Delivering babies in South Sudan: How did I get so lucky?

Kirsti is a midwife from the USA. She is currently working for MSF / Doctors Without Borders in South Sudan, where she's helping to ensure women have a safe place to give birth...

Kirsti Rinne

I love what I do.

I love it for so many reasons. One thing that is so special about what I do is the universality of it.  That women, all around the world have this shared experience – whether they live in a developed setting with safety and food security or whether they live in the middle of South Sudan, where nothing is certain. This common human condition spans distance and culture.

Regardless of what setting I am practicing in women often light up the first time they hear their baby’s heart beat (usually early in the pregnancy) and the first time their baby cries. On most occasions it is a celebration and for me, it is a sigh of relief.

Image shows Kirsti Rinne, MSF midwife, standing next to a Doctors Without Borders Land Cruiser

Kirsti at work. Photo: Jason Rizzo / MSF

Very rarely, however it is a moment of panic. But, since I’ve been here I’ve had three neonatal resuscitations.  I’m sure two of those resuscitations took years off of my life; I wasn’t sure those babies were going to survive their births.  On both occasions the infants came out blue, floppy, and covered in thick meconium stained amniotic fluid.

When a baby is born, it is often clear within 10 or 15 seconds whether or not is going to need help transitioning to extrauterine life. Here, I have fairly limited resources to resuscitate an infant, and no one to help. So at delivery, I am especially desperate to see any signs of life.  

 Every day that I work, everywhere that I work, I get to witness something universally incredible

Tuesday was my most recent of the two resuscitations.  I had been called to the ward at 10pm to evaluate a patient who, in the end needed some acetaminophen and reassurance. There was another woman laboring with her 5th baby.  For some reason, I decided to stay around for the delivery. Generally, my local colleagues attend normal deliveries and assist me in complicated cases.

The patient’s labor slowly progressed and once she was dilated to 10 cm, she pushed for nearly 20 minutes. The baby’s heart rate was present, but when we listened I could hear it decelerating with every contraction. When the baby delivered, he was placed on his mother’s abdomen. I immediately recognized that the baby was not going to breathe with only a foot rub or back massage – like most babies will.

Photo shows a smiling young woman in a black and white dress

The mom, smiling at her check-up appointment, one month after giving birth. Photo: Kirsti Rinne / MSF

I transferred the little boy to the resuscitation table, grabbed an ambu bag, and began pushing air in to the baby’s lungs. I had a difficult time getting the chest to rise because the mouth and lungs were so full of meconium. I could feel the pulse getting slower as I attempted to provide this baby with the air it needed to survive. 

Mario, one of my most capable colleagues, cleared the nose and mouth with a meconium aspirator. Only then could I finally oxygenate the baby’s lungs. The heart rate started to quicken and slowly the baby let out a weak cry. 

I caught the eye of the worried grandmother and mother (who was now hemorrhaging). The two women were notably relieved to hear this new baby whimper. I gave a weak smile in an effort to reassure them that he was going to be fine. But the truth is, I wasn’t sure, and I am still not sure. But for then and for now, he is alive and breathing. So in that moment, I let out a sigh of relief, before attending to the mother’s bleeding.

Image shows the baby sleeping peacefully after his check-up at the MSF / Doctors Without Borders hospital in Lankien

The baby sleeping peacefully at his one-month follow-up appointment. Photo: Kirsti Rinne / MSF.

The rest of the week was more of the same: labors, infections, abscesses, kala azar (a neglected disease that results from being bitten from an infected sand fly and which is fatal if untreated), and malaria. I was grateful for my South Sudanese midwife colleague, Tabitha. I could not have coped without her. 

When Friday rolled around, I was relieved that the day was a bit slow. I had a moment to catch up on paperwork, and then help out in the prenatal/postnatal clinic. Since my Nuer language skills are so limited, I examined patients while the medics asked questions and helped me communicate. 

One of the patients came to clinic for her first prenatal visit at about 20 weeks. She laid on the exam table while I felt her belly and looked for the baby’s heart beat. It took me a few moments to find it, but when I did we both looked at each other and smiled. I could see that this was a special moment in which she got to connect to her baby – I felt privileged to be part of it. 

How did I get so lucky? Every day that I work, everywhere that I work, I get to witness something universally incredible.