Monthly Archives: August 2013

What happens when the solar-powered well-water pump … stops working?

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“Pe pii.” No water. That’s what I had to tell the Acholi woman who walked to our birth center compound to get water from the long hose that snakes several yards across our fields to just outside the birth center. Even though the sun was still shining, the water was not flowing. The woman’s face looked troubled as she walked away. Her expression mirrored my own.

We are blessed to have a solar-powered well-water pump, which means that people who get water from our hose do not have to pump it like they do from a bore-hole. It just flows freely! So lots of people come, all day, and get water from us. But only when the sun is shining.  If it’s a cloudy day or a rainy day, there’s no water. And sometimes, the technology just plain doesn’t work. A few months ago, the solar-powered pump quit working and had to be repaired. A few days ago, my fellow midwife Kate and I feared we were about to face the same problem again.

I was a little tense. I had come to the hose to get fresh drinking water for the night, and there wasn’t any. I would have to get some from one of our storage jars. But what if the water wasn’t flowing the morning? What then?

The well is our main source of water. It is easy to get water because of the solar-powered pump. If it doesn’t work, we can get water from nearby bore-holes, but we have to pump the water up out of the ground, which is physically hard and time-consuming … and there are mamas and babies to take care of!

Fortunately, the problem turned out to be the angle of the sun, which was shining, but not on the solar panel. The next morning, later in the day than usual, the water was flowing again. But this made me think of how many people around us are thirsty for living water.

Jesus answered, “Everyone who drinks this water will be thirsty again,
but whoever drinks the water I give them will never thirst.
Indeed, the water I give them will become in them
a spring of water welling up to eternal life.”

~ Jesus (John 4:13)

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The Birth of Josiah

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16 August 2013 

One of the first prenatal appointments I did here was with Cirace. I was doing the prenatal alone with one of our translators, Kristine. At the end of the prenatal visit, Cirace said to me, “I am praying that you will be my midwife.” I said, “I am praying for that, too.”

Yesterday, after I returned from outreach to Okidi where I completed seventeen prenatals with our CNM, Stephanie, and our translator, Viola, I was in the birth center re-stocking prenatal vitamins when a pregnant woman came in who was clearly in hard labor: it was Cirace!

“Choli?” I asked her. Are you pushing? And Karmela, one of our Ugandan midwives, said, “Not yet.”

Cirace has given birth to seven children. I knew this could go fast. So I moved quickly to get her prenatal chart and start her labor record. Even as I entered her little room again to start taking her vitals, she was already lying down to push. I set down the chart and started looking (rather urgently!) for a pair of gloves, asking Karmela to get Kate, our lead midwife, please.

Kate arrived as Cirace was pushing her baby’s head out. She said to me, quite calmly, “A midwife centers herself.” The baby emerged in the caul with nuchal cord. I peeled back the caul, unwrapped the cord and placed the baby boy skin-to-skin with his mother. He cried vigorously!

Later in the night, with Nighty as translator, I was able to tell Cirace that I remembered her very well and how we were praying that I would be her midwife. Here, God answered our prayer.

Cirace asked me to name her baby. I named him Josiah, which means, “loved by the LORD.” Thank you, Lord.

The World Waiting for You

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I felt your life pass through my hands.
When I laid my palm on your mother’s belly,
I felt you kick, hard and strong,
as you were pushing yourself out
toward the world waiting for you.

I felt your life pass through my hands.
I tried to catch the sound
of your erratic heartbeat through the fetoscope,
and I heard it without being able to count it,
jumping and pausing and turning away.

I felt your life pass through.
I watched the midwife work to ease your head out
—too large for an ordinary preterm child—
and I saw your malformed face, your bleeding head,
and your blue body, stillborn.

I felt your life pass.
When the midwife wrapped you in a cloth for burial,
and laid you beside your mother for a moment,
I tucked a bit of her blanket around you,
because you had gone to the world waiting for you.

