From placenta catcher to baby catcher

(Not really though, because they all still call me the Placenta catcher).

I'm never going to live that name down... I'll post that story later. :)

Anyhow, I think you're wanting to hear a birth story, yes? I have one for you.

It happened on Wednesday, May 21st. I was on the schedule for prenatal clinic, which consists of an average of 100 prenatal checkups. If you think your wait is long at your OB doctor, you may be surprised to know these women are here from about 6am - 11am for morning clinic. During this time they get their BP, weight, urine tested, hematocrit levels drawn, tetanus injection (varies), and fetal heart rate, position, and lie. I rotated between the rooms that day - helping wherever was needed. We finished up with all of these appointments around 2 and the rest of the girls on my team were headed to Faith Academy to hear a Senior's presentation. I volunteered to stay back and take over the shift from 2-10 since I was still itching to deliver and there were two women in labor.

Around 5:30, my decision paid off!

Ate Jheny (one of the amazing midwives here at Shalom and pictured below) and I were sitting in the delivery room talking when we heard slow, shuffling footsteps in the hallway (I think I have trained my ears for the laboring woman's gait). Sure enough, one of the women who was in labor came in looking exhausted - a young teenager named Dalia.

She slowly walked to the delivery table and got on it while Ate Jheny chattered to her in Tagalog and donned her sterile gloves. The contractions were coming fairly quickly together, and I took her BP and temp between them as Jheny examined her. "She's 9cm already. Soon.", she told me. Dalia sighed and rolled to sit up on the table. I could tell she was ready for the baby to be out. Jheny began asking her several questions in Tagalog, and I soon sensed some tension in the exchange between them, via body language and their expressions. Their dialogue continued for about 10 minutes, and when Dalia returned to the postpartum/labor room, I asked Jheny what had been said. Jheny explained that she was upset because Dalia promised the clinic she would get a check up at the Dr due to her young age, but did not go. It was a safety precaution to be sure that she would be okay to deliver at the clinic, as we have limited medical supplies here. However, she didn't schedule it and was now refusing to eat or drink anything. "Stubborn girl", I thought. But I caught myself as I remembered seeing that same stubborn, determined look and set jaw on my own face once or twice. I almost didn't blame her for not going to the Doctor. I recall a time when I wasn't keen on being forced to do things because I was young. ; ) Of course I'm much more mature now so it doesn't bother me. Hah.

About 20 minutes had passed since Dalia had left when we heard those shuffling footsteps in the hall again, and Jheny and I knew it was time. They came in like a parade. Dalia first, supported by her future mother in law, then came who I assume was her older sister, smiling and giggling at her daughter. Bringing up the rear toddled her little girl. Her huge brown eyes stared solemnly up at me while she entered the room carrying a tiny puppy. They were all a sight for sure.

After her future mother in law assisted her on to the table, Jheny performed a cervical exam and confirmed her progression as complete. Fully dilated and 100% effaced, Dalia was ready to bring a new life into this world. Jheny chattered away in Tagalog to Dalia as her and I donned our sterile gloves in preparation for the delivery. I assume she was explaining to her the position she was to be in as she moved into the standard one (usually all deliveries here are performed with the patient supine on a bed in the delivery room). But for all I know she could've been telling her she was about to let an American nursing student deliver her first baby, and she was the chosen candidate.

The countdown began to delivery.

We watched her go through a few contractions. Jheny had to help coach her through them, as she was acting very lethargic and uncooperative at first. I could tell when the contractions started and ended as they worked their way up and down her body.  Muscles tensed as they braced themselves for the uterine contraction. It came. Beads of sweat appeared on her forehead as she squeezed her eyes shut and  pulled her lips in, forming a thin line. She grimaced as she grabbed the edge of the bed with white fingers and curled her toes beneath her. She was pushing. "Push! Keep pushing!" were her commands by Jheny. We could see the top of the head back a little way. The contraction eased, and her body relaxed in the opposite order that it had contracted.

