Sarah Allen MS IV: Juliette – Day 2 in haiti

Her name is Juliette. She’s 38, in her 7th pregnancy, but delivering her 3rd child. She has two older boys at home, 7 and 3. Her husband died in January in the earthquake. She says they were at home, and a wall fell on him. So she’s raising 2 kids on her own, and now with another one on its way. We examine her, and she’s 7 cm dilated. We take her to the delivery room, prepare for a fast delivery since she’s a multiparous woman, and sit there and wait. 15 minutes, 30, an hour, and soon 3 hours go by. She’s not making any progress. We repeatedly check her, and the exam is difficult. Its hard to tell what’s vaginal wall, what’s cervix, and what’s the baby’s head. Thats when we realize….it wasn’t the baby’s head. The ’suture’ line, was the baby’s bottom. The fontanelle was the baby’s rectum. We had a breech position on our hands.

So in the states, to begin with, most people would have some sort of prenatal care, with an ultrasound (there isn’t a single ultrasound around), and the breech position would be known about far in advance. And then, some people are comfortable with breech deliveries, but most prefer to do c-section. The doctor I was working with said she ‘doesn’t do’ breech deliveries. But at the same time this was going on, there was a lady who had hemoperitoneum needing to go straight to the OR, since 2 weeks ago she had had surgery for an ectopic pregnancy, and somehow a sponge was left in her abdomen. All of the other OR rooms were full, so we were left with this breech on our hands. Thankfully, there was a midwife, Terry, around who felt comfortable doing breech deliveries, and she came just at the exact moment that Juliette let out that final scream, meaning it was imminent. Terry delivered the baby’s bottom, then the legs, the torso, the arms, but the head had a hard time coming out. It hadn’t had the time to reshape to the form of the mother’s pelvis since he was breech. But Terry reached up under the baby’s chin, put two fingers in his mouth, and pulled the baby down and out. We laid him on Juliette’s stomach, and she shrieked that sigh of relief, realizing that her agony was over. The baby was limp, and didn’t seem to be breathing however. We bagged him with some oxygen, and soon after he came to. Apgars were 3 and 9.

I sat down and delivered the placenta, which didn’t need much help whatsoever. But since Juliette had been in labor for so long, the uterus was having a hard time clamping down, and kept bleeding. I gave some extra Pitocin, and we also gave some Cytotec to help her. She kept bleeding for quite awhile. I kept checking her vitals to make sure her blood pressure was stable. We had her feed her baby to get the natural pitocin going. And soon there after, her uterus was feeling much more firm, and she was bleeding a lot less.

Then next to her, we had a pre-eclamptic patient whose blood pressures had been 190/110 all afternoon. And in the other room a 7 month pregnant woman with malaria, a woman with a fetal demise of 4 months, and a woman progressing in labor at 6 cm. Waiting in the hallway we had a woman with cellulitis of the breast, being treated with IV antibiotics, and a group of women waiting to be triaged.

So that was my second day in L&D. I have so many other thoughts about being here, about the people, the hospital, the needs, the problems, the beauty etc. But basically what I’ve seen so far, each and every person is a victim of the earthquake. They’re all struggling. We’re having a hard time discharging patients, because they have nowhere to go. The ortho patients especially, since many of them are newly amputees. Haiti isn’t wheelchair accessible. Many are living in the tents here on campus. Others don’t have anywhere to go. And even if they do have a tent, their hygiene is way sub-par. Yesterday in gyn clinic we treated at least 20 vaginal infections. We figure they just don’t have the means to clean themselves properly.

Ok enough for today, I’m sure there will be more to come…