It’s after 3 am, and the buzzer rings by my bunk bed. I bolt up, and run to the Delivery room. This is Dulag, the heart of the Disaster zone, where Typhoon Haiyan devastated the Philippines. The buzzer means there is a birth emergency. “Lola (grandma) Robin, we have a footling breech, first time mom, fully dilated!” Lorina shouts, and the electricity goes out. “Black out!” our nurse Faye yells, and someone quickly switches on the Solar Suitcase.
The solar light is strong and yet, so much more gentle on our eyes than conventional light, which was so recently restored to the disaster zone. We can see that Marie Joy’s baby’s foot is already emerging. Midwives are meant to transport the footling breech births to the hospital, just in case the baby’s head becomes entrapped and more technical care is needed. There is clearly no time to make it to the hospital, 1 ½ or more hours away. The road is rough, and our ambulance bears no resemblance to the lovely hospitals-on-wheels that people in the wealthier parts of the world are accustomed to. Our sweet ambulance has helped us save lives, but she’s not much more than a cookie tin on wheels. It would be far more dangerous to deliver this baby en route to hospital, than to attempt to safely deliver her right here. The dependable solar light is a real consideration, for we really do need to see.
We midwives are gloved up and helping Marie Joy into a kneeling upright position on the delivery bed. Our nurse, Faye, checks the neonatal resuscitation kit. It’s always ready, but we don’t want to take any chances tonight.
Strong contractions, and the baby is born to the waist. There are tense minutes as Midwife Lorina uses her skilled hands to lift the perineum off of the umbilical cord, to stop cord compression, so the baby will still receive oxygen rich circulation via the placenta and cord. It’s virtually a life-line. Darn it, the baby’s arms are above her head; gently I sweep them down, one by one. That goes well. However, the baby’s chin is deflexed, the head is not going to slide out easily. Midwife Lorina is still protecting the umbilical cord from compression. I gently support the baby, cradling her butt in my hand, and ask Midwife Nienke (volunteering from Holland) to put pressure on the mother’s abdomen, to cause the baby’s chin to flex. The baby is beginning to jerk, as if to gasp to take a breath, but her head is still inside the birth canal. I insert my index finger into her mouth and with Nienke flexing the head from the front of the mother, while I lift the tiny butt, to relieve the strain on the baby’s neck, the tiny face sweeps the mother’s perineum, and her head comes free.
Too soon to celebrate, the baby’s APGAR score is only 2. I begin neonatal resuscitation. This baby girl is transitioning to life outside the womb slowly. Her heart has been beating steadily all the while, so we are not too worried. Breathing for her, with the bag and mask, is a precise procedure, we must position her head and neck exactly, and see her tiny chest gently rise each time we help her breathe.
“Do you have a name for this baby?” I ask the young father. Both parents are but sixteen years old. “We want to call her Josie,” he responds, his voice shaking. He knows his baby is still between worlds.
“Josie, come on Josie.” says the new mother. The placenta is now being born. Seventeen minutes pass, and finally the most beautiful sound, Baby Josie’s first cry, she can breathe on her own!
We look after Baby Josie and Marie Joy, with extra vigilance. Finally after a couple of hours of nuzzling the breast, Josie latches on, and breastfeeds. The sun is rising, and this midwife runs across the road, to jump into the Pacific Ocean, the same ocean that last November delivered the biggest storm in recorded history, to this shore. This dawn, the water is warm, there are no waves, no wind, just the most gentle ocean ever. I look at the clinic, where a tiny breech born baby is alive, and I scream: “Thank YOU!” to the red and golden sky, for I am sure Angels are watching over us.
Robin Lim, CPM is the Director of Bumi Sehat International who brought the first Solar Suitcase to the Philippines after Typhoon Haiyan. She sends special thanks to We Care Solar, Dr. Laura Stachel, Christy Turlington Burns & Every Mother Counts, Direct Relief International, Ibu Tina & Ibu Anie of Wadah Foundation and Harapan Wanita Philippines, plus All of Team Bumi Sehat International… our Earth Angels. As for the Divine Help, we bow down in gratitude and smile.