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“Some things are not OK”: Struggle and strength on a maternity ward

When the odds of survival are against two premature baby girls born in Cameroon, US midwife Kirsti finds that amidst suffering and loss there is still hope

Twins born in Mamfe, Cameroon

I am six weeks into my mission in the remote town of Mamfe, which lies in the jungles of southwest Cameroon. 

The project here is new, and change is slow. I am either working or thinking about work. The project has its difficulties and I have my ups and downs, but I feel calm about what is in front of me.

I have been trying to put my finger on it… how in the middle of a crisis there is hope. I think for me this hope comes from seeing struggle and suffering juxtaposed with strength. 

“Some things are not OK”

To be honest it is one of the things I love about being a midwife – sitting with someone in their pain and vulnerability and seeing how tough they are. In those moments, my role is not to try to change what is, but rather create space for things to not be OK.

From my vantage point, I know that “time heals all wounds.” In labour, it is several hours or days, while in other situations it is years. Here, in Mamfe, some things are not OK. 

The people in this area of Cameroon are caught in the middle of a crisis, due to a struggle between Cameroonian security forces and armed groups. And yet, there is an underlying resilience in the people here.

It is inspiring.

Premature twins and preeclampsia

Recently, I spent several days in the MSF base. The movement of the team to the hospital was restricted due to security concerns.

This was particularly hard because prior to this security measure being implemented one of my patients had delivered premature twins.

It was so tender to see this strong man melt when he held his newborn girls

She had been admitted to the ward nearly two weeks before with severe preeclampsia – a condition that causes high blood pressure, pain and potential seizures. Her blood pressures were incredibly high and her babies were quite small, even for their gestational age.

In the United States, it is likely that we would have observed and then considered delivery. Here, however, the prognosis for preterm babies at 30 weeks is poor. So, we administered a steroid for foetal lung development, gave her a course of magnesium to prevent a seizure and started her on a blood pressure medication. 

The plan

Over the week her blood pressure got significantly worse, as did her symptoms.  She stopped being able to sleep due to the abdominal pain of preeclampsia. So, the patient and the obstetrics team decided that we should plan for delivery due to the severity of her disease.

For multiple reasons, we decided that a caesarean section was the safest for her and the babies. We scheduled her for the next day. 

I spent the morning making sure we were ready. I was so worried about how we were going to keep these babies alive.  The international staff doctor that I was working with calculated their oral intake needs, while I finished the remaining work on maternity. 

Skin to skin

The caesarean section started at four.

The two baby girls started crying soon after their birth, although the second twin struggled. She was smaller and much more fragile. The babies weighed 2 ½ lbs and 3 lbs. Much less than we anticipated. 

The doctor and I quickly modified our treatment plan. However, our immediate concern was that the babies were getting cold!

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One of the newborn girls wrapped up for warmth
One of the newborn girls wrapped up for warmth

For this, the best management is usually to place the infants skin-to-skin with the mother. Unfortunately, she was still in surgery and the electricity was not flowing to the infant warmer.

I ran to get the patient’s husband and explained that I wanted him to hold the babies against his chest. Although he appeared sceptical he was open to the suggestion.

It was so tender to see this strong man melt when he held his newborn girls. While he was holding his babies, we prepared the warmer and the IV fluids. The time was late and we needed to get back to base. So, I handed care over to one of the MSF nurses on duty and came home – happy they were alive, but very worried. 

The system

The babies survived the next week, although they lost weight every day. 

By the time I finally returned to the hospital, the second baby had developed necrotising enterocolitis – an infection of the intestines that can occur in a preterm infant.

The pain is far from over and all that I can do is to hold space for her, knowing that the suffering will not last forever

These infants needed close monitoring and care. Unfortunately, that was something that the midwives were not able to do:

The healthcare system has been so disrupted that it lacks some fundamental tools – including a safe midwife to patient ratio and even consistent resources like electricity or water.

The second baby, the smaller one, died a week and a half after she was born

The system failed everyone. 

Holding space

The mother had been on the maternity ward for nearly three weeks.

I had sat with her when she cried, knowing that these babies would be born early. And now I sat with her as she cried for the loss of one of her newborns.

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The mother smiling with her surviving daughter
The mother smiling with her surviving daughter

The pain is far from over and all that I can do is to hold space for her, knowing that the suffering will not last forever.

And, while the life of one twin does not make up for the death of the other, there is still a reason to celebrate and a reason to hope.

As for the rest of this region of Cameroon, I am sure the crisis will not end soon. But, even in the struggle of conflict, it is remarkable to see strength.

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