A most considerate infant.

I was helping Ate Car do a health teaching presentation for some women in their third trimester when a woman came in to the clinic and sat down close by. She seemed rather restless, and she kept shifting her weight from side to side of the chair. Finally Ate Car asked her, "Are you here for the teaching, or are you in labor?"

Yep, she was in labor.

We brought her inside and to do an internal exam. It was about 10:30 by this time and I was supposed to be meeting Ate Rhonda for lunch at noon. So I texted her and told her I was so sorry, but I couldn't make it, there was a labor.

She was 7 cms. She really seemed to be quite active though, so we brought her upstairs to the delivery room. Her younger sister was attending her. This mum was so funny. She suddenly was starving and wanted food. Her little sister would spoon a mouthful in and as soon as it was in her mouth, she asked for the next one. She had a baby to deliver, she needed food!

About 10 minutes later, we transfered her to the delivery bed. She was 10 cms, ready to push! I pulled on some gloves, she pushed, and I cought her baby. Just like that. It wasn't even 11 am yet.

So I texted Ate Rhonda. And we met for lunch after all. How awfully considerate of that baby to accomodate my lunch arrangements!

Please Don't Leave Me!

As soon as I squatted beside her low bed, she grabbed my arm and clutched it with an iron grip. Tears were streaming down her face. All at once a contraction hit her with the force of a hurricane. Her whole body quivered like a trembling aspen tree. She held her breath and pushed.
"Ayaw, ayaw!" I gasped, horrified. She was still only 8cms dilated, and if she pushed now, she could do herself some serious damage. I told her to look at me and breathe with me. She adjusted her hand so our fingers were locked together and grabbed my other hand as I tried to steady her with my arm. Slowly, we made it through the contraction. She closed her eyes and she looked like she was sleeping, but she was softly and frantically rubbing my hand with her thumb.

...

She had flitted into the clinic about nine in the morning, in her strapless orange sundress and her hair in a high ponytail on the top of her head. She was cute as a button, 19 years old, and this was her third pregnancy. I had a feeling she would go quickly. But I was busy that morning and I didn't see her again until she waddled into the delivery room a few hours after being admitted. She was crying, and moaning in pain. She laid down on the bed and rolled back and forth, writhing. Her partner follwed her into the room. He looked just as young as she did, was super skinny and looked like he'd just watched a horror movie. He was holding up the IV tubing with two fingers, standing out of sight at the head of the bed, and shifting from one foot to the other. Poor guy, he needed just as much help as she did. But as soon as I knelt down beside her, I forgot all about everybody else.

...

Soon I could sense the next contraction coming. It hit with equal power. Once again, I did everything I could think of to keep her from pushing. I felt as if it took all my energy, and I couldn't imagine how much it took from her.  My knees began to ache from kneeling on the hard floor, and my feet were completely asleep, but I didn't want to move. I kept talking to her, urging her, rebuking her, comforting her, commending her. This went on for several minutes, the gripping contractions, the sudden calm, then the storm again. It was in the calm after one awful contraction I heard her saying something in English, but I didn't catch what it was. I bent closer to her, so I was only inches away from her. "Unsa?" I asked.

She pulled me even closer, and tightened her grip on me. "Please don't leave me," she said, the tears dripping down the side of her face.

"I won't. I promise," I told her, and I honestly don't think there is anything that could have torn me away.

After what seemed like hours, but was really more like 30 minutes, an internal exam showed she was fully dilated, ready to push. But another woman was pushing on the delivery table at that exact moment, so she would just have to give birth on the cot.  Ate Sheila asked me if I'd like to catch the baby, and of course I said yes.

Somehow this delivery was so much more emotional than usual. I don't think I've ever felt that needed by someone during their labor.  I really felt like we'd be fighting in a war, and the birth of her baby was our victory. I knelt with one knee on the low cot, balancing myself with one foot on the floor. I felt the baby's hard head with it's soft hair, as it steadily moved closer and closer towards me. She didn't have to push for long. Once the head was out, the baby girl almost slid out right out. She was a healthy pink color and cried right away. "Oh thank you, thank you, thank you, thank you!" her mother cried, over and over again. I couldn't help getting teary too.

Things got a bit tricky once the placenta was delivered. Because her labor had progressed so quickly she started hemorrhaging. There was a very tense few minutes, the baby almost forgotten as we consentrated on keeping her from bleeding to death. It was scary, very scary. I ran out of options right away, and told Ate Sheila to swap me spots. I ran back and forth getting gauze and other materials, asking someone to take blood pressure, praying. The euphoria of birth can turn so quickly to horror. But thanks to God and the skill and quick-thinking of Ate Sheila, the bleeding was eventually stopped before the situation became emergent. 


