Monday, May 16, 2011

May 16th 2011

(Happy Birthday Allie!)

May 16th 2011
Since Roxanna was late arriving, Heather was flustered with her feeling inadequate in being able to communicate.

We arrived at the Hospital as scheduled to meet with Victor Espenalda, The director of OB/GYN dept. we waited in a luxurious lounge area, with Wi-Fi and a spread of food. We were treated respectfully and kind.

3 hours later we were informed that Victor was in a classroom , as he is an instructor and was unavailable to meet with us.

We were then led to the OB ward and given a quick tour/orientation.

I was under the impression that all the back ground work had been done previously and we were expected. This was not so.

We donned our sterile attire (hat and mask) and met some of the staff of the OB ward. one Energetic Nurse was thrilled with our attendance and invited us right away into a surgery. It was a prolapsed uterus and bladder. The woman lay flat with her arms stretched out beside her, wide awake with a spinal block. she flinched and grimaced occasionally and it seemed she felt some of what was happening. The scalpel was dull, and the procedure was gruesome. Although it was amazing being able to watch and learn, (anatomy at least) it was rough to endure the over 4 hour procedure.

We next were called into our first C-section.

within a few hours time we were in full swing. Heather was invited to attend/catch the first vaginal birth we were present for. Dr. Rico Suave (not his real name) was gracious and kind, he showed how they manually dilate these women, they get to about 8cm and then routinely receive manual dilation for the remaining.

The woman was on the delivery table, in stirrups, and told to push push push... regardless of contractions.

As Heather followed what she was instructed to do, she mentioned to Terri & I as baby was crowning, that this was a sticky baby, and it was going to be a dystocia, she just felt it... baby's head presented and mom pushed (although ineffectively) Dr. Suave started to manually tug and pull on baby to aid in the delivery of the body... Heather hip-checked him and Terri applied Super-Pubic pressure, Heather then called out forcefully for us to flip mom to Gaskin ... (hands and knees) This mom had no clue what we were doing, at this point we had an audience of over 20 students watching.... Terri & I were able to flip mom to hands and knees after a few troublesome moments of trying to get her to understand what we intended...Mom was like a floppy fish, she turned half way, and collapsed on her side, then we picked her up and got her into a good position, baby came out with minor shoulder corkscrew and some pushing. baby was limp and pale.

I followed baby to the nursery, where the protocol was as this:
Baby is delivered, cord cut immediately, baby is passed onto the pediatrics staff and wheeled in an isolette into the nursery (down a short hallway) here they put a heat lamp (similar to a chicken light) on baby and start stimulating and cleaning baby off. They use paper towels and wipe off fluids and vernix...Once baby is breathing and or crying, they run an In-G tube down one nostril and syringe out the contents of the stomach. Then then syringe the other nostril and suction out the contents of the stomach. They check baby over, weigh, measure, administer VIT K and Eye Drops. at this point usually 30 min have passed and baby is chilled.

Before we arrived they put baby in the bed with diaper and nothing else. They often ran out diapers before the supplies were replenished.

We brought with us a plethora of supplies, sadly these supplies would not last more than a month, if they were lucky. This hospital attends over 35 births every month.

The mothers/families are responsible for bringing all their own supplies, Blankets, diapers, formula, sheets for their own beds, even water to drink postpartum.
May 17th 2011

I want to explain a little about how the women birth here in the DR. Some of these women travel by bus for long distances. Some arrive in active labor after 4 hrs on a bus.

The woman checks into the ER and is evaluated on whether she is in active labor, right away they receive an IV,and wait in the general waiting room with 20-30 other patients with various issues.

Once they are engaged in labor, the ER department wheels them into the delivery area (up the elevator) here they are assigned a bed, with no sheets in a room open with no privacy and quiet. This is a teaching hospital, so on average 30 students wander through on rotations twice a day.

the women are told to lay flat, and quiet, not to disturb the residents ad Dr.'s most of the time they whimper quietly and labor silently. occasionally we got a moaned/vocal woman, this woman was usually accosted and encouraged to labor quietly by having her thigh thumped and told "Madame!!" The vaginal checks were.... vigorous.... some Dr.'s were more aggressive than others, but most of them gloved, and checked a woman without warning or consent.

If she was at 8 cm or more, at her bedside they began manual dilation, she was told (loudly) to push push push, as the DR stretched her and pulled and gave her grief over being too loud. If the woman attempted to swat away the DR's hand or beg for them to stop, the Dr's got upset and yelled at the woman.

Once the woman was "Completo" they had her stand up, transfer herself to a wheel chair, and got wheeled into the delivery room.

Here she is told to climb onto a table that is waist high, with no help, other than the brakes were engaged on the wheelchair occasionally.

After the woman in active labor has positioned themselves on the delivery table, in stirrup with nothing but a black trash bag under them . once again the DR's used forceful manual dilation.

I explained yesterday how they handle the delivery of the baby, and the process for taking care of baby after.