#NurseDTakesZambia #5 #N'GombeClinicMidwives

The time is 2300 (11PM). The power is out. We have two clients in labor.  Both are first time moms. One is in active labor, one has been having contractions all day, but with no progress. One mom needs IV fluids, I offer to place an IV, but the clinic is out of IV bags and tubing. Scratch that, we improvise; we send the patient's mom and aunt to go buy some drinks that apparently helps to "safely" accelerate the labor process. We encourage her to continue walking with hope of progressing her scattered contractions into active labor.  As expecting mom #1 is pacing about in the dark waiting room, we shine our flashlights and candles on mom#2, her contractions are occurring more frequently. We do a pelvic exam,and we listen to the fetal heart rate. There are no monitors to attach the mom to, no fetal heart rate waves to examine. We use  a manual fetoscope that we place on the moms abdomen to measure the fetal heart rate. I put my ear to the fetoscope,and I hear the fetal heartbeats. Her labor has progressed, it's time to begin pushing and deliver the baby. 

The power is still out. One flashlight's battery is beginning to go. We light another candle. I make conversation with the laboring mom as she is wincing in pain. Her name is Mercy and she tells me that she thinks it is a girl. 

There is no such thing as pain medications or epidurals in this birthing ward. The women just wing it. They also pull themselves up onto the elevated bed. No machine adjusts the bed's height to convenience a body with a huge painful belly. They climb onto the beds on their own. The bed is clothed in linens that the expectant mothers bring with them. We layer the bed with plastics garbage bag that they bring from home and layer it with their "Chitenga", a traditional designed cloth that is also used as skirts, dresses, hair wraps and baby carriers. Here it is used to dress the bed that they will deliver their baby on.  We prepare the baby warmer that is not working due to the power outage, we layer it with blankets brought from home. The blankets are pink; the moms says its a girl, she feels it. 

She climbs onto the bed, and she begins to push. The nurse midwives and I don our gloves and aprons.  There are no stirrups to secure her position. I hold on one side and the midwife assist with the other. She has no family there for moral support,  so she squeezes my hand with every push. She is crowning. The midwife turns to me, "Sister Devorah, are you going to deliver this baby?". I've never delivered a baby on my own. I work on a surgical unit, the closest I had even come to caring for a newborn was handing them to the mom who was my patient. I had been spending my nights in the labor clinic in Zambia assisting with the births, and I felt hesitant but ready to accept the huge responsibility being offered to me. 

The head is out and I begin to position it and guide the shoulders. The cord is around the neck, I fumble my fingers through it and pull it over the head. The neck is free, and the rest of the baby is delivered. I place the baby on the mom, skin to skin, for kangaroo care.  I clamp and cut the cord, and I wipe the baby with towel; it cries a loud, string shrill. I hold the baby up to the mom so she can see the miracle that she just painfully but bravely delivered. It's a boy!!!

I wrap the 2.6 kg baby boy in layers of pink blankets and a pink hat. The lights turn on. The power is back. We deliver the placenta and clean the mom. She then gets up, carries her bucket of belongings and sets herself up in the postpartum room. As she rests in bed, sheltered by her mosquito net, we hand her the baby. Not one crib exists in the postpartum room, babies all sleep with the moms in the same bed. Most mothers stay in the postpartum room for six hours until they are discharged. Since it is late at night this mom will stay till the morning. 

With mom and baby #1 delivered, we reassess the progress on mom #1. It has been 4 hours since her last exam and a total of 16 hours that she was admitted. We write a referral and call an ambulance to take her to the hospital. An hour later the the ambulance shows up, we jump on board and escort the mom to the hospital. No seat belt and no stretcher, we all pack into the back and begin the bumpy 10 minute yet seemingly endless journey across unpaved dark roads to the hospital. We grab a rickety old wheelchair and bring the mom to labor ward in the hospital. There we give handoff and the hospital nurse take over. We say goodbye and head out to take the ambulance back to the clinic. I peek into the  postpartum hospital rooms. There are 9 beds per room, no curtains to generate privacy, and some mattresses on the floor due to patient overload. On our way out we grab some IV bags, tubing and some other minor yet necessary equipment lacking at the clinic. We get back to the clinic just as another mom, who had come in while myself and one of the midwives were at the hospital. She is ready to deliver her baby. We don our gloves and aprons and get to work. Another miracle is born; this one is a girl. After that mom is settled under the mosquito net with her baby, we get one more admission in early stages of labor. We do our assessment and settle her in. 

It's nearly 0500 (5AM). The midwives of G'Nombe Clinic jump into their on-call beds just as the sun is beginning to rise, for a quick nap.  Soon the roosters are croaking their morning songs. The sun is beating strongly. Patients begin to flood the lines of G'Nombe Clinic, and new day has begun in the little compound in Zambia, Africa.