Some time later, when everything was cleaned up and our patient was sitting up, I came and sat beside her on her bed. I held her baby on my knees and we admired her together.

"She's so beautiful," I told her.

"Thank you," she said, smiling at me with glistening eyes. 

I Caught a Baby!

The guard woke me up at 10:30 pm. The primie mama had come in at 9:30 only 6cms dilated, but at 10:30 she seemed to have transitioned, so an internal exam was performed and it showed she was 10 cms and ready to push! I arrived a bit breathless as always, but quickly gravitated to the side of the patient. She was very young, probably younger than me, and she smiled when I introduced myself. All at once a contraction hit her and she grasped my arm and squeezed tightly.

"Ginhawa!" the midwives urged, "Breathe!" The woman squirmed around on the delivery bed. I knew she would just wear herself out this way, she needed to push straight down.
"Ate," I said quietly, and she looked up at me, and deep down into my soul. I didn't say anything else, just held her gaze an took deep exaggerated breaths. She breathed with me, and for a few moments it seemed as if the delivery room, the midwives, and everything else dissipated away, and it was just her and me, breathing, breathing. Moments later, everything flew back into focus. She was really pushing now.

"Anna," said Ate Rose, "do you want to catch the baby?"
"Yes!!!!!!!!!!!!!!!!!!!!!!"
I pulled on a set of sterile gloves and stood beside Ate Rose, and watched the head slowly move down, and then back, down and back up. But gradually, it began to move back less and forward more. Ate Rose performed an episiotomy, and quickly the head moved downwards. Ate Rose and I cupped our hands around it as the head and face suddenly were out!  With hardly any effort, we pulled the rest of the baby out. It was a baby boy, so slippery and pink and beautiful. At once, he let out a lusty cry, letting the world know he was alive.

At that moment, I had the sensation, not that this was something I had been waiting all month to do, or even a long time to do. I felt like this was something I had been waiting for all my life.

Recipe for Mango Float

Seriously, if I were you, I would literally drop what I was doing and go make this thing. If it wasn't cliche to say it tasted like heaven, I would say that it tasted like heaven. Cause it really does.

What you need to get:
Mangoes (But I bet you could use strawberries or something like that too)
Graham crackers
Condensed milk
Cream.

What you need to do:
Mix up the condensed milk and cream....maybe 1 can of condensed milk to 2 creams, otherwise it's a bit sweet (as we discovered).
Put a layer of graham crackers in the bottom of a pan. Pour the milk and cream mixture on top. I am going to call it "the mixture" from now on to make it easier.
Use a spoon to scrape thin slices of mango. Then lay the slices on top of the graham cracker layer.
Put another layer of graham crackers, and pour on the mixture.
Put another layer of mango.
One last layer of graham crackers (you can crush it if you like).
Pour the rest of the mixture on top.
Put in the freezer of fridge depending if you like it soggy or frozen.

I am not even going to describe how divine this is because if for some reason you aren't able to make it, you would feel so disappointed I would feel guilty for describing it to you.

Amber and I made this on Monday as a thank you for all the staff for all they have done for us. And yes, I am still here in Cebu until July 4th, but Amber headed home for Canada on Monday night. I am trying not to be sentimental but honestly I was slightly heart-broken when Amber left. It's just not the same without her, but I am grateful for loving staff who make me feel like I'm part of a big family.  I am also grateful for TONS of work to keep me busy! I am certainly trying to make up for lost time this week. I have been working all three shifts everyday, and just taking breaks now and then. It's just heaven. Like mango float. Same same. 

Attempts at Communication in Carbon Market.

We both had the day off, so Amber and I decided the best thing to do was to hop on a random jeepney, see where it took us, and get off when it looked interesting.

Whether it was truly the most interesting or not we will never know because as soon as we saw Carbon market, we just couldn't help stopping. We decided just for fun we would see how far we could get without speaking English. Our private conversation went something like this:

Anna: (attempting to say) "Do you enjoy eating green mangoes?"

Amber: "Do I want to play with the mangoes? Do I want to join in with... the... mangoes?  Do I want to be a mango? What are you trying to tell me???"

Remarkably, our shopping actually went quite smoothly. We bought a pair of shoes, 3 pair of socks, a handtowel, another pair of shoes, a dress at an OkiOki (second hand) store for $2.00, and 6 apples, in Cebuano. 

Regardless of our lapses in recall, I have to admit, it is an unbelievably thrilling feeling when people stop trying to speak English to you. And when you really understand everything they are saying to you, and when they really understand you. At least usually.

As we strolled along, I suddenly had a recollection that the ocean was somewhere nearby. So we asked a lady selling vegetables where the ocean was. She didn't understand. So we showed her front crawl, and various other swimming strokes to the vast amusement of everyone within eyeshot. "Oh!!! Sa dagAT!" and they pointed down the street and to the right. We followed their directions and when we turned the corner we could tell we were getting somewhere because the street seemed to end a few hundred meters away.