Jheny looked at me. "Do you want to feel the head?", she asked. "Yes!", was my eager reply. She showed me how to do it and I carefully inserted two of my gloved fingers, imitating her and feeling for a head. I wasn't entirely confident in everything I was feeling, but I knew when I had found what I was looking for. Excited, I opened my fingers and stretched them around the circumference of the head. A surge of adrenaline coursed through my body as I felt the baby move it's head against my fingers. I don't know why it shocked me so much, but for a second I think I was so focused I had forgotten babies can move in utero! Haha. I removed my fingers because all of a sudden  I felt as if I was invading his/her home. Jheny nodded and smiled at me.

It was hot in there. Two fans were on, but I was still wiping sweat off of my forehead with my arm, trying not to contaminate my sterile gloves. Ate Jheny asked if I was okay, thinking I was sweating because I was nervous. Hah. No, this is because I just came from what felt like a 6 month winter to the hottest place I've ever been, and my body was responding appropriately by panicking. ;)

Another contraction was coming.  The baby was nearly crowning, and we needed her to keep pushing. Dalia had other ideas. She would push once, putting little effort in, then relax, adjust her hips and move her head back and forth saying "wait" in Tagalog to Jheny, who was telling her to keep pushing. My eyes moved back and forth from the small portion of the baby's head that I could see to Dalia's face. I would stare at her until she looked at me. We would lock eyes and I would raise my eyebrows, nod and smile at her, crossing the language barrier we had in what I hoped was an encouraging gesture. She would usually give me a tired smile in return, and she began to look so young to me. 3 years younger than me, this girl was about to become a mother, and she looked scared.

The cycle continued for about 15 more minutes.
Contraction.
Dalia giving one or two pushes.
Baby crowning.
Me praying, internally willing her to continue.
Jheny and I saying "Keep pushing! Keep pushing!".
Dalia saying "Wait. Wait." and relaxing.
The baby's head retreating back into the cervix.
Fast-paced Tagalog speech from Jheny.
Me locking eyes with her

Gah. I wanted to be able to speak Tagalog to help coach her. I wanted to tell her to take deep breaths to give her baby oxygen. I wanted to encourage her and tell her she was more than able to do this, that she was strong and it doesn't matter that she was young. To tell her to push for her baby, even though she was tired. However, I couldn't. But I realized that maybe it was better this way. She already had people telling her what to do. Maybe God had me there to just be someone close to her age who would lock eyes with her, smile, and encourage her with body language, without telling her what to do.

I wracked my brain for ways that could help, and the thought crossed my mind to get a mirror so she could see her progress herself. But I hadn't seen one around the clinic and I wasn't sure if that would be okay in their culture. It turns out I should've asked because a few minutes later Jheny asked the sister to get her something in Tagalog. What more did she come back with than a wicker-framed mirror, holding it so that Dalia could see her baby's head. I smiled as I watched her expression change when she realized how close she really was.

With the next two pushes, the baby's head slid further and further out until it was almost completely crowning. The room got louder and louder as we all said "Push! Push!" urgently, over and over. With the next push, the head came out as Jheny stretched the cervix to make it easier. Ahhh, victory! Praise Jesus she had done it.  Almost... Just had to get the shoulders out.

The baby was the normal blue/purple color before they've had their first few breaths of air. Wet with amniotic fluid and blood, the scrunched up face of babies before they're all the way out makes me giggle to myself. They always look so mad at you for removing them from their nice warm, dark swimming pool they have been living in. Poor things. Jheny guided my right hand around that tiny little neck to be sure the cord was not around it, then I gently pulled with the next contraction - first down, then up. One shoulder popped out, then another, followed by the rest of the body. We proudly exclaimed "It's a girl!", and I slipped my hands under her armpits and lifted her on to her momma to be skin to skin for an hour. I rubbed her down with a blanket to dry her off/stimulate her. She let out a lusty cry to show me how much she didn't appreciate that. Good. That means she won't need suctioned.