Jane Beal
for the daughter Everlyne
stillborn 14 August 2013 at 7:37 AM

“Therefore prophesy and say to them, ‘Behold, I will open your graves and raise you from your graves, O my people. And I will bring you into the land of Israel. And you shall know that I am the LORD, when I open your graves, and raise you from your graves, O my people. And I will put my Spirit within you, and you shall live, and I will place you in your own land. Then you shall know that I am the LORD; I have spoken, and I will do it,’ declares the Lord.” ~ Ezekiel 37: 12-14

Victorious VBAC

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10 August 2013

On Saturday, a nineteen-year-old young woman came into our birth center from Okidi reporting that she had been in labor since Thursday. She arrived by boda-boda (i.e., motorcycle). We checked her: she was fully dilated and ready to push. But she was also clearly dehydrated, faint, and exhausted. We gave her water with vitamin C and porridge, and her eyes became clearer and more focused. Her energy revived.

She had a low transverse incision on her belly, and she reported that she’d had a c-section with her first baby. Why? According to her, doctors had told her that, after being in labor for two weeks, it was time for surgery.

For the first two hours, she was unable to make effective pushing efforts. The baby was not descending. She said she wasn’t sure her hips were big enough to let the baby pass through. And then the baby started showing some signs of distress (late decels and meconium after the bag of waters was broken). Finally, we told her that another c-section might be necessary if she could not push the baby out.

All of a sudden, this amazing Acholi woman turned into a lioness! She was absolutely ready to push with all of her might, and she started ordering the midwives around, telling this one to sit here, the other to do this, and she hunkered down and pushed. She was not one bit interested in having surgery again.

I was holding a mirror for her, which she watched carefully as she pushed, and when she could see her baby’s head as she pushed, tears came to her eyes. It was so beautifully touching. She pushed her baby out with all her nineteen-year-old might: a boy whose significant caput and head-molding told us that he had been in an asynclitic position, which makes baby much harder to push through, but she did it! A victorious VBAC. And the baby made the transition to life outside the womb very well, needing no resuscitation.

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This woman’s experience got me thinking about how much harder it is to have a c-section in northern Uganda than America. Women here do a lot of carrying of heavy loads—water, firewood, food—usually on their heads with their youngest baby tied to their backs. I seriously doubt that the full, eight-week recovery time recommended to American women (and rarely adequate for them, either) can be honored easily by families who depend on the mother to do so much, especially when her children are too young to help.

It’s one more reason why the midwifery model of care, which makes every effort to ensure a natural birth, is so vital to supporting women in childbirth here in east Africa.

Give justice to the weak and the fatherless;
maintain the right of the afflicted and the destitute.
Rescue the weak and the needy;
deliver them from the hand of the wicked. 

~ Psalm 82: 3-4

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Life and Death in the Same Breath

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8 August 2013 

I was hoping to catch a baby on my birthday. I thought it would be a wonderful gift from God if he were willing. But that morning, two of our midwives returned from outreach in Kal with a mother who was 38 weeks pregnant reporting that they could not find heart-tones. Our lead midwife, Kate, double checked. Nothing. No heart-tones. Not even the reassuring whooshing sound of the placenta remained. The death of this little baby, technically called “intra-uterine fetal demise” (IUFD), was confirmed. This was the woman’s first child. I was filled with sadness. My fellow midwives eventually decided with the woman and her husband that we would transport this woman to the hospital, two hours away in Gulu, for ultrasound confirmation and further care.

I wandered outside in a daze of sadness over this loss, and as I was walking, Korina, one of our traditional Ugandan midwives here, beckoned me to come with her. We were going to pick up a mother in labor in Okidi, 40 minutes away. I got in our “land-rover” style ambulance-truck.

As we were driving, I was thinking about the baby and the family, and I turned my attention to God and to listening-prayer. I heard the Lord say to me, “Do not be afraid” and then, “Strengthen your heart.” (Later, I would receive an email from my mother, who on my birthday had a strong impression in her spirit that a baby had died and was praying for me all day.) So I took deep, calming breaths and looked forward, out the windshield, at the landscape as we drove: the red-dirt road, the tall green grass, the mountains.

