"There's a mama" is a phrase that now changes my whole day. It pulls me away from meetings, from meals, and sometimes even away from my beloved bed. Last night after a few anxious sounding knocks that phrase echoed through the screened front door of out communal living room. Being the assistant on call I threw my scrubs on, grabbed my water bottle, phone and headlight and headed out the door with Whitney. The mama that awaited us was having contractions, but not due to labor. She had PID pelvic inflammatory disorder caused by a sexually transmitted infection. As we looked through her book we could see she had been treated some months ago, but was clearly now reinfected. Most likely this means that her husband remained infected and probably reinfected here, that is incredibly common here in Togo particularly because of the abundance of polygamist marriages. This particular mother was actually a patient at another clinic, which is where we decided to send her for treatment. A reasonably uneventful experience, but a very good one to learn from.
5am rolls around and someone is poking me. "There's a mama" Whitney half whispers at me. I get up, put my scrubs on once again, grab my water bottle and phone (no need for the headlamp since its day light) and I head down the hill to the clinic, Whitney a few minutes ahead of me. "The baby's already here" she tells me as I walk through the door, scraping the sand off my slippers as I enter. "You're joking" I think to myself a little confused. But it wasn't a joke, the mom (a different one from the previous night) had delivered at home an hour early but had been concerned about the amount she was bleeding. As Whitney checked her uterus for firmness she asked me to do a newborn exam, to which I whole heartedly agreed. I weighed, measured, inspected and checked reflexes on a beautiful baby boy before administering antibiotics in his eyes and a vitamin k shot in his thigh. The moms bleeding was fine, but we encouraged her to stay for a few hours to rest and someone would be back to check her vitals and uterus before sending her home. Again more learning, but not the birth I was hoping for.
It was a slow day and around 4:30pm I'm working on the school's financial spreadsheet. Color coordinated and enhanced with formulas I was feeling rather chuffed with myself when another staff member walks in and utters the evening changing phrase. There's a mama.
I take my time getting out of my African dress and decide not to put my scrubs on as it's still hot out. On go my patched up elephant pants and a black tank top, I'll probably have time to change before delivery I figure. I saunter down the hill with a quarter full water bottle, my phone and my hand fan - crucial for birth during the day.
The moment I walked in the room, I could tell two things. Number one, this mama is having a baby tonight. Number two, I like her. She had a cute circular face and short hair with a few small scars on the side of her mouth that looked a little like cat whiskers painted on a child at Halloween. Here in Togo when someone is sick as a child, their parent will take them to a voodoo witch doctor who will cut them in an effort to "release evil spirits" from within them.
But this mama was strong, I could tell. At 30 she was on her fifth baby which broke my pattern of delivering only first time African mamas so far. She progressed steadily and a few hours later was ready to push. My midwife Beth asked me, a little before pushing if I wanted to do what was called a four handed catch. Both of our hands would help catch and guide out the baby, her hands helping to lead mine. As mama progressed Beth encouraged me to feel what was beginning to show. What I felt was very hard, which to me made sense as the head is hard. But Beth tole me what I was feeling was actually the bag of waters still intact but taunt creating that hard exterior as it made its way down. A few pushes later and what looked like a large bubble larger than a softball had emerged, my first thought was that this baby was going to be born en caul or entirely in its unbroken bag of waters. But just as that thought finalized I realized how murky the bubble was, it was amniotic filled with meconium - the baby's first bowel movement an indicator that the baby could be in distress. "Grab the clamp, we need to get this bag open" Beth told me. I grabbed a clamp and tried to create a small tear in the bag, but I was nervous about poking the baby's head so the bag slipped out from my clamp. Again I bit at the bag and this time created a tear as murky water spilled out. "That's not a head" Beth stated as I realized the same. A cute little butt had greeted us as if we had unwrapped a very surprising gift. I placed my hands an inch from each of the baby's hips as the words "hands off a breech" moved through my brain like a marquee sign. Despite my owns thoughts I asked "should we sweep the legs?" No let them come. Plip, plop. One then the other legs sprung out and the baby looked as if it was doing a strange dance with its bottom in the air reminding me a little of high school prom. This dance comforted me as it was an indication that the baby was alive and okay. As Beth swept one arm out and then the other. "Okay place your finger in the baby's mouth" she told me. I placed my finger at the baby's face, feeling around for the mouth fearful I would poke it in the eye. As I was about to give up I felt my finger sink in and connect with hard pallet. "I have it!" I exclaimed. "Okay we're going to somersault the baby onto the mothers stomach, keep that chin tucked" Beth calmly told me. With on hand in baby's mouth and the other on the baby I helped flip this backwards baby into the world.
One minute later after vigorous drying, stimulation and two puffs from a positive pressure ventilator this gymnast of a baby let out a hearty cry. "It's a girl" I told mom, as if she could understand me, but she could see her on her daughter there on her chest. This was a source of excitement for me and the mom as we had chatted through a translator (who is also a student in the school) during her labor about her desire for another girl. Adzo will be part of the baby's name which means born on a Monday in Awe the local language, and also happens to be the mom's name!