Baby Face

Baby face

Awe.  It’s so cute.  That’s what I say most of the time at cute, little babies that have just been born.  But this baby is certainly NOT cute.  She is plain UGLY.  She has an ugly face.  

But it isn’t her fault.  And it won’t stay ugly forever.  I hope.  

The mama came in while the midwife, Sabine, and I were doing maternity rounds.  Fideline called Sabine away from me for an emergency.  I waited for a minute, then Sabine called me for a dead breech baby.  

This lady had nine deliveries, and had been laboring for a long time.  She was at a few different health centers before finally being referred to us.  

I quickly put on a glove to examine her.  She’s about ready to deliver a baby.  About four centimeters of baby is pushing out from her, but it’s not breech.  Breech is a baby being born butt first and folded up, followed by legs and belly and finally head.  This is not that.  It looks like a baby butt.  But it’s not a butt.  It’s a face.  It’s a baby face.  And it clearly looks dead.  The mouth is wide open.  The tongue is stiff and not moving.  The skin is macerated even.  They did not find a heartbeat either on initial exam.  (It takes a while to get the ultrasound, so I didn’t bother).  

This poor lady has been in labor for a long time.  With the difficult position of the baby, coming out face first, the baby just won’t deliver.  The poor baby face has had multiple fingers poking at it, thinking it was a butt, and it was all black and blue.  The baby mouth, fingers poked in it, thinking it was a butthole.  The baby eyes.  Fingers poked in it.  Not sure what people thought the eyes were.  All from people who did not know what they were feeling, so they poked more to try to figure it out.  

I feel bad for her, so I’m going to cut an episiotomy to help her deliver faster.  I explain to the three nursing students about mentum anterior and mentum posterior, which one would deliver vaginally and which one wouldn’t.  If the chin is up, she can deliver vaginally most of the time.  Luckily for her, the chin is up (mentum anterior).  

As Sabine runs off to find another delivery kit that actually had scissors (we had taken the scissors out of this kit to use them to remove stitches on rounds), I stay with the patient and push with her.  She quickly advances the head farther out, and in a few short pushes delivers the head and then body.  

The lifeless baby lay in the amniotic fluid on the table as I clamp the cord and wait for the scissors.

Soon Sabine arrives with another kit that contains scissors for my episiotomy, but realizes I don’t need them.  As I wait (maybe a minute after delivery), the dead baby kicks her leg.  What?  Is this baby actually alive?  How could that be?  She’s got rigor mortis in her face.  Her ugly, ugly face.  Her tongue is stiff.  

I quickly cut the cord and bring her over to the delivery table to listen to her heart.  Somebody gives me a stethoscope.  No heartbeat.  

That was weird.  Why did her leg move?

I clean off the ugly, ugly face attached to an otherwise perfect corpse.  Her arm moves.  

Definitely not breathing and no heartbeat.  But extremity movement???  That’s not right.  

Okay, there’s life in this baby.  

Maybe the stethoscope wasn’t working well.  Hand me the ambubag.  

I started breathing for the baby.  This baby has rigor mortis.  Of her face.  Her tongue is stiff from being dead so long.  

The ambubag wouldn’t bag properly.  I remember our oxygen machine is still broken.  Either it’s broken or the plug is broken.  Not sure which.  The alarm had been going on for many many months now after it had been turned on for just a few moments.  We just figured it was dirty, like everything else gets in dry season.  

Olen’s gonna kill me, but this little kid wants to live.  I left her for dead the first minute of life, and now she wants to live.  

I quickly rub alcohol on the baby’s face and start mouth to mouth.  It’s the only way I can get a good suction over her nose and mouth with it being so stiff from edema.  

I’ll just try a little bit.  There is no way that this kid is going to live.  It’s already been a few minutes and been oxygen deprived.  

I breathe for her.  I get good suction with my mouth and breathe life into her lungs. 

Sabine helps me by doing a little cardiac massage.

I listen again.  She definitely has a heartbeat now.  Though slow.  

More mouth to mouth.  

After a few minutes she starts taking breaths on her own.  

Her face is black.  Not from the melanin her genes put in her skin.  From being prodded so much before she was born.  It’s more like a purple black.  Stiff.  Her mouth still is so swollen.  Her tongue is still stiff and cold.  

I breathe more for her.  We stop CPR since her heart is beating now at a normal rate.

She starts breathing on her own.  

Well, I guess she’s living now.  

Now what?  

Antibiotics and steroids.  Her poor little throat is so swollen.  Everything is swollen in that ugly, ugly face.  

Sabine gets a IV line on her beautiful little wrist and we start antibiotics. 

I don’t know how in the world this child is living.  She’s a fighter.  

I finish maternity rounds.  I finish surgery rounds.  I do 3 surgeries.  Slow season is starting, so there aren’t as many surgeries now.  There are a few hernias that want to be done, but they only paid today, so I make them wait until Monday.  Where in the world can you get drive through surgery, except here?  We often do hernias the same day they pay for them.  But I’m tired.  It’s Friday afternoon, and I make them wait.  I get to hear the complaining of the patients who have to wait.  

I go over to maternity to see if our EMR system is working over there.  I had someone cut down some banana plants today that were blocking the signal, and am pleased that it is now working.

I check out ugly, ugly baby face.  She’s still breathing.  The family had tried to give her something to drink.  Not sure if it was water or milk, but I tell them to not give her anything for a day because they are probably going to pour it down her throat and into her lungs.  I ordered an IV dextrose drip.  She is breathing loudly.  I stimulated her by rubbing her back and she actually cried!  It was a croupy cry, but still a cry.  She was sucking a tiny tiny little bit on my finger, but her mouth is still pretty stiff.  At least her tongue is a bit softer now, but still pretty hard.  

I hope and pray that the swelling goes down, and that she lives.  Cute ugly baby face.  If she lives, God’s got big plans for her!  And her beautiful face.