26 March 2020

Upside down. Also, stunned, knocked down, bowled over. This just seems like a great word for this month. The world has been stunned, turned upside down, bowled over. Even the babies are coming out upside down lately.

One of our student missionaries walked into the labor and delivery ward and announced, "I need the orders. Did you sign them?"
I glanced back over my shoulder, my hands still on the hips of a baby that was in the process of backing her way out of her mom. "What? Orders? Why?" I knew that our student missionaries were scrambling to get out of Béré to N'djamena where the U.S. embassy had been working for days on arranging a flight out for U.S. citizens. They had sent emails saying to be ready, have your bags packed, and watch for further updates. This morning the email had arrived: flight tomorrow. The usual trip to the capital is a motorcycle taxi 1.5-2.5 hours to the nearest city with bus service, then a 8-12 hour bus ride to the capital. But there is no bus service now, and taxis are afraid of foreigners. One of our missionary nurses tried to catch a taxi this week. The other passengers fled, panicked, accusing, "NASARA! YOU bring us the VIRUS!" Losing all of his customers didn't make the taxi driver too happy.
Fortunately for our student missionaries, another missionary had offered his car and driver to take them to N'djamena. They just had to pack everything and leave within the hour to try to reach the capital at a decent time and be ready when the embassy signaled it was time to get to the plane. The hospital administrator had printed forms stating the reason for their travel so that if they were stopped on the road they would be allowed to travel on. He had left a place for my signature, and now Miranda was in labor and delivery waiting for my signature.
Another contraction arrived. I told the mom to push. More of the baby's back came into view, I slid my hand up past the baby's right shoulder, found the right arm, swept it across the baby's chest and out. I started to repeat the process on the other side, but as I guided the upper arm down, the rest of the head started to come out, too. Immediately the whole baby was out and already crying. Perfect.
"That was the most awesome thing ever! I've never seen that before!"
"Well, good thing you made it to labor and delivery now and got to see one breech delivery before you left!"

It wasn't the first breech delivery of the day. This round-headed crying baby joined her twin brother, who had also delivered breech. These weren't the first breech-breech twins this month either.

Andrew happened to be on the maternity ward to visit a baby with spina bifida when a breech twin started to deliver. Andrew is a general surgeon who has also completed a pediatric colorectal fellowship. Danae is teaching him gynecology, and we're teaching him some obstetrics, too, just in case I get incapacitating COVID or cerebral malaria or rabies or something terrible, or just completely burn out and run away to join one of the camel-herding tribes.
"Hey, do you want to do a breech delivery? It's twins so we can run through the steps with the first one, and the second one is supposed to be breech also."
"Sure!" Andrew, always enthusiastic, joined in the delivery and we talked through each step as the first twin easily came out breech. I found the foot of the second twin in the second amniotic sac, which wasn't yet broken. Andrew felt the sac also and felt like he could identify the foot. I broke her water while gripping the foot and the second baby advanced down footling breech, and the mom started to push her out. This baby was bigger. I was going to let Andrew try this one, but then realized there was less space for his larger hand with this larger baby. Then we found that the head wasn't just sliding out easily with a bit of flexion as the first twin had. Andrew gave suprapubic pressure instead, and the head delivered. With a bit of stimulation, both babies were soon crying, and we congratulated the mom on two healthy babies--one boy and one girl.

Upside down and backwards month!