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

The Great Himalayan Trek!

We're back in Kathmandu: achey-muscled and crisped by the sun, but very happy and relaxed. Yarrow and I are sitting in the courtyard of our guest house eating banana pancakes and eggs on toast, being assaulted by the clamor of the city - quite the change after having been in the wilderness for eight days!

On May 14th before leaving for the trek, Yarrow and I delivered a presentation on management of second stage and routine episiotomy to approximately 20 Skilled Birth Attendants. It was very well received, and we were even asked to travel to Pokhara to present to the birth attendants there! We'll see if we end up having time...

The next day, we got up bright and early at 4:30 a.m. to start our bus journey to the trailhead near Syabrubesi (Shyafru bensi in Nepali). The bus ride was long, grueling, and colourful. The bus was overflowing with passengers, bags, sacks of rice, and animals inside and piled on the roof. We had three very curious goats nosing our laps for the better part of the trip, until they were loaded onto the roof by their horns. After nine hours in a Gravol-induced haze, we got off on the side of the road and hiked three hours up the trail to our first night's destination.

Sights included green valleys and lush terraced rice paddies. In the morning I woke up to Yarrow saying, "Oh my gosh, Lauren, wake up!! Look out the window.." This was our view:













Day 2 was long - about 18km, 8 hours, and lots of climbing up and down. The high point (literally) was reaching this lookout:
















After a refreshing lunch by the Langtang river, we ascended to 2900m, where we spent the night at the Hotel Lama. We were exhausted after the big day and slept well.












On Day 3, we hiked to Langtang village, which is at 3400m. The Langtang Region borders China and we could see a strong Tibetan influence in the culture and dress of the local people. It was another day of hard work! Thankfully, we saw lots of exciting things on our way. Probably the best was when we walked through Baby Yak Country. We affectionately named them Yaklets and I made Yarrow pose with one.















Below are some photos from the rest of the day.























































Day 4: On day four we enjoyed a short hike to Kanjing Gomba, the last village on our trek at 3800m. We were thankful for the short (3hr) hike as we were all beginning to feel the effects of the altitude and needed the afternoon to acclimatize. Along the way, we were approached by a man asking for help because he had a very infected and painful sore on his finger. We broke out our first aid kit and after treating him, a group of locals surrounded us, one by one explaining their aches and pains and hoping that we could help them. We did our best giving out Immodium and Ibuprofen, and had fun meeting the colourful group. Once we arrived in Kanjing Gomba, we had a quiet afternoon reading our books and exploring the village. We visited a yak cheese factory and tasting the goods right off the line, and also visited the monestary and stupa. Below are a few photos of our day.































































Day 5 was the highlight of the trip - and the most physically & mentally challenging day. We got up at 4:30am, ate our chapatis and set out for the Summit Day. Our destination was the peak of Chherkari, elevation 5000m. Lauren was already suffering from altitude sickness and felt extremely nauseous for the entire climb. We all felt increasingly short of breath, and became each others' "climbing doulas" as we step-step-breathe-breathe-breathed our way to the top. It was a grueling climb, but when we reached the peak five hours later, the view and sense of accomplishment were worth every painful step. The feeling of being over 16,000ft was exhilarating! Some of the mountains visible in the photos formed the border between Nepal and Tibet.




































































































The trudge down was equally as painful, as our knees gave out in protest. When we got back to the tea house, we celebrated with fresh soup made from nettles that our porter Kumar gathered from the mountain. We slept like rocks and spent the next two days working our way back to our starting point. We'll leave you with a few photos from our hike back, and end this epic blog post.

We're travelling to Bharatpur tomorrow to begin a four-week placement at the Chitwan Regional Hospital. Bharatpur is closer to India and is much hotter than Kathmandu (oh no!). Keep your eyes open for another blog post about our baby-catching there soon!

Heaps of love and hugs to everyone,
L & Y

Births, Boudhanath, and Busy Kathmandu

Yarrow and I spent our last day at the Maternity Hospital in Thapathali, Kathmandu on May 12th. It was another busy one! In all, we attended 24 births in four days.

The pace on the maternity ward is very different from the pace at home. It didn't feel busy all the time (Yarrow and I did squeeze in a few Sudoku puzzles in between births), but just when we would call it "quiet", there would be a wave of births that would happen - babies would come one after the other. Luckily, no births happened at the exact same moment so we were able to witness them all!

There were moments that were amazing, nerve-wracking, or sad:
- A primip (first-time mum) whose active labour was only 35 minutes - from four centimeters dilation until the birth!
- A woman whose cervix prolapsed after the birth and who developed a hematoma which sent her to the operating room.
- After a birth, an umbilical cord snapped as the nurse attempted to deliver the placenta, leaving it trapped inside. Despite many painful attempts to remove the placenta in the delivery room, the mother had to be taken to the operating room to have it removed under general anaesthesia.
- A stillborn baby, delivered while we were not there the night before, being collected by the family in the morning.
- 11 episiotomies, many of which were given prior to crowning and without local anaesthetic.
- A beautiful birth when a second time mum progressed from 4cm to full dilation in only 45 minutes - suddenly she was pushing out her intact bag of waters! The nurse ruptured the membranes with all of us shielding our eyes from getting splashed. In a moment, her baby's head was born and she delivered her son in another push. Her entire labour took 50 minutes. She had lost her previous baby, so it was wonderful to witness her safe and healthy birth.

Our time at the Maternity Hospital was full of learning and teaching. We think it has prepared us well for what is ahead in Bharatpur and are excited to catch some Nepalese babies soon! Now it is time for us to enjoy a week off and take in another part of Nepal.

