Record Breaking

Statistically, the maternity ward at this hospital in Togo delivers 50-60 babies a month. April is definitely going to beat that average, for its April 20 and the month is only two thirds done, but by 7am we delivered the 52nd baby. At this rate, we will do almost 80 deliveries this month, which is more than beating average; it could be a record. Pretty good for a four bed birthing room and an eight bed postpartum ward staffed by only two nurses.

Let me tell you what it looks like to deliver this many babies. 

The delivery room has four beds separated by four curtains with a desk in the middle. So much for privacy! Each laboring woman also usually brings one or two female family members to assist her in labor, so sometimes the room is quite full of people. It’s Africa, it’s open, everyone can pretty much know what’s going on with everybody, it’s all in true community fashion, and I love it. If I open each of the curtains a little bit, I can sit at the desk and keep an eye on all four of my laboring patients, counting their contractions and seeing when they are ready to push. 

That’s another thing. No more of this 1 to 2 nurse/patient ratio that we legally have in the US. On any given night, I may have two cytotec/pitocin induction patients, one fresh post-op cesarean section, one laboring patient with oligohydramnios whose baby is having variable decelerations with every contraction, plus four other mother-baby couplets on the postpartum ward, including a baby on IV antibiotics and a set of twins. That may or may not have been taken from real life experience. To say I’m learning how to manage multiple patients and prioritize is an understatement. 

So one evening, when I arrived to the maternity to work my night shift, there were two laboring patients, so I organized and prioritized and told myself it was going to be a calm night all under control. Famous last words. 

The doctor also wanted to have a calm night. He was tired, and rightly so because four of his patients had died the night before. So he said, “I would love to have everyone delivered by midnight.” More famous last words. 

Meet the characters. One was nine centimeters, and we’ll call her crazy lady because she kind of was. Most African women handle labor pain like absolute champs, despite receiving no form of pain control. Others - like crazy lady - not so much. She had been begging for a cesarean section since 9am, and I met her at 7pm after she’d been laboring all day. Let’s just say she already hated me from the start, and after trying to offer compassion and encouragement only to be completely despised, I decided to simple avoid her as much as safely possible. 

Now meet my second laboring patient - a kind, simple woman about to have her eight baby. She was five centimeters and tolerating her labor very well. 

About that time, in walks another character - a 34 weeks pregnant woman having twins. She came in with her water broken and seven centimeters dilated. She belonged to the Fulani people group, which are famous for going through labor without making a sound or murmuring a single complaint. To add to the fun, she spoke absolutely no French. We had a really hilarious time doing gestures, which I learned don’t always translate. Apparently different cultures do different gestures, and we often laughed because the other person didn’t understand a gesture that was so blatantly obvious to us. Thankfully, both her babies were head down according to the most recent ultrasound, but I called the doctor anyway to verify what he wanted to do. 

When he arrived to check on her and confirm the position of the babies, that’s the moment when crazy lady’s water broke and we entered a whole new level of hysteria. The doctor barely had time to put the ultrasound machine away before slipping on gloves and catching her baby boy. Since she started bleeding somewhat heavily after her delivery, I popped out from behind her curtain to grab some pitocin. That’s when I saw my lady with twins, laying in bed absolutely silent, face squinched, obviously pushing with all her might. She didn’t need to speak French for me to know what that meant. 

“Um. Twin’s mom is pushing!” I called from behind the curtain, and the doctor popped one pair of gloves off and another on just in time to delivery the first baby. I stimulated the baby until he was crying vigorously, then crossed the curtain back to crazy lady, who was still bleeding heavily, hung some pitocin, massaged her uterus, expressed some significant clots, and then jumped back over the curtain just in time to help deliver the second twin. 

Right when that baby was delivered, our nurses’ aide calmly interrupted and said, “Excuse me, but the lady over there (the one who was five centimeters just a few minutes ago), well, the head of her baby is already born.” 

She said it in the same tone as you would say, “I think I’d like a chicken sandwich for lunch today.” 

The doctor threw the second twin on mom’s chest, switched gloves again, and got to the woman’s side just in time to catch the fourth back-to-back baby. When I saw that this baby was breathing normally and the placenta delivered, I gave some quick methergine, then ran back over to crazy lady (who, to her credit, was much calmer and happier post-delivery) to find that she was still bleeding and her baby was struggling significantly to breath and making awful respiratory noises. I snagged and took him to the resuscitation warmer, stimulated and suctioned, and then noticed that the twins’ mom was now bleeding significantly. So with two heavily bleeding postpartum moms, and four newborn neonates - two of which were preterm and one had liked to stopped breathing, I found myself doing laps - giving cytotec, massaging uteruses, suctioning babies, giving oxygen, injecting vitamin K, hanging pitocin, and then making the rounds all over again.

I think we set a record. 4 babies delivered in 45 minutes with delivery times 21:26, 21:46, 21:50, and 22:11. All before midnight. I told the doctor he needed to be a little more specific about what he wishes for. 

At the end of it all, everybody stopped bleeding and started breathing. And after several hours of stabilization and catch-up, I sat down at the nurses desk to try to document all that. At that point, I couldn’t even remember who was born when and what the sex of each baby was. Once I got it all straight, I made a public announcement to everyone in the delivery room with all their family memebers hanging about. “The boys won! Three of them to one girl!” 

One kind family member was an older lady who had had front row seats to watching the doctor and I run around the ward, making circles around all the patients and delivering them one after the other. When I finally sat down, she came up to me and  said with a smile on her face that said it all, “Good work.” 

Such is the excitement of working in labor and delivery: Africa edition. 

Around midnight, when everything was calm again and the doctor was off to rest, he made an observation. It was no coincidence that four of his patients died the night before, but this night he brought four new healthy lives into the world. 

God didn’t have to do that - it’s not like for every person that dies he has to create a new one. He doesn’t count or measure like that. He not obligated to balance life and death like that. The four and four thing doesn’t mean too much to God, but it meant something to that doctor. It meant that God holds life and death in his hands. It meant that he is sovereign over it all, that all starts and finishes are under his control. It means that what we count as gain or loss, success or failure, good or bad might not be measured the same way by him since he sees the world and it’s events from his heavenly, eternal throne and we only know what we see from our limited perspective.  It meant that he sees us, sees the work we are doing, and sees the state of our hearts as we try to handle the amount of suffering and death we experience here. 

And this doctor noticed what could have been missed or brushed off as a coincidence - four deaths and four new lives, both delivered by a God who is sovereign over it all, over life and death itself. He is a God who doesn’t count like we do, except when he does it to show that he cares for us and wants to affirm us in the service that we do for him. 

I’m praising God for all 52 babies born so far this month, for each one is a life (and the life of an entire family) that we get to love and serve. We trust that God is organizing the events of their lives to draw them to him, and when we get a chance, we get to say his name and help them connect the dots.