12 December 2009

Indonesia's Most Memorable Births

All 32 births that I attended were special in different ways. As I mentioned previously, as each baby was born, the midwives and others in attendance would sing the Gayatri mantra. If the mother was Christian/Catholic, they (or usually me!) would sing Amazing Grace. Other religions would choose the song they wanted.

These are the births I remember the most.

The first birth I actually didn't attend. The day I showed up at the clinic, the midwives put me to work doing labor support for a first time mom. I had a total of 6 hours of sleep plus travel time the previous 48 hours so was doing my best! I started labor support around 9:30am. When the woman was doing well, I'd go make sure my family was settling in and finding food. At 8pm, I went and nursed the twins and headed back to the clinic. I continued the labor support until 2am, and at that point, I had dozed in my chair and almost fell off, much to the amusement of the woman and her husband. I told the midwives that I could not continue and they said they'd call me when she was ready to give birth. I went home and crashed, they didn't have my number yet (!), and the woman gave birth 30 minutes after I left! The next morning the new mother was so thankful to me for my help and was excited to show off her new baby. I saw her again a few weeks later at a well baby clinic. Still 100% breastfed and very healthy!

Birth #1 - my preceptor hollered over to me to hurry up because there was a baby coming fast. So I went in and saw my first birth at the clinic!

Birth #3 - My first waterbirth at the clinic!

Somehow I managed to see most of the scary births that summer...

Birth #4 - This was the first birth that I was told I was going to be the one to "catch". I was there for all 3.5 hr of pushing in a variety of positions and the baby's heart tones all over the place. Everyone was ready for resuscitation if needed. The baby I caught came out completely floppy as I placed her onto her mother's chest. After that, I stood back and took orders as my preceptor took over with CPR and works. It took 45 mintues before the baby was stable! This was the first resus I had seen and the whole time my heart was in my throat. I kept cool and prayed a lot! The next day the baby would not nurse and the mother was worried that something was wrong. As I watched her try to nurse, I knew that something was "off" but I couldn't figure out what. I called in "M" a volunteer L&D nurse who had worked with 100s of babies. When she came in to check heart, respirations, etc, she didn't notice anything and the baby was not acting strange anymore. I went home for lunch and mentioned the odd behaviour to my preceptor and she said, let's go back and take a look. When she walked in, the baby was acting "off" again. The baby was having petite mal seizures. The clinic decided to transport the baby to a NICU in Denpasar (about 45 minutes away). The day after I left Indonesia, at 6 weeks old, she passed away.

Birth # 6 - Recognized my first posterior baby at crowning. One of the fabulous Indonesian midwives worked with me to help deliver the head with minimal tearing. The tear still needed suturing, and I got to assist with suturing for the first time.

Birth # 7 - These women love crowds in the room for giving birth. 10 women (mother, midwives, family, etc) plus the father, plus my daughter Grace watching! (At the time of this blog, my 6 year old has observed 7 births!)

Birth #9 - This mother worked for hours but finally when the heart tones got too high, she transferred to the hospital for a Cesarean. The baby's head was asynclitic (crooked) and posterior. She tried so hard with a great attitude through any position change we could think of to get him out, but it just wouldn't work. I went the next day to the local hospital to see her and she was already breastfeeding well. That was also my first experience with the local hospital... not good!

Birth # 11 - the "doughnut lady" - this is how I will always remember her! A very young mother who did not want to eat the healthy foods/drinks we brought her. She finally decided to start pushing when her husband brought her a doughnut that she inhaled! She pushed in a variety of positions and finally ended up on hands and knees on a pile of towels on the floor. It was suspected that the baby was 4 weeks early, and the next two days I spent a lot of time helping her get this tiny baby to the breast.

Birth #12 - One of my most memorable! This mother's obstetric history is typical for a 3rd world country. Her first baby died during labor due to horrible mismanagement by her village midwife (who is still practicing). Her second baby, she decided to skip labor and have a live baby by paying a lot of money for a cesarean. She finally came to the clinic wanted a happy birth, and a VBAC. She had a vertical scar and labored for 2 days. Until this point in my career, I had NEVER seen a woman work so hard for what she wanted. This was also my first shoulder dystocia, and I learned a technique from my preceptor that I'd never read in any books!

Birth # 14 - My biggest baby ever! 4,650 grams aka 10lb 4oz. Not only was this the biggest baby I had seen birthed, but it was the biggest placenta my preceptor had ever seen!

Birth #16 - Saw manual removal of the placenta. Not pretty, but necessary in this case. It's rarely needed but it was this time. The mother did really well despite the interventions.

Birth # 17 - My favorite birth for the summer. Most of the families coming to the clinic were Hindu or Muslim but this time a Christian woman came in with a lot of her family plus others from her church. She had wonderful moral support from her older sister, and by the end of the birth, her sister and two other women were singing praise songs as the baby came out. When I got back to Thailand, the first song we sang in church happened to be the same song as this baby's birth and it brought tears to my eyes in memory.

