Me, Caity and the Honeymooners

Since Caity and I finished at the hospital we have done our best to have some fun!!  And by fun I mean tours that include 12 couples on their honeymoon and us.

The first tour we did was a land and sea tour that one of the Midwives hooked us up with. Her friend Joe owns the company and he gave us a big o’l discount. We showed up at the gated dog guarded empty shopping area by the water and were guided in. About 15min later two buses from a local resort dropped off two large groups of American honeymooners. We happily jumped on the boat and at 10:30am the Rum punch started flowing.  The music blasting, the Rum flowing, and the sun shining, it was pretty sweet.  We stopped at some local towns and then they docked the boat and had us jump in the water where we snorkeled and saw some of the most amazing fish!!

 After that we hopped back on the boat and went further south to Soiufriere where we enjoyed the view of the Pitons and we then lathered ourselves at the mud baths and swam in the waterfall.

We then stopped for some delicious Creole Lunch and enjoyed fresh coconut and coco

The tour guides and the couples on the boat were all such awesome people. It was the perfect way to see the island and for the first time I felt like a tourist.

The next day we recovered by the pool and then headed out that night to the local street fair with one of the midwives we worked with and her friend and danced in the street and in the rain.

Today we did what we had been planning on doing for weeks, we zip lined through the rainforest with yet another bus full of American honeymooners.  I’ve wanted to zip line forever and it was pretty awesome. 12 lines that got higher, faster and longer as we went.

We have only one more full day in St. Lucia and then we head back to the overcast chilly 60degrees of Seattle and I can't wait!!

So Long Victoria Hospital

Caity and I decided to work our last day doing the morning shift together and it was the longest slowest day EVER. No babies, and hardly any admissions. We bantered one last time with the Nurses and Doctors, Nursing students and medical studnets who we’ve become so fond of. I said my goodbyes to the security guard who I befriended over the last few weeks.  I helped some moms with breastfeeding and said my last goodbyes to some of the moms who have been on the Maternity ward for the past few weeks.

(Going to miss this mom who was on bed rest for the past 3 weeks awaiting the arrival of her twins)

As I’ve said I got what I came for, I grew and expanded my confidence in my skills.  However, I totally wish I had another breech birth under my belt. It became a joke today that we’ve missed all the vaginal breech deliveries because it either happened fast or the Midwives were unaware of our request to be called.   Regardless they all happened when we weren’t on shift so it just wasn’t meant to be.  Today there was a mother who was stuck at about 4cm with a footling breech. Basically this baby was trying to walk out and it just wasn’t going to happen.  Caity checked her and felt little baby toes grab her fingers. (I so wanted to check her but couldn’t make this Mom go through another exam after all she had been through so far)  We helped get her ready for a C-section and that was the last birth that occurred while we were on our shift.

The day before I caught my last baby as a Midwifery student. This 4^th time mom was hardly contracting and hanging out at 7cm for hours. We finally broke her water and still not much was happening so we did as they do here and gave her an enema.  She went for a walk. Came back almost two hours later and I checked her and she was still 7 so we gave her a tiny tiny bit of oxytocin in her IV and within 10 min she wanted to push. I checked her again and she was STILL 7cm but this time her baby was MUCH lower. We helped her breath, I set up for the birth, put my gloves on just in time to turn around and see the head almost out.  1.5 pushes and her first baby boy was earthside.  It was a great last birth I did everything with ease and sutured without anyone over my shoulder, and after I was done the midwife happily approved of my work. (PHEW)

It’s so weird to develop relationships with people and work with them every day for a month and know that you most likely won’t see them again. There are a few midwives that would love to venture out of St. Lucia and I hope one day to have them come visit and see how we do things on our end.  The hospital is also planning on moving to a new location in the next year and attempts are being made to do things a bit differently so I’d love to come back in a few years with some bright eyed students to see these amazing women again. 

4 more days in St. Lucia and hopefully a little bit more fun before we leave.

Last few days....

We leave in a week and only have a few more shifts left at the hospital!