As we got closer, tiny wisps of suspicion began to float through our minds. Where was the fresh sea breeze, and where the wailing of gulls and the scent of sea weed? There was a scent alright, but it wasn't sea weed. The road ended just up ahead. We came up to the embankment and looked over.

It was rectangular in size, although the edge was not well defined. The water was brown and had floating plastic bags, styrofoam wrappings, banana peels, crates, and a great deal of greenish scum floating on it.  And there was a man peeing in it.

I think we almost died of inadequate air supply related to gut-wrenching laughter while we sped away in the opposite direction. I couldn't help but wonder what the vegetable ladies were expecting us to do in the "ocean."

And....the Baby's Out.

In my dream, the person I was talking with was starting to annoy me. They were rapping their knuckles on the table over and over. They just kept on drumming away incessantly, all the while pretending to be listening attentively to my story. I was just about to tell them how annoying this was when I woke up. Knocking. Somebody was really knocking. Knocking... means...AHHH! I flew out of bed, tripping over the garbage and getting stuck in my sheets. I swung open our door and was blinded by the small hall-way light. Somebody was saying "there's a labour."
"Ah, kuya Niox, Salamat kuya. Pila ka cms na? Wala pa?"
Ok, so she like JUST got here. I woke Amber up and we raced to the bathroom, and literally 2 minutes from the time we woke up, we were flying down the stairs and were at the clinic. As we entered the gate, we heard the shrill, high-pitched, distinct and unquestionable cry of a newborn.
Screeching to a halt, we just stood there. Then we rolled our eyes, trudged upstairs and confirmed what we knew was true. Yep, baby out, and we missed the whole thing.

So we went back down and sat with Kuya Niox on the bench on the street in the warm darkness and lamented our bad luck. We asked Kuya Niox how long the patient had been at the clinic, and he said he literally ran to get us the moment he had informed the midwives that the patient had come. She'd come in fully dilated and as soon as she got upstairs, she pushed once, and the baby was out. Golly.

The night before, a patient had come in at 2 am and was only 4 cms dilated, but because she lived far away, the midwives let her stay downstairs. At 2:20 am, the husband was knocking on the midwives' door in a frantic and persistent way, and 2 minutes after that, the baby was out. OUT! Yep, we didn't make it for that one either.

Amber and I came up with several ideas for how to avoid missing births in the future, including sleeping in our scrubs; giving the guards different strategies for noisemaking devices to wake us up if unresponsive to knocking; sleeping in the clinic; sleeping in the delivery room; and, as last resort, sleeping on the delivery table.

I honestly don't know how Hilary didn't miss a single birth for what was it....the first 750 births or something? Dave, her husband, said if you try to wake her up by talking to her, shaking her, etc...it is ineffective, but if you whisper "labor...10 cms"in her ear, she is up and out of the room by the time you're done saying it. Maybe I can train my subconscious mind to associate knocking with labour.

Practice on Pork makes Perfect on Perineums.

I squinted, blinked, took a deep breath and then tried again. The slice of raw pork on my plate slipped again under the needle which came out on the other side in entirely the wrong spot. Arg. If that hunk of  pig on my plate had been alive it would have been crossing it's arms and sticking out its tongue at me. But honestly, I wondered, how on earth are you supposed to do this on a real live PERSON???

Hilary, the clinic manager was doing a little workshop on suturing, so I decided to to join in. I learned so many interesting facts, techniques, and strategies. Suturing is really ridiculously difficult to get right. And when it comes to a perineum, it is quite a job, I can say that for sure. I have seen quite a few suturing jobs now, and before they start I always wonder how on EARTH they are going to manage it. The repair process is so interesting. You have to start with the very deepest layer, top to bottom, then the next superficial layer, bottom to top, and then the skin is very last, top to bottom. But the thing is, you can plan all you like but every single tear is different, and you really just have to be awfully creative. And the problem with practice makes perfect is that this is a women's body we're talking about here.

Thus, the pork.

I actually stitched up a banana first. That was pretty fun. I was rather impressed with my neat row of stitches, but apparently they were too close together. I'm beginning to think a short jaunt to sewing school might be a good step on the path to midwifery.

Oh by the way, if you are a young and terrified girl reading this, don't despair, please be assured you might never need suturing, and if you do, it will probably only be once. And even then, you get a baby out of the deal. So don't worry. Honestly.

This was Saturday, my first day back. I also attended a seminar by the clinic's OB doctor about management of labour (fascinating!!), and went to another dumpsite. Great day back in the clinic. Thanks God for health at last!!!