I'm sorry, your baby is dead

Those are words no one wants to hear or say. Just last week, a fellow missionary had handed me a brochure with one woman's story of hearing those words. Of praying the ultrasonographer could find a heartbeat. Of hearing the heartbeat of the baby in the next cubicle and praying it was her own baby's. They were words I dreaded to ever have to say.

Wednesday was busy. It usually is as I don't do ultrasounds on Tuesday so I usually have catch up to do with the women from Tuesday and Wednesday prenatals. I had just finished my 5th and was going on to my 6th. She was an unusual woman for here. Short hair. A rambunctious 4 year old girl at her feet. Big belly. Very matter of fact. I could tell her time was stretched thin.

I introduced myself as I walked her down the hall to the exam room. I asked her why she had been referred for my care.

"The midwives said no heartbeat."

Oh Lord, I thought. I took a bit of her history...4th pregnancy, 32 years old, breadwinner for her family. I palpated her belly, a bit boggy.

"When was the last time you felt your baby move?"

"I'm not sure," she said. "But my belly keeps getting hard. Not really contractions, but not normal with my other pregnancies."

I gooped up her belly and applied the probe. A little head appeared, baby was breech. I brought the probe down the neck to the chest area and nothing. No movement...and it wasn't even round anymore. My heart started to race in protest. I searched and watched. Nothing.

Silence.

The mom's eyes were watching me earnestly, not the monitor. They followed my every movement. Never have I felt the weight of a gaze so strongly. I took a deep breath and grasped her hand. "Wala na, po. Patay na ang puso ng baby mo."

No more, m'am. Your baby's heart has died.

Is there ever a kind way to say those words? She looked at me with that burdened gaze, "But why? What did I do wrong? How will it come out? Do I have to have surgery?"

I explained that often times there's no way of knowing why the baby died, but that because the head was still firm, if she went to the hospital right away, they could induce the labor. It sounded to me as if she had already started to have weak contractions.

I brought in a wonderful Filipina nurse to help explain more fully in Tagalog while the mom broke down in sobs. Why had this happened to her? Just two days before I had scanned a woman whose baby could very well have died from medications she had taken before she knew she was pregnant, but that woman's baby was perfect and alive.

All I can say is I am so grateful the choice is not up to me. I am not sovereign and I am ever thankful for that. I do the best that I can to give love fully, to touch gently, and care greatly. The rest is up to God. We prayed for Rosa before we gave her a letter of referral for a local hospital.

Would you pray, too?

“For who has known the mind of the Lord,
or who has been his counselor?”
“Or who has given a gift to him
that he might be repaid?”
For from him and through him and to him are all things. To him be glory forever. Amen.
(Romans 11:34-36 ESV)

"Beware of fainting fits, beware of swoons"

Movie quote? Anyone?

I absolutely love teaching. I love showing a mom where her baby's head is and having her feel that hard noggin in her belly. I love having students show interest in maternity care and teaching them how to discover the baby's position and where to find the heartbeat. It's like opening up a whole new world and most people love learning about it.

And I love having high school girls come to volunteer a few hours to help file records and hopefully watch a live birth. Last week, I had a junior in high school who is interested in medicine come for a few hours. Let's call her Charise. I saw that there were quite a few women in labor, so I was hopeful that she would get to observe and help with the birth.

After filing a few records, we gave a baby her first bath. Shortly after, one of the laboring women started showing the classic signs of transitional labor. It was time to push. I got Charise her own pair of gloves and put on a pair myself while we waited behind the curtain with the midwife. I positioned Charise standing in the 12 inches between the bed and wall, while I stood on the other side. Jheny (midwife) stood at the end ready to catch.

Sure enough, a head popped out followed by a slippery and wiggling body. Jheny placed the little girl on her mama's belly while Charise and I vigorously dried her. I kept checking Charise to make sure she was doing ok, because birth is not a typically beautiful thing...and it can get very claustrophobic behind those curtains! Charise kept exclaiming how cool the whole thing was...and how little blood there was.

After the little babe was dried, we placed her skin to skin on her mama's chest and draped a blanket over her to keep them warm. I darted out to get the oxytocin to inject after the placenta was delivered. When I came back in, I saw the midwife inspecting the placenta, then glanced up at Charise...she was white as a sheet! I quickly asked if she was ok. No response. Uh-oh!

I leaned over the mama and baby, quickly grabbing Charise's torso, forming a bridge over the newly delivered mom. Charise started to sag while I held on to her. I asked for the baby's father to help manuver her from between the bed and wall, then met them at the head of the bed, draping Charise's arms around my neck while I "danced" her over to the recovery bed. The sweet mom already on that bed moved up her legs while I draped Charise on the end of the bed.

As soon as Charise laid down, she came to...giggling! She was LAUGHING! I was wishing for a video camera as we talked about what had just happened and everyone in that tiny little room just burst out laughing, even the mom still on the delivery table.