Friday started off with a bang with baby after baby and since then I’ve had no babies on my past 2 shifts. It’s been slow but I’ve been keeping busy with the theme this week of “my baby is still hungry and I don’t have milk” Oh how these women would benefit from Lactation counselors in the hospital. The midwives do all they can in trying to educate these moms about how the breast is best but some of these new moms aren’t understanding the natural process and would like to hand their baby over to be fed by us. I get it; I can only imagine how exhausting and frustrating it can be to breastfeed especially in the first few days postpartum when these little ones are working so hard to make the milk come in.  And I also understand that breast feeding doesn't work for everyone but it's at least worth a try, right?!  Anyway I’ve done lots of education with these Mommas this week about latch and positions and the process of breastfeeding so hopefully they will be able to take these little nuggets home with them.

  I’m so grateful for my time here . Being here I feel I was able to improve so many of my skills and grow personally and professionally.  I now feel competent in doing catheters, enemas, suturing, and giving IV’s.   Yes, yes I know all very exciting!!  I also was thrilled to learn how to rupture someone’s membranes without using an amnihook (which will no doubt come in handy when I’m stranded at a homebirth with a multip and a birth-bag that wasn’t properly restocked).  I feel more skilled in how to do skills when and if all the luxurious accoutrements aren't available.  The midwives also taught me how to open a bottle without a bottle opener or a lighter, so I’m feeling especially skilled after that.  Being here has made me appreciate the care that I’m able to provide back home and the stressors that come with providing care in a hospital no matter what country you’re in.  I’m grateful for the midwives showing me how they do things and being open to how I’ve learned how to do things.  It’s been an awesome experience!!

Caity and I will now spend our last few days here finishing up our final school work and going on a land and sea tour with some mud bathing and snorkeling along with some other day adventures so stay tuned!

A Sacred Moment

I’ve been able to help welcome so many lovely new little lives into this world.  With this amazing job of witnessing life we also have to be prepared to handle death.   Although it’s not commonly talked about many women experience early losses and miscarry.  As midwives it’s something that we sadly handle more often than we would like to.  However, it’s less common that we witness a delivery of a baby who has passed on.   Since being in St. Lucia there have been three stillborns.  After the first I asked the midwife how common it was for this to occur here and she told me it’s been a while since they’ve had any.  I’m that person who believes these types of things happen in three and I had a feeling after the second one that another may occur.  

 I walked into my morning shift just after a mother delivered a 28 week stillborn baby.  The midwife who did the birth told me the family would return and the mother wanted to say goodbye and take some pictures with her baby boy.  I was then asked to dress the baby and arrange for all of this to happen.

I asked the mom for a onesie, socks, a hat and a blanket that she wanted to dress her baby boy in.  

I’ve held so many new lives in my hands it was the first time for me to be holding death.   She told me his name was Trevon.  I dressed Trevon’s delicate cold little body and wrapped him in his blanket. When she was ready we walked together to the basket that I had placed him in.  I stood there with her as she said her final goodbye.  She was trying to be so strong but after a few minutes of looking lovingly at her son it was clear she couldn’t hold back her tears and neither could I. I handed her baby boy to her and took one last sweet picture of her kissing him, an image that will stay in my heart forever. I told her he looked peaceful and she smiled. We sat together not saying much. When she was ready I walked her back to her room where she showed me pictures of her 5year old son who she promised to snuggle tight when she returns home.  Before leaving my shift we hugged and she thanked me for being with her.

As much as I feel it’s a privilege to witness life, I felt privileged to be there in these last moments with this mom and her baby.  It felt sacred and a good reminder to me how fragile life is. 

What Mothers go through for their children

A few days ago I had the pleasure of being at a birth of a mom who thought she would never get pregnant. She tried for years  and after 8 years of trying she gave up. Soon after she found out she was 2 months pregnant.  It was beautiful to see the Joy on her face and her sweet husbands face when their son finally made his debut.

Last night was an interesting shift. I walked in to find out there was an 18 year old mom who was at about 5 cm and not coping well. I did some back rubbing and breathing with her but at the peak of a contraction she screamed almost every time. I was starting to think she was more than 6 and luckily so did the new nurse coming on the shift with me. So we checked her and she was fully meaning  shes complete or fully dialated. I know this term is used in Canada and I’m guessing the UK, I just love it for some reason. 

The nurse and I set up and suddenly there were about 5 eager medical students in the room watching our every move.

