2 Aug 2023

I flipped through the little portable health record booklet, or carnet, that the nursing student had just handed me for the patient who had just walked into the delivery room and was lying quietly on her side on a delivery table. I read the summary from the referring hospital. Patient refuses emergency c section. First pregnancy. Completely dilated since 11 pm last night? We listened to the baby’s heartbeat through a contraction. Normal. I examined her and smiled. This wasn’t going to be an emergency c section. She was so close to delivery! We pushed with her, which did take longer than it usually does for the average patient who has already delivered multiple babies, but she hadn’t delivered before. This was her first pregnancy, and she was advancing normally with each push. Her contractions were short and a bit far between though. We started oxytocin dripping slowly into her IV catheter on her forearm to increase the strength and length and frequency of her contractions. She started feeling more pressure, and convinced that she was about to have a bowel movement, insisted on squatting over a bedpan. I was sure for a few minutes that she was going to deliver into the bedpan. She eventually realized that the pressure she felt was just the baby’s head pressing down in her pelvis and climbed back onto the delivery bed. After more pushing and coaching in French and Arabic and occasionally some English and Nangjere thrown in by accident, with many skeptical looks from her and smirks at my limited Arabic, she gradually progressed and delivered a baby girl. We breathed for the baby with a bag valve mask until her breathing became more regular and her lips turned pink. She didn’t cry much though. After the placenta delivered, the uterus didn’t contract. We gave the oxytocin rapidly now through the IV. We thought maybe since she’d already been on oxytocin she wasn’t responding to it as readily. The nursing student injected Methergine into the patient’s thigh, which also should help contract the uterus and stop the bleeding. The uterus was still floppy and bleeding. No more placental membranes inside—it was easy to sweep since it was so floppy and not contracted. No bleeding tears. The nursing student from the operating room came into labor and delivery. "They’re ready for you in the operating room. The spinal for the c section is already in." Another patient had already been prepped for c section before we knew that this patient was going to need this much intervention. I placed a Bakri balloon (like a water balloon with a tube attached) into the uterus, and our OR nurse Abouna who was waiting for me to join him for the c section helped inflate the balloon to 300 ml with water. The pressure from the inflated balloon pressed on the inside of her uterus and stopped the bleeding. We packed some compresses then in front of the balloon for the lower part of the uterus, gave instructions to the labor and delivery nurse, and hurried to the operating room. In the meantime the grand multiparous patient (eleventh pregnancy) on the other side of the delivery room—who had been wailing and saying she was going to die and that we also needed to take HER to the operating room right away—delivered normally without complication. But not without a lot of yelling and wailing. The primiparous patient and her family were judging her. "How could she cry like that?" "So embarrassing." "We learn at a young age not to cry out like that."

The next day on rounds, the baby of our young, stoic, primiparous patient was no longer so stoic herself. Rather than breastfeeding, she wailed and refused to latch. The exasperated family declared, "the baby doesn’t want to eat." They also informed me that they were naming her after me. The nurse helped explain how to pronounce my name. Thankfully they were Arabic speaking patients who seem to have less trouble with my name than some of the other local dialects that don’t usually include this particular combination of sounds together. Baby Staci was loud and angry, not having breastfeed much at all since birth. I worked with the mom and baby for a long time, helping her latch and encouraging the mom to teach the baby and have some patience for both of them in learning what can be a challenging process. She gave me the same skeptical smirks that she did while I coached her through pushing during her delivery. She still didn’t seem to believe that I had any clue what I was talking about. Finally, the baby calmed down and figured out how to latch and suck. After a couple of days of observation with no more hemorrhage for mom, baby Staci learned to breastfeed on her own and went home. Some of my most challenging (and even skeptical) patients seem to be the ones who end up naming their babies Staci!