When we arrived in Okidi, the mama was in transition, nearly dancing in pain and leaning hard on a sister-friend with each contraction. Once we helped her in the truck, she was sitting beside me and leaning against me, and I could feel her pushing. I asked her if she were pushing, and she said she would stop. (Ha! Who can stop pushing when it’s time? Hardly any woman …) I had my hand on her belly, and I could feel the baby kicking the top of the fundus like babies do when they are pushing themselves out.

Then the young mama lifted her skirt, and here, the baby’s full head appeared in the caul! We quickly pulled to one side of the road, and I got my gloves on, catching the whole baby as he emerged. He cried loudly as he came, so I knew his lungs had transitioned well. I peeled back the caul so he could breathe through his nose if he wanted, turned him over on my forearm and rubbed his back to help clear his gargly lungs. He was covered in vernix! I put him skin-to-skin with his mother and waited for the placenta, which arrived in two minutes (Duncan side first): complete, healthy, with a central cord insertion. I checked to see that the fundus was firm, which it was. Korina, who was with me, tied the cord with cotton strips and then cut it after it stopped pulsing with saw grass. It was a healthy, three-vessel cord: artery-vein-artery (AVA).

On the ride back to the birth center, the sun was setting, turning the sky beautiful colors over the tall green grass and rows of cassava plantings that stretched out ahead of us. The mother was breastfeeding her child peacefully when we crossed a river. But I felt for her as we continued down that bumpy, unpaved, pot-hole filled road.

When we arrived at the birth center, she leaned on me as I carried her son for her and brought the little family to a room where they could rest together, side-by-side.

Truly, truly, I say to you,
unless a grain of wheat falls into the earth and dies,
it remains alone, but if it dies,
it bears much fruit.

~ Jesus (John 12:24)

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the beautiful baby boy
born near Okidi

Outreach

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6 August 2013

Sometimes mothers come to our birth center for their prenatal appointments – and twice a week, we go out to meet them in their parishes and villages. Yesterday, I went out with Stephanie, a certified nurse midwife, and Viola, our translator, and Viola’s baby, the beloved Maggie, to meet with more than 20 women in Palukere.

In the course of checking blood pressures, we discovered one women on the verge of preeclampsia in her first trimester of pregnancy and referred her for further care. We treated urinary tract infections (UTIs) and yeast infections. We discovered fibroids and a probable tumor. We palpated mamas’ bellies to discover the positions of babies, and we listened to their hearts. They all have strong hearts!

The process of getting medical history with the help of a translator is time-consuming but invaluable. We learned many things about these women’s lives and health, and we helped them as best as we could. I am praying that the needs of these women and their babies will continue to be met.

Beating

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On Sunday morning, a woman came to the birth center with her husband, initially asking for a prenatal appointment. She came because was bleeding, as she said, “too much.” As we asked her about what happened, it turned out her husband had been beating her and had shoved her into a chair. This tramatized her lower abdomen, and the next day, she began bleeding. A few days later, Friday, she miscarried. Two days after that, she was still bleeding heavily.

To get to the birth center, her husband rode a bicycle with her on it until the tires popped. Then they walked. Then a “boda-boda,” a motorcycle for hire, drove by and they were able to take it the rest of the way here.

Needless to say, a woman who is bleeding too heavily after a miscarriage should not be walking long distances and further straining her body.

After resting here a while, the woman had a massive post-partum hemorrhage. We treated with cytotec and transported her for further care, suspecting retained tissue in the uterus preventing it from clamping down completely. She needs surgery to remove the tissue so the uterus can close and stop her excessive bleeding.

It turned out that a family meeting was called to deal with the husband’s actions. I asked one of our translators what the family would do to the husband for what he had done: beating his wife and causing a miscarriage, which nearly led to his wife’s death from post-partum hemorrhage. She shrugged and said, “Most often they will just say, ‘Things happen.’”

Jesus said to Martha: ‘I am the resurrection and the life.
Whoever believes in me, though he die, yet shall he live,
and everyone who lives and believes in me shall never die.
Do you believe this?”

~ Jesus (John 11:25)