Sunday, December 02, 2007

Unusual occurrence....

Just four days before leaving Carata something rare occurred. During my service in the village, I regretted one thing that never happened. I hadn't seen a birth. Until Friday Nov. 23rd. I awoke and looked out to the health post. But the door was closed. I had a couple of tasks to complete (wash clothes, pack up my room, and organize a few things for my replacement Kimberly). By 10am Talia, the obstetrician was still not back from wherever she went. A neighbor was out on the street. I asked, "¿Donde ha ido Talia?" (Where did Talia go?) and their response, "Se fue a Cayamus para atender un parto." (She went to Cayamus to deliver a baby.) My head was so full of things it didn't register.

At lunch time, Merli my host sister and I sat eating. "¿Y Talia?" Maybe she's lost. And so we imagined the possibilities. Maybe she fell in a hole like the dog did last year! We should go find her. Even worse, maybe...she's dead! (I'd like to think based on my influence that Merli has become a much more creative and imaginative girl after living with a gringo for two years!) "¡Ya regresó!" (She's returned!) Yelled someone from the kitchen. After eating, I went to the health post to drop off a bag of things and sort documents in my desk. Talia answered the door and I asked her about the patient in Cayamus. She hadn't give birth yet. She was only 16 years old. Talia had been at the house all morning and still nothing. And then it occurred to me. Here's your opportunity... Take it! ¡APROVECHA!

The patent's family planned to call Talia when the patient, who's name was Lydian, was closer to giving birth. I explained to Talia to call me so I could help. And she agreed. The rest of the afternoon went by quickly. Merli and Susan wanted to play 'volley' for a minute than helped me pack up my room. I felt a mix of emotions about leaving. The girls were quick to distract me from my thoughts. We took out the board game, Twister and played it on the patio. Two older girls, Fanny and Yessica stopped by for help with their English homework and I got a text message. "Ya me voy al parto- ¡Apura!" (I'm going to the birth, hurry!) It was 4:30pm.

I grabbed my jacket, camera and flashlight and quickly ran down stairs- I said sorry to the girls who were waiting with their text books- it would have to wait. Off to the health post. Talia was practically ready. The trails to Cayamus are confusing. It's a maze of tree farms and tiny roads-trails really, that wind around the few houses that exist. I've gotten lost more than a few times. I said to Talia that I hoped the girl didn't give birth yet, it would have been a waste of time! And Talia responded in Spanish, "Maybe she did, maybe we missed it!" I hoped not.

After a good 30 minute walk down the steep mountainside, we eventually came upon the humble home where some people were waiting outside. A baby lamb greeted us at the door. Inside a small room, Lydian lay covered in blankets. She got up and began pacing the room with her Sister-in-law. At least she felt like walking. That was a good sign. She was in a lot of pain, and still very pregnant. She was wearing so many layers of clothes and a poncho.

I knew it would get dark in the next hour and a half. It didn't look like there was electricity in the house. Another night with candles... It seems like those without "luz" spend a lot of money on candles. I'm glad I've had the luxury of having electricity during my service, even if it wasn't constant. I stood watching, not knowing what to do. Talia seemed to have everything under control. She assessed Lydian and said she was 10 centimeters dilated. Although to me, she didn't seem to be in active labor. But what did I know? It was only my first time seeing a birth. Talia could palpate the infant's head. We thought, at any moment the baby would come, just a little longer! However, we were terribly wrong.




It got dark and cold and the poor patient was not making any progress. The family called Talia this morning at 6am thinking Lydian was ready. False alarm. All day, the pains came and went, 12 hours later there was little to no progress. Her water still hadn't broken. I was confused, because wasn't 10 cm almost the end of labor? And wasn't the water supposed to break before that? Could Talia be wrong? By 8pm, I knew I would be there for the long haul, and possibly all night! Frankly, I wanted to witness this and that included the boring parts too.

Lydian had little appetite, so they spoon fed her soup. I saw a brown beer bottle on the table, through the candlelight. Than I noticed how they forced her to drink out of the bottle. Pregnancy and liquor. Hmmmm. I asked the family, "Isn't that bad for her?" And they replied, "Naaahhh, we've mixed punch into the beer." A homemade epidural? Talia and I just looked at each other, shaking our heads. Lydian was up and off the bed walking, the contractions were coming and going with more frequency. IV access was crucial. If at any point we needed to give her pain medication or heparin, we would need to give it quickly. Imagine placing an IV in a patent's hand in the dark? Than where would we hang it? We had no IV pole. From the ceiling! Improvisation in Peru.

Lydian sat up again and squatted on the floor, improving natural forces of gravity. She needed to push with every contraction she felt. The contractions were coming closer together. We took off her poncho and a blanket wrapped around her waist. I grabbed hold of something long and thick. What? I illuminated the area with my flashlight and it was a deer leg, two actually. They bring good luck during birth. Go figure. Not listed in the standard nursing manual. Lydian's father came in and sat next to her in a chair. She squatted in front of him holding his shoulders. Her dress covering her legs. Talia wanted to make an incision to prevent natural tearing from occurring. But the babies' head was not yet visible and we would have to wait. I wondered if it would be a boy or a girl?

Another hour went by. It was 9:30pm. We were all a little worried. What was taking so long? Was she not pushing hard enough or was there a complication? I took her blood pressure. It had not dropped since I last took it. Nevertheless, we decided to call the ambulance at the health center in Agallpampa. Within an hour they could be here to take her to the health center and induce the labor. Shortly after making contact with the ambulance via cell phone her water broke! Luckily, I had already eaten dinner. The family invited me to a bowl of potato soup. Delicious!

In recalling the few things I remember from obstetrics in school, the water breaking was a very good sign! Lydian got up from squatting and Talia and I examined her. We still couldn't see the head and thus, didn't want to make the incision. Every contraction that followed was cheered on by Lydian's Mother, Father, Sister-in-law and us. "PUSH!" They yelled, "DON´T PULL!" And with every push the Mom and Dad would blow on Lydian's head, as if to aide in pushing out the baby with their own breath. And than as the screams got louder, I knew this was the moment. Lydian pushed and screamed and all of the sudden a baby girl slipped out from between her legs and slid onto the sheep's skin carpet where she squat. Talia quickly scooped up the babe, as I took pictures. She cut the umbilical cord. The ambulance arrived another 2 hours later.



The next day I sat thinking about life's complexity. Here I am, all caught up in the fact that I'm on my way out of this village. And at the same time a baby just arrived. Symbolic I suppose.

1 comment:

Braintree Gal said...

All I can say is "wow". What an incredible post! And as I am doing my law school applications right now, I can't help thinking that is would make an amazing personal statement!