1st day as a Malawian Midwife

It's official I'm now a Malawian midwife. I successfully jumped through all the necessary hoops and now I have my badge, which I proudly wore to L&D yesterday. Yesterday was quite a day actually slow but not without drama. In the morning a woman came in with a cord prolapse, so severe that you could actually see about a foot of cord dangling between her legs. On arrival her baby was still alive and preparations started for a c-section. In my mind people were moving so slowly, walking to get the IV, walking to get a catheter, talking in normal voices, walking to get a gurney. I tried to breathe and stay calm but it my head I was screaming and pulling out my hair. Somehow the baby was out within 35 minutes. Initially blue and floppy but after a little resuscitation and she picked up and did just fine. Afterwards I was told that usually there are no emergency c-sections. Usually the baby is left to die and the woman delivers vaginally. Everyone was happy with the end result, including myself, and I was reminded that everything is relative, especially expectations.

The second birth of the day that I participated in was a vacuum extraction. The charge nurse did it and I pumped the vacuum (during the procedure someone acutally has to pump in order to maintain the suction which is an incredibly tiring task). She said next week I'll do the vacuum - see one do one. One thing I won't be doing though, is cutting an episiotomy with a razor blade as she did. It was a necessary epis but with a razor?! Although I heard the midwives do this, this was the first one I saw. Your fingers and the baby's head are both less than a centimeter from the razor blade and lots of possibly HIV+ blood. And if the mother jumps?! I know the ALSO group left scissors and this practice really must change. Anyway the vacuum procedure birthed another blue baby so in one day I did two resuscitations. This little one also did fine and left the ward in her mother's arms.

The third birth of the day was another c-section. The mother, who had 4 previous births, was completely dilated but the baby was still floating high in her belly. I went to receive the baby in the OR. It made me pause to realize that I represented what would be an entire pediatric team at a delivery in the US. Thankfully the baby came out screaming so my job was easy this time.