Hangin' up the (dirty) scrubs

Namaste dear readers,

Our month in Bharatpur has sadly come to an end. It is amazing how quickly it passed, and now we have only memories - of beautiful births, stressful moments, sweet sleep at the end of long nights, madly itching mosquito bites, monsoons cooling the sweltering days, juicy watermelon and mango fests, elephant riding, making new friends and feeling blessed by such an incredible and unique experience.

In our final week at the hospital we put in a full week of 12hr night shifts to going out with a bang. It was exhausting and completely worth it!

In total over the four weeks, we each caught 34 babies and attended 154 births. We had 1 stillbirth, 2 retained placentas, 3 cervical tears, 4 shoulder dystocias,5 postpartum hemorrhages, 7 premature babies (who all did just fine), over 50% of births with meconium, too many episiotomies, 61 intact perineums, and 44 resuscitations. There were 92 first-time mums and 62 multiparas.

We have grown so much as practitioners and members of humanity through this experience. As we finish this phase of our journey, we would like to leave you with some of our most memorable (joyous and scary) moments from this week:

- Attending births in the dark when the power was out - thankfully, catching a baby can be done by feel but this is a bad situation when the baby needs resucitation. This happened to Lauren who needed to suction a meconium baby but the power was out, so she did PPV until someone was able to get backup power on. The baby came around well once she was able to clear the baby's airway.

- We both helped a nursing student do her first solo catch. It was a fun teaching moment and we got a taste of what our preceptors must feel. Yarrow also walked a student through her first suturing job - a small first degree tear, straight foward but difficult to instruct when you have a left handed person trying to teach a right handed person!!

- Yarrow delivered a very flat baby after it was brought by vacuum to the perineum and Lauren did resuscitation with suctiong and PPV. After the baby was stable, Lauren found a piece of the woman's cervix on the baby's head - it had ripped off during the delivery! Pretty crazy to find that.
- We each had birth "complication-trends" which seemed to follow us. Yarrow's complication was cervical tears (she had 3, while Lauren had none) and Lauren's was shoulder dystocias (she had 4, while Yarrow had none).

- We only had one birth where we were alone - just the two of us. Usually, when we were catching a baby we'd have a huge audience of nurses, students, visitors, and other curious strangers, but for this birth the woman laboured and pushed silently. No one else knew it was happening and neither of us had time to grab a supervisor. It was a fun birth to attend. Throughout our time at Bharatpur we loved working together and became very good at it - communication in times of emergency was smooth, efficient and thankfully all our outcomes were good. We felt blessed to be able to work together and teach each other our little tricks!

- Later that same night, a nursing student delivered a baby that Lauren was resuscitating when Yarrow noticed that the student didn't look well. Soon after, the student fainted and Yarrow caught her and held her up for several minutes until she came to. She was okay afterwards, but it was a weird few minutes waiting for both an adult and a newborn to come around!

- Toward the end of the shift, Lauren was watching a birth that a nursing student was attending. The student delivered the baby's head, but then the shoulders wouldn't come. She didn't know what to do so Lauren had to climb onto the bed and, with a lot of effort, free the anterior shoulder. It was Lauren's 4th and final shoulder dystocia in Bharatpur. Thankfully the baby was okay.

- We each caught babies within minutes of each other, and neither of us were able to get more than one glove on before the babies' heads were out. It was slimey, but pretty fun to have super fast births next to each other.

- We saw a lot of episiotomies. Lauren caught a baby for a first-time mother after a nurse cut four episiotomies on her. The reason for the epis was not because the fetal heart rate was abnormal, but because in first-time mothers a "tight" perineum is considered an indication for episiotomy. At birth, the baby was very flat and Yarrow had to resuscitate it with bag and mask for over 10 minutes. Meanwhile, the mother had a postpartum hemorrhage so we were both pretty busy! Luckily both the baby and mum recovered well and are healthy now.

- Baby boys are highly valued in Nepal and mothers are often very happy when they hear us tell them "Chorra paunu bayo" (You have a baby boy). One mother had literally just delivered when Lauren told her she had a son, and she sat up, grabbed Lauren's face and kissed her on both cheeks, overcome with joy. It was delightful to see her so happy. We make sure to give extra kisses to the baby girls though, since we think they deserve the love too.

