Journal Day 33 - I sutured

I tried to journal every day and then caught up on journal entries after I got home. Some of the entries are too short or confusing and some are too scary or revealing. Keep in mind when reading any entries that this is a clinic in a 3rd world country with some high-risk mothers.

Here is Day 33.

Got called in early for a birth, and it turned into my 2nd primary; nice waterbirth but with tear needing stitching. "R" said, OK Erin you suture.... (EEK!!!) So I said, OK let's do it. They gave me size 7.5 gloves and after about 2 minutes of watching me struggle with them (I'd mentioned they were too big) they found me smaller ones to trade. Getting in the lidocaine [pain killer for suturing] wasn't hard; between "S" and "R" it worked OK; "R" was quite intense telling me to hurry up. Duh! Lidocaine only lasts 20 minutes! I had trouble with needle angles that I'll have to practice with. Afterwards I was quite "cotton mouthed" probably from the adrenaline of being up all night and suturing at 8am! "R" apologized for being too intense but I told her I totally understood with the limited time.

Three hours later was another baby. "R" and "D" helped me support the baby's head and try to protect a prior episiotomy scar. Baby was fine despite odd FHT's. "K" sutured and it was great to watch how precise she was!

Went out to dinner with friends and decided to walk home. It was totally dark. And we had to walk through Monkey Forest. Pitch black with 4 kids and stroller. I had to use the tiny light on my cellphone and we made it. It was so awesome to look up at a sky full of stars... so different to see Southern constellations!


Update - 4 months later. I have studied more suturing and am practicing at home with my equipment and expired suture material. I'm ready for more practice with supervision when we go back to Indonesia in Dec/Jan for 21 days. I still can't believe that in less than 5 weeks there I was actually ready to suture. I watched every other suturing job there and have watched at doula births here. "R" sutures with finger ties and very quick. "K" and "S" would suture and not use finger ties - they also went slower and would show me how they decided where to put the needle. "R" could suture in her sleep probably (and does kinda if she gets called at 2am to do a suturing too difficult for others).

Clinic Postpartum Care

Women at the clinic stay for 48 hours after their birth. They cannot go home until their baby is breastfeeding well and the mother has shown she can care for her baby. Some people have questioned this 48 hours saying why not go home early if all is well. As soon as the mother goes home, she is back to taking care of everyone and everything, handwashing laundry, or out in the rice fields, or picking through the garbage dump. This is a way to make sure that the mother has 2 days of food and rest before going back to hard labor.

After the baby is born, the mother stays in the birth room for a couple hours. Less if there are more women needing the room. (I heard from my friend there that they had 2 days of 8 babies each day over the last week!) There are two postpartum rooms, with 3 beds in one room, and 4 beds in another. If overflow is needed, there is an extra bed per birth room that can be partitioned off, and room for another 6 beds in the open acupuncture clinic area if needed.

The first morning, the cord is cut if it wasn't done sometime during the night, the baby is weighed, has the newborn exam, and receives it's Vitamin K shot. Later in the morning or the next morning, the mother is shown how to bathe the baby and care for the cord. At some point during the morning, all of the new mothers sit outside in the sun and nurse their babies so the babies can get some direct sunlight to help with any jaundice.

(midwife Ibu Agung Mas, new baby boy, and his mother Nyoman)

The mother is fed breakfast each morning and her family brings her food for the remainder of her meals. A mother, her husband, the newborn, and maybe another small child, will all share the twin bed together, or the men will go out and snooze on the plastic covered acupuncture tables or on one of the sofas outside. With all of the mothers together in a room, they can chat, share stories, and help each other out. The aunties and grannies share plenty of advice as well! It is also a great way to teach as a midwife can help one mother and the others will watch. Or as the pic below, my friend Kate was teaching baby massage and many mothers, and grandmothers, and children circled around to watch.

I loved going into the postpartum rooms, trying to communicate with the mothers, ooh and aah over the new babies, helping with breastfeeding, or just observe how the mothers interacted with their babies. It's the mother's special pampering time!