A Birth in Dominican Republic!

Christina Cummings and I had the opportunity to be in clinical at the hospital on Thursday under the guidance of two midwives from the University of Massachusetts. As mentioned in a previous post, there are multiple women in each room. We started out the clinical day in the post-partum room where we performed newborn assessments. Often, newborn assessments are not completed unless the newborn is in obvious distress. This can cause serious problems to be overlooked and not identified immediately. There were a few pre-nursing students that came with the midwives from the University of Massachusetts. Because Christina and I did newborn assessments in our maternity rotation, we were able to help teach the other students how to assess the babies.

After we did newborn assessments, we went into the room for women waiting for Caesareans. This provided Christina and me the opportunity to learn about antenatal care in an area of low resources. Unlike most places in the United States, electronic fetal monitoring does not occur. We were taught how to perform Leopold Maneuvers to figure out the position of the baby in the mother’s uterus. By doing Leopolds, we were able to estimate where the baby’s heart was and use a fetoscope to listen to the baby’s heart and take heart rate. It was so incredible to be able to hear the baby’s heart beat while still in utero, but it was even more amazing to watch the mother’s face when we let her listen. We were able to do this for a mother with twins also so it was informative to compare what the Leopold’s felt like for a multigestation pregnancy compared to just one baby.

From there, we moved into the early labor room. These women all were having vaginal births and were less than 7cm dilated. A few women were on Pitocin to augment the contractions to speed up the labor process but no pain medication was given. Christina and I provided labor support by fanning them to keep them cool, holding their hands, encouraging them to change positions, and rubbing their bellies during contractions. One lady had been there for several days and had not progressed in cervical dilation. Fear was etched across her face and she kept asking why the pitocin wasn’t working as she had been at 4-5cm for 8 hours. The doctors said that if she didn’t progress to 8cm by 3pm that day, they were going to section her. Therefore, food and water were withheld from the patient. However, this was not communicated to the patient and she was obviously frustrated and scared of what was going to happen to her. One of the midwives really advocated for this patient to have her pitocin turned up because there was really no need for a section. We found out the next day that the doctors listened to the midwife and once her pitocin was turned up, she delivered vaginally 3 hours later. This experience speaks volumes about the role of the nurse in patient advocacy. Because this midwife acted as the patient’s advocate, the patient was able to deliver in a way that was healthiest for both her as well as her baby and in the way that she wanted to.

While we were there, one of the other ladies broke her water and after a vaginal exam was performed to check how dilated she was (no privacy), she was taken into the closed off area of the maternity floor to deliver. Christina and I went with her and in less than half an hour later and after Christina excitedly yelled “Empuje, Empuje!” many times, she delivered a beautiful baby boy. Christina stayed with the mom as she delivered the placenta and I went with the pediatrician and the baby. The babies are not washed but are just dried with a towel. One of the practices that the DR doctors do is stick an NG tube down the baby’s trachea because they believe that it helps to suction the fluid out of the lungs. However, there is no evidence to this practice and actually can hurt the baby. No footprints were taken but weight and measurements were. After all of this was done, the pediatrician handed me a diaper, a baby cap, socks, onesie, and a blanket, and mittens for their hands. I dressed the baby, swaddled him in the blanket, and then gave him to his mother
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No words can describe the beauty of pregnancy. How incredible it is that two people can create another being that grows and develops inside of its mother. It fascinates me that the baby knows how and when to be born and the process by which it transitions from intrauterine life to life outside the uterus. Watching all of this unfold at clinical was breathtaking and it was beyond an honor to share in this moment with the mother and the baby, whom was named Jahle (spelling unknown). I felt undeserving of the privilege to dress the baby for the first time and to hand the baby to his mom and was unable to do so without beaming with tears in my eyes. Yes, birth is messy and laborous, but it is nothing short of absolutely miraculous.

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