Tomorrow we are leaving for an 8 day trek through the Langtang region. We will take lots of pictures and update our blog with our adventures upon our return.

Today Lauren and I are presenting at a midwifery Continuing Medical Education day at the university teaching hospital. We have prepared a presentation on "Management of the Second Stage of Labour: an evidence based approach". We will be talking about routine vs restricted use of episiotomies, pushing positions, and perineal support. We hope to have some good interaction with the 15 skilled birth attendent participants.

We will leave you with a few photos of our trip to Boudhanath Stupa, one of the largest Buddist temples in the world and a World Heritage Site. It is known in Kathmandu as "Stupa", and we spent the afternoon there yesterday. It was a beautiful mix of colour, ringing of bells, prayer flags flying in the wind, monks circling the temple and children laughing and playing in the square. Overall it was one of the highlights of our sightseeing so far.

Much love,
Yarrow & Lauren

7 Girls, 4 Boys

Good morning,

We have spent the past two days at the Thapathali Maternity Hospital in Kathmandu and finally got to see some births!!

The Maternity & Women's Hospital is the only specific government run maternity and gynae care hospital in Nepal (think BC Women's and Childrens). They have about 60-80 births a day there between their two labour wards - in the past 24 hrs (two 6 hr shifts) we have been at 11 births! We are only observing at this hospital for 4 days, but are learning a lot by watching and talking with the staff. The labour ward we are on is run by nurses who have skilled birth attendent training (SBA's) and they do all the births. Women are sent to the ward once they are in active labour. Most are first time moms, yet all the births take only 3-4hrs from 4cms dilation to delivery! We are working on our Nepali so we an speak with the women and find out their secret :)

We just wanted to share few pictures with you before we head out the door for our third day. We will do a more detailed post soon!

Love,
Yarrow & Lauren






Us on the labour ward - there are beds in each cubicle.











A proud mama cuddling with her bundled baby.















A beautiful new baby girl, waiting to be weighed.

Hindu monk in Durbar Square

Yarrow and I have had a wonderful few days exploring Kathmandu and letting it sink in that we really are in Nepal. There are two items of good news: the strike has ended (for now!) and we have a new placement at the Maternity Hospital in Tapathali starting tomorrow. We are excited to start there, as it is a busy hospital and we were given permission to observe births for four days.

We have a backlog of photos to share! The first few are from Durbar Square, which is a beautiful and ancient Buddhist holy site very near our guest house in Kathmandu.




















































This photo was taken on the last day of the Maoist strike (May 7th). You can see the Nepali police in the bottom right. The actual protests were much larger, hugely crowded, and lined with riot police. It would have been crazy to take photos of those, but there are some in the news.













This is an antenatal checkup bed in the APS Kendra Birth Centre, which we toured today. They offer ante/intra/postpartum care, comprehensive abortion care, and family planning (including copper IUD & Norplant insertion). The centre is the first of its kind in Nepal, and the people involved in it are passionate about providing accessible, quality health care to women.













After visiting the birth centre, Yarrow, Matthew and I went to the Monkey Temple (Swayambunath) in the evening. It was gorgeous. There are 365 steps up to the temple, and along the way are many little monkeys, playing in the trees and swinging on the prayer flags. We were so happy to be there.




















































Sorry these are sideways! Can't be helped.






















Yarrow and I will update after our hospital experience tomorrow. Especially today (Mother's day), we both send all our love to our mothers and grandmothers. We are so thankful for your support and unconditional mother-love, which keep us going every day.
- Lauren

OUR FIRST FEW DAYS

On May 3rd we had our first day of placement at the Kathmandu Model Hospital.

Our day began with a half and hour walk to the hospital through crowds of peaceful protesters. People are friendly and respectful to us on the streets, and despite the tense political environment, we feel safe.

Our first stop in the hospital was to receive our official ID badges. After, we were given a tour of the maternity floor by one of the supervising nurses. Due to the strike, there are very few maternity cases as women are unable to get transportation into the hospital.














Yarrow & Lauren at the Model Hospital before our first shift

The Labour and Delivery unit and nursery were empty. There was one postpartum mom and a several gyne cases in the postpartum area. We were warmly welcomed by the nurses who loved our white uniforms (theirs are blue), especially our work clogs. We spent the rest of the shift looking through patient charts and sitting at the nursing station. We were interested to see that all the charting is done in English. Apparently all the nurses are educated in English as well. Unfortunately we were not able to be involved in any cases that day, as there were none.

The one hiccup of the day was that it was Lauren's turn to be sick. After going quite pale and sweaty while sitting at the nursing station, she welcomed up her morning mango smoothie. Our first taste of Nepal GI tract upset! Lauren is feeling much better although still a little feverish.

Today and yesterday were similar - after colourful morning walks we arrived to empty wards. The nurses are lovely and are interested in hearing about midwifery in Canada. We are also learning about maternity care policies in Nepal. We have been able to observe some dressing changes & staple removals, participate in patient rounds, and observe a few antenatal checkups in the Outpatient Department.

Yesterday, the Director of the Midwifery Society of Nepal picked us up from the hospital and took us on a very interesting walk through the city. She welcomed us into her home for a spectacular Nepali meal. Then she took us to her sister's house where we were fed even more delicious food. We met both of their families and were overwhelmed by their generosity. We could barely walk home because we were so full!

Tomorrow we hope to be able to start at a different hospital, which is higher volume and exclusively for maternity patients. We are spending the rest of today visiting Durbar Square, which is a historical site full of beautiful temples and monuments. We'll post pictures soon - as long as the internet access cooperates.

Love,

Yarrow and Lauren