I felt the umbilical cord, waiting for it to stop pulsing, while I beamed at her, so proud of her and her momma. :) Jheny handed me the clamp, which I put on. Then we clamped the other end and I cut her cord after placing my fingers between her and the cord. I realized I still had a large smile on my face because it hit me what had just happened. However, I soon returned to my focused state as I realized I still had to deliver the placenta. I had to live up to my nickname after all. :) I wound the cord around the clamped scissors and gently pulled, with a method they call controlled cord traction. Her cord was pretty long and thick, but I soon saw the placenta beginning to emerge, I stuck my right hand below the cervix. Ate Grace jumped up to grab my camera, laughing and saying she had to get a picture of the placenta catcher. Very funny. Hah. I delivered it and gave her a heart face for a photo with me holding it up. We examined it after that to be sure it was intact and healthy. Good news only! =)

Jheny began doing sutures to repair her 2nd degree tear as I watched in case she needed anything. She was an expert, so I just watched her do her thing. :) the rest of the group got back from Faith right when this was going on, and I watched their excited faces come into view one by one. I held up my bloody gloves in response to their questioning stares, and they responded with cheers and smiles. :) When the sutures were finished, I held the baby while Jheny and Grace took photos of me and my first delivery! They were great sports and Dalia was more than willing to let me borrow her daughter, whom she named Jezebel. I'll treasure those pictures forever, and I'm so glad I got them! =) Jheny could tell I was excited so she asked Grace if I could use the wifi to post pictures. She didn't care so I got on and shared my news with the world. :) The rest of the girls trickled downstairs to see me and use it as well. Eventually we ended up taking fun and crazy pictures with Precious, Ate Jheny  and Ate Grace. It was so fun. =) I finally headed to bed around 12 after I showered and ate my dinner, which is almost 4 hours past my bedtime here. Not to mention I had been on duty downstairs since 8am. I was a wee bit sleepy, but I wouldn't change a thing. :)

Day 2-3 - From pancit to placentas.

IAll of the babies... All of them.

Friday and Saturday here were very full. Saturday was crazy! My goodness... But I'll get back to that in a minute... ; )

By Friday night I had mastered the art of sleeping here... Wear as little clothing as possible, sleep as close to the ground as you can, ice yourself down, wet cloth and freeze it for a few minutes, then place that over yourself and sleep in front of a fan. Magic. And most of those things i have access to because I'm a spoiled American here... We don't realize how much we take air conditioning for granted in the States. That's for sure! I am so thankful for the beautiful place set up for us at the clinic. It's amazing with so many amenities we weren't expecting. The Becks (missionaries who helped us plan this) have spoiled us rotten! :)

Anyhow... Friday! We woke up and started working at the clinic doing prenatal check ups again. I took ladies weights at the start of their appointment, then helped direct them to other offices for other portions of their check up. After finishing that, I was able to learn how to do post natal checks on the Mom and baby with Sari (our leader). The babies are SO STINKING cute here! My goodness. It made me even more itchy to deliver one. ,; ) The language barrier for checks is interesting, because Filipino culture is that they just smile ALL the time, and they always try to be polite. If they don't know the answer to what you're asking or they don't understand what you're saying, they just smile and say "yes" so they're not portrayed as rude. This can be a bit of an issue, but we work around it with lots of smiles and laughter. : )

After working at the clinic, 4 of us girls went to Faith Academy with the Becks. This is the largest school in the world for Missionary kids, and let me tell you.. It's amazing. We were able to go on a tour and heard testimony after testimony about the campus there and how it all came to be. Speaking of, Shop at Forever 21. The owner completely funded their swimming pool and HUGE auditorium, which was over $5 million dollars..
Seriously.. The stories we heard. Incredible the way God has worked! While we were there we helped out making health promotion posters for Kindergarten and High School students. :)
We went back to our house for dinner, made by our sweet Filipino helper, Ate Cora. Pancit, lumpia, and chicken adobo... My goodness. The food here is amazzzzing. :) Following dinner, I took my Bible and went up.on the roof of the clinic for Jesus time during the sunset... Gah. This coupled with the babies is nearly enough to make me want to move. ; ) it was so peaceful!

