Reporting from Les Cayes, Haiti
Last week I started working nights. I work three nights, then have three off. I’ve decided that despite the fact that I’m not a huge fan of the night shift, that this is the way that I can be the most useful to the Maternity staff. During the day there is an overabundance of staff: 3-4 nurses, 1-2 interns, and 6 (or so) nursing students from the nursing school associated with HIC. At night however, there’s one intern and 1-3 nurses. As a result, at night I’m actually able to not only use my skills as a provider, but decrease the patient burden that each provider has—thus (I hope) improving the care those women/infants receive.
When I arrived to work last night I was immediately clear that we had more patients than beds (we have 20 beds in the maternity—and moved back to HIC Sunday during the day to a cleaner and dry hospital). There were pregnant women and their various friends/family outside on the benches, sitting on chairs in the back of the ward and on any available floor space, and generally milling about.
Most women stay in the Maternity about 6 hours after delivering, so I typically don’t get to see the women I’ve labored with/caught after the end of my shift. So I was delighted to be hailed by a woman I recognized from the night before occupying one of the beds. I had labored with her for a while and had had broken conversations in French/Creole trying to encourage her through her labor (although I speak French, my Creole level is about that of a 2 year old and she only spoke Creole, so you can imagine how profound my encouragement was). She was a G8P7 (meaning she’d be pregnant 8 times, and had 7 living babies, she’s now a G8P8), and just seemed tired, and (from what I can gather) didn’t think she was going to be capable of pushing her baby out. I reassured her that I knew she’d be able to—and of course she had—as I saw her beautiful baby girl lying next to her. I admired the baby and congratulated her, and then went to see about the other patients.
Among them I found a women who had arrived sometime in the early morning of the previous day—as I recognized both her and her husband. At some point during the day she had been given a bed, and was receiving a Pitocin infusion to help move her labor along. This woman was a trooper—she labored hard and long all night. Despite finally dilating to 10cm the head nurse and the doctor on call that night didn’t think that her pelvis was going to be large enough for the baby to come out (I disagreed, but didn’t feel I could argue my case to them, as it wasn’t my decision) and so around 5am we told her and her family that at 6 she was going to get a c-section. I’d talked a lot with her family members and the woman throughout the night as I encouraged her through her labor and helped her find ways to relieve her back labor pain. As a result, it was always me that her family came to to talk about her case. They were distressed about her having to wait until 6 to give birth, as she was so tired from the sleepless, painful night. I couldn’t say much to that, only that I thought she was doing a great job laboring and that her baby was going to come soon (one way or another). Around 5:30 she finally got the urge to push, and push she did. I was lucky enough to have been able catch her baby girl. She and her family were thankful and overjoyed at the birth, and I was really happy that she got to deliver vaginally—as I though she could all along—and that I got to participate in the birth.