Let me back up. So the midwives do the births and they have nursing students and midwifery students. The doctors help with high risk situations but don’t tend to be the ones to manage births unless there is a complication that comes up or a need for a C-section.  These medical students usually follow the Doctors around but they are all new and EXTREMLEY eager to see birth and learn about it in all its glory, which is great but something I’m so not use to. Having 5 other bodies that just stand and stare as you do your job feels really weird for me so I can only imagine how I would feel if I was the one pushing this baby out.

Ok back to the birth. So this first time mom pushed for about 15min and her sweet baby boy was out.  (back home it’s typical for first time moms to push an hour or maybe two) We put her baby on her chest and she started glowing!!  Next comes the hard part, the placenta. Usually placentas come out within 15min after the baby is born and in my world if the placenta isn’t out 30min after we get a little anxious. (If we can’t get it out and she’s bleeding we go in for it, and if she’s not bleeding and we've tried everything we can to get it out we go to the hospital)   So her placenta wasn’t coming and she wasn’t having any contractions to help it come. Basically she went from 5cm to fully to baby really fast and her uterus was tired and didn’t want to keep working. We gave her oxytocin in her IV bag, I made her do nipple stimulation, the midwifes have patients breath into a brown paper bag to get them to relax and they say this usually helps. I asked the midwife to rub her stomach to make sure her uterus wasn’t filling up with blood and sure enough gush after gush came and then it would stop. In St. Lucia if the placenta doesn’t come after 30min they call the Dr. and find out how to manage the situation. (Although they know how to manage they just need the okay from the Dr.)  It’s now 45min and she’s still bleeding and in my head I’m thinking “OMG people just go in and get it out PLEASE” But I of course just stayed calm and waited because I’m trying to be respectful of different management styles and seeing how the retained placenta that happened last week was in for 4 hours and came out without anyone going in after it I was feeling hopeful.  So I rubbed (Mind you every time I rub her uterus she’s screaming at me and pushing my hands away because as all you mothers who have had this done know, it does NOT feel good) and I rubbed some more and gush gush, PLACENTA!!! Woohoo!!!  I soon learned upon inspection that this was not an ordinary placenta it had what’s called a succenturiate lobe (almost like a mini placenta attached to the normal placenta) and a battledore cord insertion (the cord inserted at the edge of the placenta). The lobe explained why it was likely not coming. Phew glad that one was over.  After controlling her bleeding and her blood pressure finally going down I was happily able to snuggle her and her baby back to their room for the night.

After they were all settled in we had a readmission of a mom who I became close with last week. She was induced and labored for a few days and eventually ended up with a C-section.  After that she stayed in the hospital to recover for about 5 more days.  Both Caity and I became close to her and helped her with breastfeeding and postpartum support. I really enjoyed her and was excited to learn she was going to be moving back to NJ where the father of the baby lives in a month or two once she was strong enough.

She was back because she had a seizure at home that day and when she came in I didn’t even recognize her. She was likely hit by the silently and occasionally deadly eclampsia. I think pregnant moms know about pre-eclampsia happening prenatally because it’s talked about so much but it’s not talked about as much postpartum. 

At home I feel like I’m constantly reviewing the signs and symptoms with moms who have elevated blood pressure. It goes like this “If you have a really bad headache, vision changes, right upper quadrant pain or any extreme swelling especially in your face please page the midwife”

 When she was discharged her blood pressures were on the high but normal side.  And in 24 hours things changed fast. It was heartbreaking to see this typically smiling chatty woman in this state, her baby crying to be fed and her unable to hold her baby or even focus on your face.  

This situation happens no matter where in the world you are. It’s happened with midwives I know and it came very close to happening to a client I had this past year. So scary and so frustrating because we don't really know why it happens!

I guess I shouldn’t end on a sad note. So here is a sweet picture of the baby boy I caught. I held him for a bit last night to allow his mom the opportunity to eat.  He just kept staring at me and it's always so sweet to see new moms instantly fall in love!

Getting My Wings....

