4:30 12/8/10

I was leaving my office Wednesday afternoon. It was 4:30 and everyone was going home for the day. As I walked across the courtyard Julian, one of our nurses, waved me over. “Jackie, they are delivering a baby in the ER”. Now, we don’t generally do deliveries at our clinic. We are in the middle of nowhere and we prefer to have them in a facility that can do an emergence C-section or resuscitation if necessary. However, if a woman comes in and we determine that they will likely deliver before we can get them to the hospital, we let them deliver here. This particular woman had been seen at another clinic in the morning and referred to the district hospital. She came to us instead.

                I walked back to the ER to find two of our nurses surrounding the woman. It was clear that her water had broken fairly recently (ewwww). Moline looked up from the patient and said, “The cord is prolapsed and the contractions are very weak, but she is fully dilated.” Great. Why does this stuff always happen at 4:30? You see, if a loop of the umbilical cord is coming out in front of the baby, it means that the baby is going to press on it as it is being born. If the delivery goes quickly, it is not a problem, but if the baby gets stuck it compresses the cord and cuts off its circulation (which is not good). Since the contractions weren’t doing much of anything and the labor wasn’t proceeding very quickly we decided we needed to transport her. “You coming, Jackie?” “Sure, why not.”

                So, Moline and I hopped into the back of the Land Cruised/ambulance and helped the woman and her mother in. The mother’s job was to hold the IV bag. Moline and I were to monitor the patient and keep her from falling over. You see, the road to St. Camillus Hospital in Karungu is very similar to the Migori road. It winds through the hills with craters and rocks littered at short intervals. Since we didn’t want the woman to deliver on the way, we put her in the best position to slow labor. We put a mat on the floor of the vehicle and had her sit with her knees and elbows on the mat, bottom up. Think of it as a modified “downward dog” in yoga. While fairly effective at slowing labor, it is neither stable nor comfortable in a wildly bouncing vehicle.

                We began the 45 minute journey with Daniel driving faster than I’ve ever seen him drive. It was clear he did not want to have anything to do with a baby being born in the back of his ambulance. Each time the woman began contracting Moline and I checked to make sure there was not a baby imminently arriving. As the trip went on the amount of blood in the back of the car started to get concerning. “I really hope this baby is patient,” Moline whispered to me just before the IV came loose. Now, we not only had a woman in labor in the back of the car, but there was blood spattered all over the inside of the vehicle as well as running over the floor and we had to change IV bags while bouncing along at 50 kilometers per hour.

                About 15 minutes from our destination the mother yelled and a gush of blood emerged. “Daniel!!!” Moline and I cried in unison. Dan pulled the car off the road, much to the confusion of the cows standing there. We opened the back of the car, got the woman on her back, and checked again. We were still okay; no baby yet. Daniel got us back onto the road, threw on the siren, and raced to the hospital. When we arrived, Moline jumped out to grab a stretcher and I helped the mom down on to it. We got her into the room and explained the situation to the nurses there who promptly did an exam and called for an operating room. “The cord is still pulsing, but the labor seems to be obstructed. We’ll get her in right away.”

Once it was clear that the baby was still okay, Moline and I got ready to leave. The doctor stopped us as we were walking out into the hall. “What? You’re leaving?” He joked. “You don’t want to stay for the C-section?”

“Tempting,” I replied. “But I think I’ll leave that to you.”

Moline and I walked out as Daniel pulled the car up. “Where did you go?” We asked him. “To hose out the back of the car.” Ah, yes. Good plan. That will make the trip home much more pleasant.