Birth # 18 - This was a special birth because it was so simple. A 19 year old's first birth with no fear. She just came in, did her thing, pushed her baby out and put him to the breast.

Birth # 19 - Pushing was going so well. And then the mother reached down, felt the top of the baby's head, yelled "BAYI!" (baby) and pushed like crazy. She had an awful tear which was confusing to me when watching the suturing. Oh, and baby's one thumb was actually 2 thumbs fused together.

Birth # 20 - My first birth as primary midwife. One of the longest labors, 6.5 hr of pushing, 3rd degree tear. I had a fabulous Australian CNM working with me and she took on the "doula" role for me and was great whispering encouragment in my ear through the whole thing!

Birth #21 - See previous post about my first time suturing!

Birth # 23 - In general, boys are desired, and girls are OK if you already have a boy. So some births were sad when the mother was obviously disappointed in the birth outcome. For this birth, finding out the sex was quite funny and they were very happy with the outcome. Dad thinking: Boy or girl, I will look. Hmm, I'm not sure, from this angle, I guess I'll wait. Mom (5 minutes later feeling the baby): Boy or girl, I'll feel it out. Boy? Hmm, oh it's a girl!

Birth # 25 - I'll call it "Bucket Brigade Birth". The gas wasn't working in the water heater, so we had to carry bucket after bucket from the other birth room, and it was barely filled in time!

Birth #26 - We finally convinced the older brother (10 yr old) that it was OK to come in for the birth. Even though at this point my Indonesian was still in the baby stages, I could figure out that this kid was hilarious. His questions had the midwives cracking up the whole time. The birth was noneventful but the baby had a hard time breathing on her own. She had multiple birth defects, especially odd sutures, and she was transferred to the hospital a few hours later.

Births # 31 and #32 were the hardest two births for me ever. I'll start with # 32.

Birth # 32 - My preceptor and I had just finished birth #31 and ended up at the hospital for an induction. The father made all of us uneasy and as the night and then morning progressed, he basically decided that he wanted his wife to have a Cesarean that she didn't want. She had gone from 0 - 10 cm with induction and pushed for 2 hours with progress, but he was quite forceful that she was to have a C/S. I saw the Cesarean and stayed with the mother until she got to recovery. My preceptor stayed with the father because she was asked quietly by the nurses to keep an eye on him because he even made them uneasy. After we saw that the mother was breastfeeding and doing well, we went to leave but the father blocked our way, shoved my preceptor and demanded why we let her have a Cesarean. It was a really scary situation and the nurse in the room called security to make sure we could get out. That was my last birth in Bali.

Birth #31 - Not a day goes by that I don't think of "K". She was an older Muslim woman that I saw a few times for prenatals. At her prenatals she was measuring large, suspected polyhydramnios (excess amniotic fluid), and an ultrasound showed only one baby. "K" had decent English so we made a connection and she was happy to have me as her midwife. I came to the clinic as soon as I heard she was there and helped her with labor support. She was all alone and had very little in her birth kit. She labored well, pushed an hour, and her baby boy was born. After holding him a few seconds, we placed him on the bed and started resuscitation. All of the senior midwives and a nurse with high-level resus skills was there. We could see that he had problems. He also had no desire to breathe on his own. Two midwives and two students eventually took him to the hospital in Denpasar helping him breathe the whole way there. I stayed with "K" and reassured her that everyone was trying their best to help him. Of course I'm leaving out many many details here, but it was an awful situation.

A few hours later, "K" was stable enough for her, my preceptor, and me to go to see her baby. We got to the hospital and I held "K"s had tightly as we walked to a waiting room to sit while my preceptor and her husband searched the hospital for her baby. My preceptor and I made eye contact and I knew. We walked with "K" to the room where her baby was and held her up as she saw her baby laying in a baby bed in the corner with his blanket pulled up over his face. He had passed away just 30 minutes before we arrived. I can't say more about this here. We stayed with "K" until her husband could come and collect the death certificate. The last I saw "K" was her wheeled away in a wheelchair, holding her baby in her arms, off to ride away to the graveyard.

I saw so many wonderful and sad things in Indonesia. All of these women willingly allowed me to share their beautiful experiences, and I am forever grateful to them.

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At 10:55 AM, Blogger Katrina said...


I am just checking my google reader after 6 weeks of working with a tradiitonal midwife in rural guatemala. Im a student midwife, currently on summer hoildays, from New Zealand.

What experiences you have had!

Thanks for sharing!

At 1:19 PM, Blogger rcsnickers said...

WOW! I can't say it enough... but what an experience and lessons you have learned. Thank you so much for sharing these births with us!

Glad you are back to experience and catch some more babies!

At 9:50 AM, Blogger Emily said...

I'm late reading these b/c my RSS reader was offline. Wow, what experiences....lifechanging. Thanks for sharing them. I look forward to hearing more this summer.

At 2:50 PM, Blogger Walker Mitchell said...

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