Anyhow, the scissor trick appeared to work, and a head popped out. A whole head with a pale, bluish face and plenty of hair. I couldn't believe the size of the head compared to the opening I had seen earlier. The midwife reported that the baby had an umbilical cord wrapped around his neck, but thankfully it was loose, so they just had to wait for the child to rotate naturally to the right or left. The midwife demanded one last push, and with some quick maneuver, the shoulders came out, and the rest of the body just slid out like a fish out of someone's hands. The midwife quickly grabbed the baby's feet and hung him upside down as the cord was removed from his neck. The mother was told to hyperventilate to deliver more oxygen to the baby.
The baby looked so fake. He was bluish and slimy and looked like a doll that had some manufacturing difficulties. Man, babies are so gross when they first come out. The umbilical cord also looked unreal. It was so organized and smooth that it looked like a man-made plastic tube with a twist to it. Anyhow, the cord was clamped and cut, and the baby gave out one tiny but purposeful cry to tell the world that he's ready to do some damage (well, he's already done plenty of damage).
The mother's ordeal continues. We waited for the placenta to detach as we watched for elongation of the umbilical. That did not happen, so the midwife had to manually push down on the uterus to contract it while pulling on the cord. Each time the midwife pulled on the cord, the mother cringed with pain. Soon, a bag of blood vessels and lobes came out - the placenta. The midwife checked to make sure there were no clots and the whole thing was intact before putting it in a bag so the mother can take it home and bury it in a special ritual.
To finish up this whole process, the opening's cut had to be sutured. The midwife haphazardly stabbed the mother in various places near the cut to put in local anesthetics. Then she continued to suture the cut. I don't know if it's because the anesthetic wasn't enough or failed to take effect, but each stitch caused the mother to writhe in massive pain. It seemed like it was done so roughly. The needle sometimes got stuck at the outer skin level and the midwife had to really jerk it to get it through the skin. I don't know how the mother would ever want another kid after this ordeal. After 5 sutures, she was finally allowed to rest.
This whole process took place in a tiny room the size of a small bathroom. The mother laid completely exposed on top of a cushioned bed that was simply layered with a plastic wrap. The sutures were the wrong kind, so it had to be doubled up. The mother didn't bring a lapa (fabric), so the child was wrapped up in her t-shirt. But a real kicker was that to soak up the endless flow of blood, they used pads. Yup, the same ones women use for periods. A box of them was sitting on the empty bed next to the patient. I guess if you think about it, they're probably the best at sucking up blood. But still... there was one patient who had post-partum hemorrhage, and the doctor gave her some oxytocin shots, rubbed her uterus and breasts, and stuffed several pads up her vagina to stop the bleeding. It was quite disturbing.
Caesarian:
That was a lot of fun to watch. The doctor went through layers and layers of various bodily material. Then all of a sudden, there was a massive flow of fluid all over the place as the doctor entered the uterus. The baby was extracted and hung upside down as in natural childbirth (do they always hang babies upside-down?). Then the WHOLE uterus was pulled out of the tiny slit they cut in the abdomen to be sewn together. The doctor was so smooth with his suturing that he was done in a couple of minutes. After that, he just left - with the whole uterus still outside the mother's body - and had the medical officer (I'm guessing it's the term they use for doctor in training) finish up the suturing. Oh man, it was a pain watching him suture. Not only was he slow, the suture got caught up in clamps, the suture came out of the needle, he left too little suture at the end so he wasn't able to tie a knot, and many other little things that I'll probably do when I start rotations. Ultimately, he finished, squished the uterus back into the abdomen, and sutured the rest of the layers together. Mission accomplished. Baby delivered.
17 Year Old Mother:
I knew the mother was young, but I didn't realize she was only 17 years old! She was just starting high school, and she had not married yet. As she labored, I harbored a slight prejudice against her and kept on wondering if she had regrets.
Anyhow, the birth continued with no complications, rips, or necessary scissor snips. A tiny girl came out, but to everyone's surprise, her stomach was still distended. She had twins! Many people in Sierra Leone still don't have any prenatal care, so it wasn't a surprise that she didn't know she had twins. The midwives suspected twins because of the large distension, but other than that, I think they were just as surprised.
After the birth, I got to talk to the girl, and her story is a sad one. Her father had died during the civil war, and her mother died unexpectedly when she was in elementary school. She has several aunts, one of whom is very wealthy and have children living in London and America; however, the aunt abandoned her because of some strife with the girl's mother. The cousins in U.S. or America would send money or gifts to the 17 yr old girl, but the aunt confiscated everything and made sure they never met.
The teachers saw she was a smart girl, so paid for her education. Then this boy near where she lived started to like her. The boy's family got to know her and like her as well, so eventually she was living with them and they provided for her education. At first I suspected some foul play, but when I asked if the boy and family were kind to her, she said they were like a blessing. I wish her the best in her aspirations to be a bank manager.
She had quite a lot of postpartum bleeding. Please let her be okay.