We had a meeting after that with our leader Sari at her parent's house here. We talked a lot and eventually got to the point where we were so exhausted that we were nodding off. But since I don't do much halfway, I nodded off in the middle of a  conversation and almost fell off my chair... I was going no one saw once I realized what happened, but of course Dee saw and started cracking up. Nothing much has changed there. ; ) When we got back to the clinic we all went straight to bed. This was when I figured out how to get to sleep. ; )

Saturday I woke up at 7 to find two of the girls making pancakes and two downstairs with deliveries because 3 women were in labor! Sarah got to see a 4:30am delivery and deliver a baby herself at 6:30 (of which she became the godmother) She came up and finished breakfast with us while the other two women progressed. I went downstairs with Lindsay and Dee to see what was going on with the births and take pictures since they claimed them (just wait for those) ; ).

When we got downstairs, one woman was ready to deliver so Lindsay said she would take it since she was with her earlier. : ) The Dad for this birth... My goodness. He was precious. Running around the delivery room fanning his wife, then rummaging through their bag looking for diapers and baby clothes, smiling sometimes and staring at the birthing process. ; ) I took pictures while Lindsay got ready to help pull the baby out - she placed her hands around the baby's head once she started crowning and gently pulled up and down to help ease the shoulders out. Again, the mom barely made a sound. Between their high pain tolerance and wanting to avoid shame by crying out, you wouldn't even know a woman was delivering until you heard the newborn's cry. And all without pain meds! If they can do it, I can. ; ) I probably won't be as quiet though. Hah.
Anyhow, the baby slid right out and Lindsay had the biggest smile on her face! So did that Dad and everyone else in the room. :) Lindsay placed the baby directly on the Mom's chest skin to skin, as their protocol insists. Golden hour!

The cord stopped pulsing and Lindsay got to clamp and cut it soon after the birth. The placenta came next as the midwife pulled on the cord, which scares all of us but we are trying not to go around the clinic saying what's wrong or right about how they do things. The risk with this is retained placental fragments in the uterus and possibly even pulling the uterus out. Scary stuff. There was actually a bright red gush of blood right when the placenta started to exit, and I caught my breath, praying everything was going to be okay. As it slid out, the midwife checked it, then began pulling out pieces of it that I believe got left behind. Goodness. So anyhow, the baby was perfect and healthy and began crying right away. Everything else went perfectly with the birth and postpartum. : ) 

As soon as that woman delivered, another came in ready to go and Dee took her, ready to embark on this baby-catching adventure. : ) I stayed and snuck in on this birth as well, taking pictures to document it and getting in all of the births I can possibly see. : ) I love it and can't get enough!

Dee got gloved and ready to help as the woman began pushing. I had my camera in one hand and one hand around a leg holding it back, then changed positions so I had one hand behind her neck, one around her leg and my camera on my hip. Truly both of my loves coming into action! Hah. :) I let go as the baby began to crown and the mom's Mom took over the job. I got my camera set up as Dee exclaimed "Ahhh look at the head! Yay!!!" She started clapping and was a giddy little mess. It was precious. : ) Again, she slipped her hands around the baby's head as she came out and gently pulled to allow the shoulders out one at a time. The baby girl slid out and Dee placed her on the Mom, with everyone in the room in that collective gasp as another human breathed it's first breath and joined us here on Earth.

Mmm beautiful.

Again, they pulled the placenta after clamping and cutting the cord, but no problems this time. :) Another successful birth and happy family! I gave an oxytocin IM injection to the Mom to help with uterine contractions to prevent later  hemorrhage.

