Its 23:00 and I walk in for the night shift. The head midwife for the evening shift looks up at me, "Gila"? She doesn't even need to say the words.
I know.
Its funny how quickly the bizarre becomes routine. Humans are exquisitely fragile and resilient at the same time. We are always adapting, adjusting, and moving forward subconsciously through the challenges that life throws at us.
I get the gown, mask, face shield, gloves, shoe and hair covers, and go.
I arrive at the Corona ward where there is a woman having her 11th baby. She is bleeding.
A lot.
The midwives from the evening shift are treating her and monitoring her very closely. This situation is fluid yet critical. One the one hand she can delivery quickly due to the fact that she has had multiple uncomplicated deliveries, on the other hand she is not currently stable. She could bleed a critical amount putting her life, and the life of her unborn child, in danger.
It is the cornerstone of our profession to believe in, and support, her ability to progress and deliver in her own way, all the while disturbing her process as little as possible.
The midwives fill me in. She has not been bleeding for long. She is currently stable but she isn't progressing and the head is very high. The evening shift leaves and it's just the two of us.
The birthing mother looks at me in the eyes, the only part of me visible to her, and with tears in hers she says, "I don't want a Cesarean Section". I look at her, straight in the eyes, and answer, "I don't either. Lets get this baby out".
This baby is very very high. For whatever reason (and there are many) it had not entered the pelvis in the ideal position. We began to work. I flip the mother into every position under the sun in an attempt to maneuver the fetus into the pelvis. She is pushing and sweating and giving every ounce of her soul. But she is still bleeding and her baby isn't descending.
Finally the blood loss is simply too much. The attending physician is called. I explain to her that her life is truly in danger and we need to get the baby out now. She understands. Tearfully we move on to a Cesarean Section. The physicians begin to cut. She feels pain. We need to move on to general anesthesia. She grabs my arm, "don't leave me", she says.
"Not for a moment. I will be here when you wake up". I answer.
"Don't let me die." She responds.
General anesthesia requires a process called intubation where a tube is entered into the woman's mouth and lungs in order to help her breathe. It is also the procedure with highest rate of Corona infection for the medical staff. The anesthesiologist does this day in and day out for COVID-19 positive and negative patients. Without the slightest hesitation he intubates, and stabilizes the patient.
A few moments later we deliver a baby with the cord wound tightly 4 times around his tiny neck, crying and wriggling in defiance. He is handed over to the waiting midwife outside.
We finish the c-section and I sit and wait for her to wake up. She is groggy and asks over and over about her baby. I remind her again and again that is he healthy and fine and in the nursery. She asks for pictures and information again and again. When she finally returns to herself I sit and talk with her. She describes a sense of failure and trauma. She is profoundly disappointed that her birth ended in a c-section. She asks over and over, is it related to the Corona? Are they connected? I assure her that the two are not related. I wipe her brow and hold her hands in mine. Her pain and sadness are palpable.
She stays in the Corona recovery ward to be monitored for a few hours while I am called back to the Labor and Delivery ward to assist.
As I remove my protective gear the tears fall from my eyes. I so badly wanted her to have the birth she imagined. I so badly wanted it to be perfect within the chaos and uncertainty of COVID-19. I begin the long walk back to the Labor and Delivery floor wiping my eyes. My phone rings.
"Gila. Don't move. The next one is on her way. Ruptured membranes. Corona positive. Pushing. ETA 8 minutes."
I turn around and walk back.