Babycatching!

Hello Everyone,

Today we attended our 40th Nepali birth!!! We have arrived in Bharatpur and worked four shifts at the government regional hospital, including two night shifts (7pm to 7am). We were excited for the night shifts because we thought the temperature would be cooler, but so far, they haven't been cool at all - we are forever covered with beads of sweat rolling down our faces! The staff find it quite amusing and wipe our foreheads as we suture; they are so sweet.

Yarrow with two Nursing students

We've had very good learning experiences so far, and are amazed at the strength and speed of the labouring women we've been working with. Our supervising nurses and the nursing students we're working with are lovely and excited to welcome us to the hospital.

Below are a few of our notable birth stories from our first week:

- On our first day, we saw a woman push out her third baby after only 15 minutes of labour and two pushes - a surprise birth!

The next birth was quite sad: a woman came in and the nurses were unable to hear her baby's heartbeat. She delivered a stillborn baby a few hours later, and he appeared to be anencephalic. It was our first experience with stillbirth.

The labour room

- On our second day, we attended more births. Lauren caught her first Nepali baby with one bare hand and one glove half on...there wasn't much time to prepare when the mother grunted only twice and her baby's head came out!

One of the babies that Yarrow caught was brought down to the perineum by vacuum due to an abnormal fetal heart rate. In Nepal, nurses and doctors who are trained as Skilled Birth Attendants have a wide scope of practice, so the maternity nurses at Bharatpur Hospital perform vacuum deliveries when they are needed.

- On our third day, Lauren delivered a placenta in total darkness after the power went out in the hospital.

The delivery table

She set the bowl with the placenta inside it onto the sterile delivery cart, and when the power came back on, the bowl was teetering on the edge of the cart - luckily it didn't fall on the floor!

During the births, we have been talking a lot with the students and staff about their routine birth practices. Many practices are the same as in Canada, however there are some differences: for example, episiotomies are routinely performed for first-time mothers and umbilical cords are clamped immediately after the births. Yarrow and I have been demonstrating and encouraging management of the second stage without routine episiotomy and with late cord clamping so that babies can receive their full component of blood from the placenta. We're happy that during our time at the hospital, there have been no routine episiotomies cut, and at many births the cord clamping has been performed after two minutes. We are very thankful for the receptivity of the staff toward our different practices and look forward to continuing the dialogue.

- On today's shift, Yarrow's first birth was a first-time mum who had a lovely delivery and was very happy and emotional after the arrival of her baby. It has been unusual for us to see mothers showing emotional responses after their births and interacting closely with their babies. This might be due to the high rate of neonatal mortality in Nepal. Unfortunately, after the delivery that Yarrow attended, the woman had a retained placenta which required her to go to the Operating Room to have it removed.

Lauren caught a baby after a mild shoulder dystocia with Yarrow as the second attendant - the shoulder dystocia resolved smoothly, which was a relief. The night before, Lauren had a more difficult shoulder dystocia which required several maneuvers and it was a challenge communicating with the woman (in limited Nepali) and the staff under stress. Both babies were fine, and it was a thrill to work with Yarrow through a complication. She is the best second attendant!

This morning, our last two cases were amazing "Rocket Baby" births. Yarrow was in the assessment room, where a multip had just been examined and found to be 2cm dilated. Ten minutes later, she sounded grunty and Yarrow thought she would check on her. To her big surprise, the baby's head was coming out! She threw on her gloves and caught Rocket Baby #1, a little girl of only 5 pounds, 5 ounces.

Meanwhile in the labour room, Lauren was monitoring the women in labour when a first-time mum (who had been 4cm dilated an hour before) made the tiniest grunting sound. Not

Lauren with Rocket Baby #2

expecting to see anything, Lauren checked on her and to her surprise, the woman was delivering her baby's head! Lauren got her gloves on just in time to catch Rocket Baby #2 - a tiny baby boy of 5 pounds, 1 ounce. We found it incredible that we both attended such similar and unlikely births; each of us catching babies on our own with amazing mamas birthing within fifteen minutes of each other. It was a wonderful way to end the night shift!

We spent today sleeping, reading, and relaxing in preparation for another week. Tomorrow we head back to the hospital and look forward to the surprises and learning that the next births will bring.

We hope this post finds everyone healthy and happy. Sending love to you all,

Lauren & Yarrow