I waited around to see if I could get a birth in myself, but no one else came in and the woman laboring ended up having to go to the hospital because of failure to progress and fetal distress. : (

We headed to Sari's for dinner and made picture frames for girls who we're having a tea party for tomorrow (Josie's angels). They have been rescued from abusive homes. I'm excited to meet them and heart their stories tomorrow. :)

Good morning in the US! Goodbye for now. :)

Days 1

I made it! :) After several hours of traveling and a little bit of sleep, we arrived in Manila around midnight last night. We got to Shalom clinic around 2am, and I went to bed around 4. This may have had something to do with the C2 I drank (caffeinated Green Tea = my replacement for coffee while here), and my body isn't quite sure about what's going on yet. Hah. Between the rooster farm below us and the three guard dogs chained below our windows this morning, the caffeine was necessary 2 and a half hours later. ;)

We woke up at 6:30am (6:30pm your time) to get ready for our clinical orientation, which began at 7. We walked downstairs (we sleep above the clinic) and were welcomed by 60 or so Filipino ladies waiting in line for their prenatal checkups, as well as nurses and midwives. We were shown around and met the woman who started the clinic - Ms. Mavis is 86 now, and a wonderfully sassy lady from England. We jumped right in helping take blood pressures, weights, urinalyses, hematocrits, listening to fetal heart tones, palpating fetal positions, and talking with all of these beautiful women. It was amazing to be a part of what a successful ministry this is here in Manila. The morning moved on pretty steadily as I helped in the check-up area palpating the baby's position and listening to fetal heart tones with the doppler - both of which I had never done professionally.

 However, around 9:30am things got a bit more interesting! I heard some commotion and a young woman running down the hall and the midwife I was working with jumped up from her chair and started walking out the door. I heard the word "labor" come out of her mouth and you can bet I was right behind her! :) We went to the delivery room and sure enough, there was a young Filipino woman there pushing away, just as silent as can be. The only way you could tell she was pushing was from the grimace on her face and beads of sweat on her forehead. Both of the midwives from the clinic looked at Katelyn (another nursing student) and I and asked if we wanted to assist. "Yes!" was our pretty enthusiastic reply. Another girl went to get gloves but they motioned Katelyn over and said she didn't have time if she wanted to catch the baby. It was coming NOW. Katelyn got her sterile gloves on while I was peering over her shoulder at the baby's head beginning to emerge. She got them on and placed her hand under the baby's head and with a couple more pushes it was out! Just like that... Fastest delivery I've ever seen! She was probably in the clinic 5 minutes when she delivered... Imagine what Doctors in the US would do if women came in that close to delivery. ;) Hah! Maybe I'll try it one day. :)

Katelyn also got to deliver the placenta and clamp the umbilical cord (they practice delayed cord clamping here, which I think is wonderful after doing research on it last semester. Anyhow, it was a beautiful baby girl, and the Momma did SO great. We found out later that her water broke in the car on the way to the clinic, speeding things along a bit. ;) A few different ladies were present with her, all with the HUGE smiles that seem to be so common here. Katelyn and I observed as the midwife fixed a laceration the Mom had endured - all with no pain meds and not a sound above normal speaking volume... What a trooper. Goodness.

We implemented the Golden Hour (recommended by the Dept of Health here). This is where the baby is delivered and goes straight up to the Mom's chest and stays skin to skin uninterrupted for an hour. I became so excited when I heard about this, as it is SO good for the mom AND baby! Not only does it help the baby bond with the Mom, it also helps the baby thermoregulate (the Mom's temperature will rise and fall naturally to keep the baby at a normal temp), helps promote effective breastfeeding, stable glucose levels, normal respiratory patterns, and reduces baby's stress. Why wouldn't we do it in other words? Raised by a mom who had natural home deliveries, the hippie side of me kicks in and LOVES this, as well as many other natural things they do here... :) If I stick around here awhile I may end up coming back for longer, or becoming a licensed midwife (who knows?!) After our first birth adventure, we all resumed our positions doing prenatal checkups, and then dispersed and helped organize meds upstairs and bombard the midwives with questions. :)

When we finished at the clinic for the day, we all loaded up and headed to Faith Academy (the largest school for missionary kids in the world). It's located about 20 minutes away from where we're staying and the Beck's (the missionaries who helped plan our trip) both taught here for many years. We ate lunch when we arrived and then were treated by being able to go swimming! This was a nice break for us, as well as a great way to keep us awake as our bodies are still adjusting to the time difference/lack of sleep. Needless to say, we've been spoiled on our first day. I can't wait to see what God has in store for the next 29!

Thank you so much for your continued prayers and support!

I love you!

Victoria