I went back to helping Jheny with the mama and baby, forcing Charise to keep her head down for a few minutes. Afterwards, she was something of a celebrity as everyone repeated the story and whipped out their cellphones for a picture with the American girl who had fainted.

Awesome.

And the movie quote is said by Fanny Price in Jane Austen's Mansfield Park.

A Quick Update on Lynette

When I saw Lynette's name on the roster for Friday prenatals, my eyes eagerly scanned the crowd for her face. I called her number and impatiently waved my hand for her to come sit by me. I was desperate to know what her second ultrasound revealed. I clasped her hand within mine and asked if she had been able to get the scan and she nodded slowly, reaching for a brown envelope to give to me.

I pulled out that white sheet of paper, my heart racing with dread and hope simultaneously. The sonologist remarked that the baby boy was only 28 gestational age (roughly 7 months) and had a grossly enlarged left ventricle in his brain, indicating hydrocephalus - or extra fluid in the brain. The uterus was also filled with too much fluid.

As horrid as this sounds, I was thankful. Anencephaly is a certain death sentence. Hydrocephaly is not. I explained what her ultrasound possibly meant and asked her to be sure to show the results to Mavis when her number was called. Then we briefly prayed together. (I'm still puzzled by what I saw on the screen when I scanned her compared to what the ultrasonographer saw.)

I later asked Mavis what she had decided to do: during her exam, Mavis felt two strong, definite contractions...much too early for labor! If the second ultrasound had confirmed anencephaly, we may have tried to deliver her at our birthing home because no amount of money, of which they have very little, could save this baby's life. However, if it is truly hydrocephalus, there is a good chance the baby could survive with advanced medical attention and equipment. She was referred to the Philippine General Hospital as they are the best institution for dealing with this sort of thing. I hope her family was able to scrounge together the resources to take her. Room and services are free, but all medications and medical equipment must be paid for in advance.

Please pray for Lynette and her little one. I have no way of knowing if she did deliver, if her baby still lives, or if she made it to the hospital. But God does.

Anencephaly

As wonderful and fun as last Wednesday was, is as heart-breaking as today was.

I was referred to scan the belly of Lynette to determine if her nearly due baby was breech. I got her situated on the bed and palpated before placing the probe. It seemed like she could be breech, because the only firm structure I could palpate was at the top (fundus) of the womb. Although that structure felt more like the rump than a skull.

I placed the probe on her swollen tummy and immediately saw a beautiful beating heart. I scanned up to the top of the womb and saw a baby boy and his rump. I brought the probe down to where the head should be and was puzzled. I couldn't see a skull, just some mush at the bottom. It looked like there could be some sort of hard structures, but it was very small and oddly shaped. This is the first time I'd seen something like this. My heart sank into my toes.

I scanned the rest of the little one and his body looked perfect. I just couldn't get over it. My probe kept going back to the head, trying to see if I was wrong.

I finished up the scan and had Lynette sit on the bed. I explained to her that I wasn't certain, but it looked like there may be something wrong with the head of her baby. I asked her if she had the money to get a second opinion ultrasound at a lab we have a relationship with (they give our patients a good discount). She nodded yes with very round eyes. I asked if I could pray with her and she eagerly asked me to. How do you pray in a situation like this? How do you pray in a foreign language when your heart is so heavy.

My heart breaks for her. If her baby isn't anencephalic, then there is something else that is wrong with the skull. Nothing can ever prepare a mother for this type of diagnosis.

Nothing.

Please pray for Lynette tonight. She should have gotten her second opinion ultrasound today, but I haven't heard the results. I may never know. But God does.

a full circle

Mayette was a gal who was referred to me last week for an ultrasound who was quite large, but had been breastfeeding her first baby so we didn't have an accurate way to determine her due date. That was supposedly my job...

I went through the preliminary questions and then placed the probe on her swollen belly. The baby looked beautiful with a good sized noggin and was most definitely a boy. I talked with her about labor, but she had been through it once before so I kept it brief. We closed in prayer and off she went.

Fast forward to today - I returned to Shalom this afternoon after a leisurely lunch and saw Mayette groaning on the bed. She was our only active labor. I kept watching her out of the corner of my eye as I chewed the fat with Mavis.

Hmmm...she's getting pretty restless!

The 2pm midwife came on duty, took one look at her, and asked for sterile gloves while Mavis scrambled for her record. (The other midwife was out of the room sterilizing instruments.) Because we also had no nursing students at that moment, I grabbed a pair of gloves and prepared to assist. I was still putting them on when I heard the sharp cry.

I raced over in time to help place the little guy on his mama's chest, dry him off, and snuggle him up skin to skin. In about 10 minutes, he was happily sucking away, warm and dry, safe and secure, finally in the arms of the one who carried him inside for 9 months.

Praise God for easy deliveries like this one!

After an hour, I grabbed a photo with Mayette, her mom, and little Kean Mike. What a cutie!