- Yarrow was attending a second time mother who was pushing for a while until we saw something dark purple/maroon covering the glimpse we had of the baby's head. Once we got a better light, Yarrow realized that the woman's cervix had prolapsed while she was pushing, and it was preventing the delivery of her baby's head. It is very unusual for a cervix to come down that low - normally it dilates out of the way before we start seeing any head! Lauren pressed down on the baby's head while Yarrow slid the cervix out of the way, and very shortly after, the baby was born. We hope this woman doesn't suffer from a uterine prolapse in the future. Unfortunately, most Nepali women must do very hard manual labour (and often quite soon after giving birth), which puts them at higher than average risk for uterine prolapse. Hysterectomy for this complication is a very common surgery here.

Perhaps the best night shift of all was our last - fitting, we know! Here are some of the stories from that night alone:

- Yarrow caught a baby in the assessment room with one arm while she was holding another baby in the other arm! It happened because she was carrying a wrapped baby that Lauren had caught over to the scale to be weighed when she saw a commotion in the assessment room. Yarrow walked in and saw a woman pushing, so she lifted her skirt up and discovered the woman had already delivered her baby's body up to the umbilicus! After it was delivered, that baby needed a lot of resuscitation so the baby that Yarrow had been carrying came along for the ride and lay very quietly on the baby warmer while Yarrow worked hard to resuscitate the other baby. After several minutes he stabilized and both babies did fine.

- Later that night, we went to the hospital canteen for a break and a cold Sprite at 2am. As we were walking back to the maternity ward entrance, we passed by an ambulance and glanced in to see a pregnant woman and an older woman companion. The ambulances here are usually Tata 4X4s and are fairly basic - a gurney, oxygen, and a driver. As we walked by, the companion banged on the back door of the ambulance from inside. Lauren opened it, and to her surprise, the pregnant woman had delivered her baby's head and there was no one else around to help! Lauren tried to put her gloves on but was so full of adrenaline that she ended up doing the delivery bare-handed with the gloves in useless soggy lumps under her fingers! She had no idea how long the baby's head had been delivered before we had arrived, but thankfully the baby came out crying and vigorous. Yarrow came running with the delivery set and then we helped the woman inside. It felt like it was a dream because it was so late at night and the birth happened in such a strange setting. Lauren felt sorry that the woman seemed so scared and that they had been alone in the ambulance during such an intense time. It was lucky that the mother and baby were both fine. It was an amazing birth and Lauren felt the incredible "birth high" for a long time afterward.

- We barely had time to look at each other and say "that was crazy", before Yarrow delivered an unexpectedly premature baby to a first time mother. She had been in labour for only 1h 20 minutes when she delivered a very small 4lbs 6oz baby boy who appeared to be 34 weeks gestation (6 weeks early). We were all thankful that the baby cried vigorously and didn't need to be resuscitated. It is much harder to help a premature baby get started (and keep them healthy) in a hospital without a NICU. Lauren was sure there would be a twin because this baby was so small, but there wasn't another baby... just this little one! We had been hoping to see a twin delivery here but we had no such luck. In fact, we missed a twin birth and a breech birth in one shift while we were sleeping off a night shift!


- We each caught three babies that night - our busiest night of the trip. There were all normal, healthy primip deliveries. It was the perfect end to our placement.

Now we are enjoying a few relaxing days in the beautiful city of Pokhara. Pokhara is a major tourist destination, which is not exactly our cup of tea, but since it is the low-season it is pleasantly kui-ray (aka: slang term for "white person" in Nepali)-free. The surroundings of Pokhara are spectacular - the city is next to a pristine lake edged by the Annapurna mountain range.

Unfortunately it has been very cloudy, so we have yet to see the snowy peaks. However, tomorrow we are getting up at 4am to hike into the mountains and watch the sunrise. Today we visited Devi's falls and the Gupteshwor Mahadev cave, an eerie place where a huge 500m high waterfall cascades into the cave and disappears into the ground. Tonight we took a row boat out into the lake to an island temple at sunset. It was quite a lovely way to wind down after working like crazy for the past month...

It is hard to believe we are coming to the end of this "blogging relationship"! We feel touched that so many of you at home have been following our humble adventures, which we have so enjoyed sharing with all of you. We plan to do one or two more posts, back in Kathmandu and when we arrive home in Canada, so keep your eyes peeled over the next few weeks!!

Much love, us....