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L’accouchement: Éclampsie by Esther Barry (Author of the Month)

 


In the morning before the heat set in, I stopped by Maternity to see if I could be of any help with check-ups or deliveries. Maman Lilliane was working that day and it was pretty slow – there was only one lady in labor at the time. Maman Lilliane is a short and fat lady with a hot temper. She looks and sounds angry most of the time. Although I wished it was one of the other nurses on duty, I am not afraid of her moods so I asked her if I could stay and deliver the baby and she said I could. The woman in Maternity was laboring on the delivery bed with the broken footrest. The other one is empty. Why does she not lay on it?

I prepared the baby’s things – knitted sweater, pants, hat and booties, blanket and I checked the betadine jar to make sure there was string to tie the cord. We use thick sutures, or the cuffs of gloves soaked in betadine because cord clamps are scarce. Maman Lilliane seemed to think that the woman was nearing delivery, so she wanted me to put on sterile gloves. She insisted that I wear the elbow length ones and whispered to me, “Azali na makila mabe” “She has bad blood”. For some reason she only had me put on one of the long gloves which I thought was odd. The room was becoming stuffy and the smells of body odor, blood, and floor cleaner blended together.

As we stood there watching the woman toss and turn on the bed, moaning quietly, Maman Lilliane had a sense something wasn’t right. These Congolese nurses can usually sense things that aren’t apparent. They can sense when the mother is about to deliver without her saying anything. They just know. She checked how far along the woman was and pulled away a bloodied glove. She showed me her glove and asked me if it was normal for blood to come out before the delivery. I said I didn’t think it was, but I didn’t know. Why is this woman asking me? She is the one who should know, right? What am I supposed to do? I was starting to get nervous. While we were discussing the situation, the woman on the bed called out saying she felt dizzy. Maman Lilliane told me to go get the nursing supervisor immediately. He is the one who is always called for difficult deliveries.

I left quickly to go look for him. He could be anywhere. Where should I begin? It was still early so I hoped he would still be on rounds so I wouldn’t have to go all the way to Administration. How much time do I have before things get serious? I had no idea why Maman Lilliane needed help. Nothing seemed wrong to me.

Thankfully I didn’t have to go far. He was still doing rounds and hadn’t left Suite De Couche. Relief! That was the first place I looked since it was the closest. I told him Maman Lilliane wanted him to come right away. I made my voice sound as urgent as I could, so he came immediately. I was sweating by this time and my arm was soaked underneath the elbow length glove. He laughed at my gloved arm and I told him that Maman Lilliane made me put it on. When we got back, the woman was obviously becoming more agitated and kept saying she felt dizzy. The nursing supervisor, Papa Urbain was not impressed with what Maman Lilliane had done for the situation. He asked why the woman was in the broken bed and wanted us to move her. She couldn’t walk so the three of us picked her up and heaved her over to the remaining delivery bed. Papa Urbain asked Maman Lilliane what her blood pressure was but she said she hadn’t gotten one. Why hadn’t I thought of that? I quickly took the woman’s blood pressure. It was 20/11 (200/110)!

Papa Urbain demanded somebody start an IV as he quickly began to prepare the necessary medications. Maman Lilliane gathered the supplies but was moving so slowly that I took the stuff from her and started the IV myself. I had started many IV but it had been a while and never had I needed to do it in an emergency. I didn’t let myself think but just went through the motions I knew so I felt no nervousness and my hand was steady. Papa Urbain said that Maman Lilliane would deliver the baby. He kept talking to the woman asking her how she was feeling. As the seconds past she become more and more unresponsive. And then everything happened so fast…I got the IV in first try. I was very thankful because there wasn’t time to waste. Papa Urbain quickly connected the IV tubing as soon as the IV was in and started a magnesium drip and gave a D5W bolus in a syringe. I didn’t even have time tape the IV in place because the woman began to seize so I just clamped my hand to her flailing arm over the IV. I’m not letting this come out! I tried to keep her arm still as I pushed my body up against hers so she wouldn’t fall off the bed. The sweat from her body soaked through my shirt. Between the woman’s seizing body and Maman Lilliane’s rough pulling, the baby was delivered. Maman Lilliane flipped the wet baby onto the belly of the now still and sweaty woman. Thank goodness the baby is out!

I continued to hold the IV in place with my left hand and reached over to secure the limp baby against the mother with my right hand. Papa Urbain began suctioning the infant’s mouth with a bulb syringe and Maman Lilliane clamped the cord with forceps. I rubbed the baby’s chest as Papa Urbain continued to suction the nose and mouth until the baby began to cry. Thank you God! The baby is alive. Papa Urbain looked at us and with relief in his voice said, “Mosala malamu!” “Good job!.”

Maman Lilliane removed the baby from the mother belly because she was too weak to hold the child. I securely tapped the IV and took the baby from her. I continued to dry the baby’s head and body and then I tied the cord, removed the metal forceps, and dribbled alcohol over the stump. After weighing the baby, I folded the cloth diaper over her little bottom and dressed her in the knitted outfit the mother had brought and wrapped her in the many warm blankets the family had provided. I love being the first person to dress an new little life. This beautiful baby girl. Your mama worked hard for your life. The baby began to scream so I took her to her mother to nurse. The woman was tired and weak, so I helped hold the child as she sucked from her mother’s breast.

 

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