, their two year "general" nursing has no rotations through clinical areas like peds and mentla health, just basic medical/surgical nursing. They then started going into the room of a woman who was moaning really loudly, and I noticied that she was laboring hard and her contractions were close togetehr. I let Cathine and Courtney (who were with me) know that she was close and we went in and hugged the wall while she gave birht. They don't do epidurals (or any pain meds) so it was a pretty nerve-rakcing things to watch. The nurse stuck her fingers into the vagina, and then positioned the scissors for a episotomy (the baby wasn't crowning yet) and cut very, very, slowly. The mother seemed almost out of it, but was able to push. The nurses kept telling her to push, even thorugh the strong contactions that she had been feeling seemed to ahve decreased. Finally, she pushed out a little girl, who was slightly blue but crying. The baby was taken away, and the mother layted back while her cut was stiched up.
At this moment, Dr. schivone came in. She a nice lady (a mental health nurse) and she is very good with patient's but some of the things she does make me alittle uncofortable. She went right in, stood next to the patient, and started speaking to her in very bight, happy English about the little girl that she ahd had, and what was she going to call her. The woman clearly didn't undertstand everythign that she was saying, and i couldn't help thinking about how I would feel if I had ust given birth with no meds and someone started speaking perky Frnech to me (it would not be pretty). I was probably jsut feeling very akward, and afraid of doing the wrong thing, which never seems to run arcoss her mind.
Dr. Schivone then went into the waiting room, sat right down next to a woman and started teaching about labor breathing. She looked at me and said "this woman needs a labor coach" so I sat down and chatted with her a little. The language barrier may not be as extereme as it is in Inida, but it was enought ot make conversation, strained to say the least. I was glad that Lunch came quickly.
After lunch at the cafeteria, we rutenred to find that a bus had dropped off four mothers, two who were in active labor and one who was screaming her head off. I took a gulp and went in with ehr, said hello and my name and started holding her hand and tlaking to her (luckily she spoke fairly good Englush). She alreaay had a daughter and was having a son, and was HIV postiive (50% of mothers are). I stayed wiht her off and on for the aftnoon, holding her hand, helping her get comofrable and sit up, and trying to support her (all mothers labor alone here, just like in Inida but with even less nurse support) Iwas told to leave her alone because she just wanted attention, but she semeed to be really scared. Her first child had been born at home, and she ahd never been to a hostpial before.
At one point, she said that she needed to use the bathroom, and I told the nurse, who told me to put in catheter. She came in, dumped some supplied on the table, and left. Putting in a catheter is a sterile proceedure, and in the uS everything comes in one kit that you open at the bedside. This colelction of gear on the table was unsettling, but I started to put things where I thought it would make sense and be sterile. I was doing well until I actually had to put it in, but I didn't aim correctly and unsterilized the whole thing. I knew I had to start over, and knew that I wasn't up for this. The woman was crying, and I felt awful. LIke a failure because i had not been able to put the catherer in, and like a I had failer her. I got the nurse, who put it in with reasonable sterile technique in about five seconds.
Just as I had managed to talk myself down from that one (I didn't know, it was so fidderent from the US, I didn't even have any lubriactation, ect) and realize that asking for help is somethime she best thing that you can do for a patient, I managed to make another mistake. The paitnet said that she wanted to sit up, so I got her up and held her there (she was really unsteady and tippy). She starteed trying to turn around (bad idea!) and said that she wanted her bag. Iwas afraid to leave her on the table, so I helped her down as I ran for the bag. She directed me to take out a white plastic bag, with some pills in it. I was looking at her as she popped on and started to take in, and I stopped her and told ehr that I had to check with the nurse. They were in her bag, so I assumed that they were pain pills or some other OTC medication, and I didn't want her to take anyhting that wasn't ok. I brugh tthem to the nurse who said "Oh, yes, she can take these, she's due" I asked what the pills were, and the nurse said "AZT".
Oh. I felt bad again, that she might be embarassed or anxious that she wouldn't get her medicaiton. I brought ti back with an I'm sorry, and a cup of water, and reazlied taht I wasn't totally off the mark. Never would a patient be able to take a medication in hostpial without the nurse checking on it first. I had done the right thing, given what I knew.
When time came for us to go, we all gathered by the van an reazlied that we had all had rough days. For Endera, two patient's had died in the medical unit. Jenn had done CPR for a baby that died in the NICU. And when we got back and were able to check internet I had bad news waiting for me. We allagreed that she didn't feel ike dinner out, and so had pata at the B and B and went to bed early.
More about Today Tomorrow.
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