“We have the strangest job!” Susan sighed while pulling up a chair at the nurse’s station next to Jenny. Jenny laughed while continuing with her nursing paperwork.
Susan sipped her coffee as she opened a medical chart, “I just got here,” she vented quickly to Jenny, “I walked into the room of a woman I’d never met. In less than ten minutes I’d introduced myself in Spanish and said ‘I need to put my hand into your vagina and remove blood clots because you’re hemorrhaging inside. Don’t worry. This will hurt. I’ll be careful. Oh you’re baby is so cute!’ Then I reached inside her vagina, removed a liter of blood clots, and apologized. I fussed over the baby in her husband’s arms, told her to breastfeed, hugged her, and left. She will never see me again. All the while I could only think about finding this other chart, and needing coffee. It’s not even 8 a.m.” Jenny laughed again, nodding in agreement.
Susan savored the warm brown morning elixir while reviewing a chart. For a nurse-midwife, it’s the most normal thing – another vagina, baby, placenta, blood.
Marta just became a mother for the second time, each interaction was memorable in her intensity of childbirth pain, joy and fear. Marta’s previous baby had been by cesarean section; this was her first successful vaginal birth.
Marta’s uterus filled with blood after recently giving birth on the previous shift. At Susan’s request, Marta’s young new nurse had already used a catheter to empty Marta’s bladder since a full bladder can prevent a post partum uterus from contracting to control blood loss. An empty bladder and anti-hemmorhagic medications pitocin and methergine had not helped.
Susan had just arrived and needed to act quickly. She made eye contact with Marta speaking with calm certainty to keep Marta focused, “Respira produndo y sople – Breathe deep and blow.” Susan’s gaze held Marta’s eyes with exagerated nodding her head to guide Marta with deep breaths, she slid her lubricated gloved right hand between Marta’s swollen labia through her vagina until forearm-deep into Marta’s most intimate area. Susan tried not to traumatize Marta as she felt a large masses of jello-like clots in the lower uterine segment. Susan scooped several handfulls of blood clots into a pile of beet jelly between Marta’s brown thighs. Susan felt the rough texture of the inside of the lower uterus clamp down around her fingers after removal of obstruction. Gently retracting her bloody gloved hand, Susan used her ungloved hand to massage Marta’s abdomen. Marta winced in pain while her uterus tightened to a round cantaloupe inside her soft abdomen. Marta opened her eyes “Ah, me siento mejor. Gracias! – Ah I feel better, Thank you!”
Marta’s husband looked woozy as he stood aside holding their new son. He said he was fine when asked. Susan directed him to sit down on nearby sofa and wondered if seeing a stranger’s arm inside his wife’s bloody vagina would affect their relationship. After washing her hands, Susan checked Marta’s blood pressure then gently placed her hand on Marta’s husband’s upper arm, “Todo está bien ahora. No se preocupe. – Everything is all right now. Don’t worry.” They made eye contact, smiled and nodded with reassurance.
Susan felt like she violated a woman when she had to take aggressive action before having developed personal rapport with a patient. Since she just arrived on duty, Susan and Marta had not met before. Regardless of feelings, Marta was now stable together with her husband and newborn – that is what mattered.
Back at the nursing desk Susan scanned the next patient’s chart for areas of concern. She quickly reviewed prenatal blood test results, blood pressures, diabetes status, weight gain, ultrasound results, uterine growth. The previous shift’s midwife had been too busy to complete the admission process for a recently arrived obese woman in active labor. Obesity carries concurrent high risk issues for pregnancy, labor and birth. Susan learned her new patient’s medical history, and quickly needed to complete a physical exam and admission paperwork to prepare for potential surprises. She was responsible for four other laboring patients – two diabetics, one with oligohydramnios, one with elevated blood pressure whose membranes had ruptured with thick meconium in the amniotic fluid before beginning labor. It was early in the day and Susan was already behind.
Susan smiled to Jenny again, holding up the right hand with coffee cup, “Really, who would believe what we actually do, where our hands go and what we say each day? While the whole time I only thought about needing coffee.”
Jenny laughed, “My husband has no idea. He gets nauseous if I mention even a little about work. Oh, I have a student nurse today, she’s been trained and is doing all my work for me. You’ve met Olivia before.”
“Hi Olivia! Good job! You’re lucky to be trained by Jenny. Thanks for taking care of the woman in room 20. She seems stable now so I’ll be in later; I have to check on some other worries first. Call me for anything.”
Jenny laughed, “You know we will!”
Susan stood up to meet this morning’s laboring women and their families.