Tales From the Field - Part 5

I feel someone grabbing at me, or maybe just something to hold on to. It takes me a second to figure out it’s the 14 year old in bed two. I reach out and hold her hand as Christina and I do an ultrasound on the patient in the bed beside her.  

“And somewhere we must have a head,” she says in her German accent. 

You would think. With a quick feel of her abdomen I thought I felt a head, but the ultrasound is unclear. We keep searching.There is a spine, and a heartbeat, albeit slow.  She moves the probe back down to the pelvis again and we both examine the screen closely.

“It’s something like a head, but there’s things missing. You can see the mouth and the eyes. It’s another anencephaly, like the other day.” 

Anencephaly: A baby with a face and some features but no brain or skull, a baby that is incompatible with life.

“Ok, we find the husband and tell him.”   

In the developed world we know to take folic acid to prevent this kind of defect. Our cereal is fortified.  We take prenatal vitamins. If there is an anomaly we catch it early on sonogram and can decide to terminate. Many of these problems we can fix after the baby’s born. Anencephaly is not one of them.

I do a vaginal exam and feel a spongy mass. It must be this non-head. She is 3 centimeters with ruptured membranes so we decide to give her some pit to see if she’ll dilate. With no pressure from a skull it may be difficult for the cervix to open as it would with a normal head. 

The hand I’m holding suddenly develops a tighter grip. I turn to its owner and instantly recognize that wild look in her eye.

“Kashi!” she says as she clenches my hand with all her strength and starts to bear down.

It’s one of the first words you learn as a midwife, in any language –

I’ve got to shit, poop, move my bowels, i.e., the baby is coming!!! 

I pry my hand loose and go in search of a delivery set. As usual, we’re out. I manage to find two cord ties and a sterile blade. I sit on the foot of her bed and watch the perineum stretch as the head starts to emerge, slowly with each push. Even though she’s young, I’m pretty sure she’ll make it.

There’s a woman on the other side of her that could easily be her grandmother. She too is pushing and there’s a midwife gathering up her supplies for delivery. The patient is quiet, with just a few beads of sweat on her brow.

As I wait for the baby to come I scan the faces of the women and try to imagine what is going through each of their minds. I look at the young girl and can see how terrified she is. Is it the pain, or is she afraid of the baby that will soon be in her arms?  For the older woman, I see indifference, acceptance maybe. She’s been here 10 times before, delivered stillbirths and had babies die days or weeks after birth. And the woman for induction, who will soon give birth to a baby so deformed it will not live. What could she possibly be thinking?   

They are all the same in wanting this to be over. This much I do know.

Not surprisingly the older woman delivers first. Without much fanfare, she gives one solid push and out slides a baby covered in meconium, the umbilical cord wrapped around his body.  The midwife untangles the little guy, cuts the cord then shows the mother the baby’s genitals so she can identify the sex. The mother just closes her eyes. 

Our 14-year-old takes an hour longer but she too is able to push her baby out. She shrieks when I place the squealing baby on her abdomen. It’s a boy. I know the family will be so pleased with her.    

Finally the anencephalic baby comes too. He is born without a heartbeat, which in a way is a relief. We place him in an empty Ringers Lactate box and give him to the family.  

All three women are postpartum now, and I can see the line of women in triage waiting for their beds. I help the young girl get her baby latched on the breast. It’s hard to believe she is somebody’s wife, and now a young mother.

I don’t have much time to get her cleaned up. I hear another woman pushing. I quickly rush off to get a new pair of gloves.