Midwives have told me that going overseas will give you more experience and help solidify you feeling like a competent midwife and although I heard this I didn’t really know what this would look like or feel like. 
It’s been a busy week at Victoria Hospital, 3 babies born on my shift today two yesterday and one the day before.  Yesterday the nurse I was working with left me alone for a bit in the labor ward and told the nursing students to follow me and watch how I do things.  Wait a minute, I’m teaching them??!! Ok I got this I thought.  There were three moms in the ward. One in early labor who was not coping well, one that needed a NST (Non stress test) and one new admission who was in labor and needed a full physical assessment, NST and eventually an enema. I was totally juggling it all and somehow managing to teach these three eager students how to do things.  The supervising nurse would come back check on me make sure I was filling out the forms right and then disappear to do paperwork or help other patients on the maternity ward.  (We had done two births together, one being the toilet birth so I guess she trusted my ability) I was doing everything!! I answered the students questions, did vaginal exams, checked the NST strips to make sure the fetal heart rate looked good, got the women back to their rooms who weren’t in active labor and checked on the other ladies who needed help with breastfeeding.  I walked back to the labor ward and the mom who we just admitted under 2 hours ago and was 4cm when I checked her was brought back by one of the students and looking like she was about to push her baby out.  We got her to the room, the nurse now joined me and soon after, we welcomed a baby girl into the world. 
 I had an hour left of my shift and was thinking no other babies would be born.  And then a patient came walking through the door who was a second time mom and was admitted last week in early labor and sent home because her labor stopped and she was just walking around at 3cms.  I had spent many hours already with her and was excited to see her back on my shift ready to push her baby out.  She was 8cms and working hard so I set everything up and the nurse wasthere and then gone again.  I checked her soon after the first check and she was 9cm and sounding pushy.  She started to push and I could see her sweet baby boys head.  We were alone in the room and in my head I was thinking, “Hmmm I could totally do this birth on my own”.  I kept waiting for the nurse to walk in but she didn’t.  So I yelled for her and as she walked in the baby was out and in my hands.  Today I was doing a birth and the baby’s head was out when the nurse walked in the room and realized that I was totally fine and thought “Oh this is what those midwives meant”.  It feels good to be in this place of trusting myself and being able to feel like I could manage whatever comes my way. 

The hardest part about being here is developing relationships with the moms and babies and after they have their baby they only usually stay for a day or two and then that’s it, they’re gone never to be seen again.  I’m so grateful for the relationships we form at home with the moms and partners before their birth and after and I really miss that here. It’s hard to think I’ll never see these families ever again, but I’m so glad I got the opportunity to be there in the moments they needed me.  

St Lucia Tid Bits

Things to know about St Lucia:

It rains every day. And by rains I mean pours buckets so you always leave your house with an umbrella

It doesn’t matter if you wear scrubs or short shorts you will get SSSSS’ed at. Yes that’s right SSSSSS like a snake

Grown Men wear Jelly shoes. You know the ones like you had in the 80’s that were hot pink and made a comeback in the 90’s with the buckle? Yes those.

Dogs sleep with roosters and follow chicks around. There are so many street dogs and some cats. But whenever I see a street dog I see a Rooster nearby.

Horses and goats roam the side of the streets.

The people of St Lucia are extremely friendly and helpful. This is especially true when they see a girl walking the hot streets with bags of groceries and a jug of water.

Its loud outside!! Dusk through Dawn sounds of Dogs crying and barking, music playing and frogs and insects chirping through the night until the Roosters take over in the morning. The roosters also continue on and off throughout the day with the chirping birds.

It’s gorgeous here but very poor, the streets I walk down to the Hospital are definitely not paradise, which is personally very humbling.

You can always tell when the cruise ship docks because the vendors are out trying to sell their goods and the cabbies are eager to give rides and you can spot the white people with their bags full of souvenirs looking lost.

Walking the hot streets of St Lucia reminds me of walking down Fulton Street in Brooklyn

To have a vaginal birth here cost $100 EC, If you need a C-section that’ll cost ya $1000 EC. Translation= These Midwives don't make much at all!!

The mangoes are the most delicious mangoes I’ve ever had

Food here is expensive. Cereal can cost anywhere from 10-18EC’s which is about 5-9 USD. Yogurt is $4EC and we spend the most on the gallons of water that we consume which runs us about $8EC’s for 5Litres. (See empty jugs below from past 4 days)

There's no "hot" water. Cold showers for everyone!! (Which hasn't been an issue because it's so hot) Not to worry electric kettles can be found everywhere including the hospital.

 The local beer Piton the Rainier Beer of St Lucia.