Episitomies, Dilation, and Feeding Tubes

We got off work around 8:30am this morning and our laboring women were at 8cm and 6cm. We were bummed that they did not deliver because we labored with them all night. We told the African midwife on for the day shift that we would go home and eat and then come back to hopefully deliver the woman who was 8cm. We had developed a bond with her and wanted to deliver her. We got back to the hospital about 2hrs later and she was on the delivery table with the baby coming. It was not even the midwife delivering her it was one of the nurses. By the time we got there the nurse had already cut a large medial- lateral episiotomy without the head even showing. The baby soon came and it weighed only 2.4 kg. It seems that all the nurses and midwifes here give the woman episiotomies even when they don’t need one and then watching them stitch her up was a even more horrific experience. Mind you I have not seen many repairs but this just looked brutal. They used very little lidocane, we actually asked them to please use some more because the woman was in so much pain and squeezing the life out of Linda’s hand. They reluctantly gave her some more. Then the repair began. All of their stitches are interrupted and the knots they use are slip knots. They used 3 packs of suture which was 2.0 catgut (which was like rope!). Her bottom was so full of suture it was painful to look at! The stitches were all knotted externally leaving pokey ends and a great opportunity for infection. When the laceration was all repaired it was not approximated well at all and was all puckered, nothing near smooth. Linda is making plans to give some in-services to the midwifes/nurses on how to suture because their technique is so bad. Hopefully they will be receptive and willing to learn.

Before we had left for the end of our shift we had requested several things to be done with the preemie infant to help her such as change her IV dressing that was soaking wet and insert a feeding tube through her nose so she could be fed though it. She did not eat well for me the whole night, she was not swallowing well and she needed nourishment. When we came back for the one delivery we were happy to see that they had preformed the tasks we had asked. The baby was still hanging in there but still doing far from good.

After sleeping for several hrs we had all the Americans over for lunch after church and then visited in the afternoon for while and then took another nap in the afternoon. That evening after sundown Linda and I decided to have a movie night so we watched a movie on my laptop, we found one plug that works in our house and an adapter for US plugs!!! After our movie it was off to bed for tomorrow was another day of work. Here they have 6 day working weeks. Linda and I are really blessed for the accommodations we have, running water most of the time and electricity to power the lights and one plug-in. We are truly living in luxury!