We're way overdue on an update!
The first day at the hospital was rather overwhelming. It's so different that what we're used to of course. They had several babies born early that morning before we got there, so we only saw one birth that day. The midwife asked if we wanted to deliver the baby and suture, but we wanted to watch one of the local midwives do it at least once. They have their own routine there so we wanted to observe their way of doing things. They have 2 delivery "theaters," and each one has 2 delivery tables. The 2 rooms are connected in the middle, so you can hear (and partially see) what's going on the other room. The women are admitted when they are contracting regularly and are are at least 4 cm dilated. They are assigned to a labor bed and either labor there or wander the halls until they are really moving along and seem to be getting closer to pushing. Then they move to the delivery theater. Their standard procedure is to do active management (give medication to prevent bleeding after the shoulders are born), then give additional medication to prevent hemorrhage a short while after birth - ergometrine (methergine) if her blood pressure is ok, or more syntocin (pitocin) if it's high. Personally, I feel fine with following their protocol on this, as they don't have someone checking on their bleeding to the degree that we do at home. There just isn't the staff and the time. Also, I don't expect that they will be able to rest after they go home the way we expect our moms to at home. They seem more likely to repair tears here than we might be inclined to as well, but it seems like that's probably a good thing.
Our second day at the hospital was pretty crazy. Apparently this is a busy time of year for them, as their independence celebration was 9 months ago. :) We had several women in labor and only 2 staff midwives working. 4 women delivered within a short time of each other. Sara and I each caught one baby, and the midwives caught the other 2. I was assisting Sara while we waited for the other lady in the next bed to start pushing. We had a kind of scary moment where Sara's lady was bleeding, she had gotten her injections and her uterus was firm, but she had been bleeding before the birth of the baby's head so we suspected vaginal tears. I was holding pressure trying to reduce the bleeding while Sara went to find someone to assist and suture. It turned out she had quite an extended tear on both sides that the docs came in and sutured, using multiple suture packs, but it only qualified as a 2nd degree tear. Nothing poor Sara could have done to prevent it since it was inside, but she still felt bad. The thing about the suturing they do there is that they use 1-0 suture (much thicker than what we use), and they do interrupted stitches on the outside of the perineum. Sara referred to it as "Frankenstein sutures." (ok, I think she actually said Frankenstein crotch. nice.)
Day 3 at the hospital was just a crazy as the day before. It started out seeming more mellow, but once again we had 4 women close to delivery at the same time. I was with a young woman having her first baby. She actually told me (through her wonderful family support ladies) that she wanted me as her midwife... after the local midwife had given her a rather rough cervical check. Sara caught the babies of 2 multips in the meantime... it's kind of crazy to be in the next room able to hear what's going on, and not be able to go assist because the woman in front of me is close to crowning, and no one is there supervising me. I had a student doctor from the UK assisting me though, which was great. So nice to have an extra set of hands, even if she's new to the maternity ward! Her perineum was so tight I was afraid she was going to have a bad tear, but she only had the tiniest one. She did have a few internally that I sutured though. Again, a bit surreal to do that without supervision!
Today we needed a break, so took the free ferry over to Erakor Island to lie on the beach for a while. The water was really shallow around the island and there were starfish everywhere! It was very nice and relaxing and beautiful. Really need to take some pictures of normal island life here though, it's not nearly and lovely and gorgeous as the pictures so far might suggest.