Baby's posterior birth in PNG - Rebecca's Story
After my last baby (born unexpectedly at home), we were bound and determined to get to a hospital this time. When I started having slightly painful contractions at 39 weeks, we finished up the family evening prayer time at 7 pm and called our babysitter. We did not stop to put the big kids to bed or make school lunches, aware as we were that there would be a Covid-19 test I had to pass in the emergency room before they even let me on the ward. I had heard there was a birthing tub and I wanted to use it.
We arrived at the hospital and contractions had slowed down a bit. They put me in a triage bay and it became clear that laboring women did not fit into the expected patient behavior in the ER. I declined repeatedly to lay down, pacing and squatting in the narrow space between the bed and assorted medical equipment. I declined the antibiotics, IV painkillers, and anti-vomiting medicine when I threw up. My contractions stayed about four minutes apart. After two hours, I was heartily sick of that triage bay, and very glad when our Covid-19 tests came back negative and I got a ride to the maternity ward.
The maternity room did have a large, deep tub, a shower, and a birthing ball. Things were looking up. I gave my medical history to the midwife on duty. She checked my dilation and proclaimed me 4 cm. I declined to have my water broken. I had to endure 15 minutes of external fetal monitoring, laying down with the monitors strapped to my belly. When I got up my back was really uncomfortable. (Hint, hint). The midwife left us and I roamed around the room, leaning over during contractions and getting counter pressure from Brandon, or bouncing on the ball. The contractions intensified, but not to the point that I had to make noise. Around 2 am I was getting discouraged, so Brandon suggested I lie down and try to rest. We got about 3 hours of patchy sleep. When we decided to get up around 5 am, the night midwife checked me again before going off-duty: 6 cm, and no, I still did not want my water broken or painkillers.
The day midwife arrived and introduced herself, and said that she understood we wanted a natural birth (finally, someone who got it). She put the fetal monitor on my belly just for a few minutes, not even strapped on. Then I headed for the tub, and, it was even more glorious than I had imagined. It filled quickly with hot water, and the sloshing over my back during a contraction was delightful.
After some time, Brandon talked me out of the tub (he wanted to go get himself breakfast, and thought I should eat mine). I moved to the shower to rinse off, and that was equally glorious. The water pressure was amazing, and with the hot water pounding on the small of my back I could barely feel the contractions. A towel finally arrived, and I got dressed and went to see the breakfast.. which was slices of untoasted bread, two hardboiled eggs, a slice of processed cheese, and a salad with onions (?!). I grudgingly ate some egg to supplement the dates I had been noshing on and resumed my roaming about the room.
Something weird about this labor was that I kept bleeding. Mostly it was just like a semi-continuous bloody show, but during one contraction there was some splashing of blood on the floor. The midwife barked, “On the bed! Do you have an IV line in your arm?” Me: “Yes, they put it in at the ER, why?” Midwife: “So we can give you medication in an emergency.” Me: “…Is this an emergency?”
After an internal exam she determined it was not, in fact, an emergency, and that I was at 8 cm. The floor was cleaned and I resumed moving about, laboring. The contractions were now painful enough that I had to vocalize through them. I was feeling low and wishing for the rice sock I had left at home, when Brandon had the idea to fill a nalgene with some of the nice hot water in the bathroom. Pressing it against my lower back in a contraction helped a lot. The heat from the water bottle helped my mind interpret my pelvic sensations as heat as well, rather than pain.
It was now about 10:30 am and I was exhausted and discouraged. I was laying draped over the birthing ball, almost falling asleep in between contractions, and wishing my water would break already so that I would be in transition and have the baby, when there was a change in the contractions. I thought, oh yeah, I remember, this is how it needs to hurt for the head to come out. Soon I was catching my breath and grunting slightly during contractions, and the midwife told me again to get on the bed.
I managed to endure being checked for dilation while having pushing-adjacent contractions, one of my least favorite parts of labor, and was cleared to assume my birthing position. I overhead the midwife explaining to the trainee doctor in the room that knee to chest was in fact a normal position for a natural labor. My water finally broke after the first few real pushes. The midwife really shone during pushing, helping me breathe through contractions, and Brandon was busy encouraging and keeping me clean. The top of baby’s head appeared, and she told me to wait and push with a contraction. Then the baby’s head came out– face up! This is why my back had been killing me for hours! After an excruciating wait for a contraction, with the midwife’s help in positioning so I wouldn’t tear, I pushed the rest of the baby out!
It’s a boy! Brandon received him in a blanket. I wanted to get off my hands and knees and hold the baby, but the midwife was doing something with the umbilical cord – collecting some cord blood to find his blood type. I reached back and touched his little foot. After the cord was cut, the baby went to get cleaned off and weighed (3.57 kg/7lb,13oz), and Brandon went with him. I was getting resettled on the bed, pushing out the placenta, and being checked for internal tearing (my other least favorite part of labor.) No tearing, or hemorrhaging, despite all my contraction bleeding, praise the Lord and pass the dates.
A nurse tried to get me to put on a hospital gown again, but I explained that I wanted to nurse the baby. He came in all swaddled up and I finally got to see his little squashed face. He latched after some licking and sniffing. I declined more antibiotics (I didn’t tear, after all), IV painkillers, and opioid painkillers. A pediatrician came by and gave Benedict a once-over. He gave me a pep talk about breastfeeding and vaccination, and I assured him blearily that I was a great believer in both.
My blood pressure was low so they had me stay in the birthing room for a few hours while I ate lunch, dozed, drank lots of water, and talked names. Benedict had been Brandon’s boy name choice for the past several pregnancies and I finally came around to it. It honors Pope Benedict XVI, and the nickname Ben reminds us of Brandon’s late college roommate. Martin is for Brandon’s father and grandfather, following our grandparent naming pattern, and honors St. Martin of Tours, one of Brandon’s favorite saints.
After another lovely shower and a discussion about when I could leave the hospital (they were shocked by the idea I might go the same day I had the baby, and we decided to stay and recover lost sleep and blood) so we moved to the postpartum room. Our babysitter stepped up to the challenge and put four kids to bed for the second night in a row. In the morning, after another breakfast mysteriously containing salad with onions, I had my belly squished, hemoglobin checked, declined one last round of antibiotics and habit-forming painkillers, and we were free to go introduce Benedict to his sisters and brother.
To my friends in-country who might be considering this hospital, I would say it is worth it for the labor ward amenities and midwives. However, bring your own towels and wipes, be prepared to pay for everything the staff use down to the gloves, and above all be able to advocate for yourself.
Rebecca kindly allowed me to share her story which she had written in her blog. If you'd like to read more of her posts, check out this link: https://plotinusinthejungle.wordpress.com/ and her other birth stories can be found here - Unassisted sudden home birth - Rebecca's Story and Dad's experience of birth in PNG - Rebecca and Brandon's Story