Feldgruppe
A day in the life

It's been a tough couple of days. The unit has quietened down a lot from last fortnight's influx of babies but as usual that doesn't mean you can take anything for granted.

It's been a tough couple of days. The unit has quietened down a lot from last fortnight's influx of babies but as usual that doesn't mean you can take anything for granted.

Yesterday, two minutes before my shift was due to finish a woman brought her baby to my ward. There was initially some confusion as our patients are normally admitted from the ER or direct from Maternity, so we were confused why she had just appeared on the unit.

She had with her a piece of paper telling us that the baby had been born premature that morning. As a general rule we send everyone that comes straight to the ward back to the ER to be assessed but knowing that it was a preemy made me decide to check the baby first. 

I was glad I did. 

As I opened the blanket the baby was pale and still. It wasn't breathing but felt warm when I touched it so it can't have stopped too long before.

Luckily the CO (Clinical Officer) happened to be on the ward so I called him. Together we attempted to resuscitate the baby. The CO gave the baby some artificial breaths with the Ambubag and I used two fingers to start chest compressions. One of the assistants radioed for the doctor and by the time everyone was assembled we had managed to get the baby's heart beating fast again.

It was still only making occasional, ragged attempts to breath so we continued to give the artificial breaths, taking it in turns so that no one got too tired. 

The guidelines are very clear for neonatal resuscitation, if after 30 minutes the baby cannot breathe for itself then you should provide oxygen but stop the artificial breathing. This clarity is very necessary; no one ever wants to accept that it is time to stop. 

After 40 minutes we stopped the resuscitation. The little boy was a fighter and continued to cling to life for almost an hour afterwards. We tried to make him comfortable, and his mother was close by when he finally slipped away.

In that last hour I couldn't help but draw comparisons to the little baby girl a few beds down.

She had also stopped breathing on her first day of life; the tiny, premature ones just forget sometimes. Luckily, she had stopped breathing just as one of my assistants had been on her way to check her blood sugar so it was quickly noticed and, luckily again, the paediatrician and I were only a few metres away. As my assistant brought us the floppy baby with the immortal words "This baby is not correct", we were able to start the resuscitation almost immediately.

The baby girl had begun breathing for herself after only a few minutes of artificial breaths, and three weeks later I'm happy to report that she never forgot to breathe again. She has put on weight and has learnt to breastfeed and we are planning to discharge her home tomorrow.

I don't know how long the baby boy had been fighting for life before he got to us. 

Reading the paper that his mother had with her we could see that the baby had been born at 11:30 that morning. He had been very unwell as soon as he was born and the attendants at the birth had recognised that he would need help to survive. They told the mother she should come to MSF. They arrived at 6pm. 

It's humbling to recognise what a large part luck plays in survival.

But that wasn't even the end of the evening's drama. After finishing everything that needs to be done after a baby passes away, and making sure that my assistants who were working the nightshift were clear with the plans for all the babies on the ward, I went to look for Mara the midwife as her shift had finished at the same time as mine, several hours before.

I found her in the delivery room with a woman in labour. Mara told me that the baby was breach so she wanted to wait and see if the midwife on shift needed any help. I'm by no means an expert but I know that if the baby isn't in the right position this can cause problems for both mother and baby so I realised I should probably stick around too, just in case. The baby delivered without incident but as soon as it was out they realised that there was another baby yet to come — twins! 

The first baby was looking OK, but I wasn't entirely happy with the way he was breathing so after we got him weighed and wrapped up warm he and I hung out for a bit while we waited for his brother to be born. It feels like a privilege to spend such a life defining moment with another person. The only time in his life he will ever be an only child, not sharing with or defined as the other half of a pair. He will never remember it or even be aware of my existence but for those few moments we shared, mine was the only face he'd ever seen, his first impressions of life were from my arms. It feels special.

When the second twin finally made an appearance he was a bit sicker than the first so we decided to admit them both to neonates so that we could provide them with the support they would need to get through their first few days.

My assistants, who thought I had gone home for the night, were surprised to see me return with two tiny babies, but once we had got them settled and their mother was recovered enough to come and join them, it was finally time for Mara and I to go home for the night.

The next morning felt like it came far too quickly but I was happy to find all the babies were doing well and the night had passed without any more drama.

I should learn not to have thoughts like that because it seems to tempt fate. Before the CO and I had even seen three of our 12 patients on ward round, Mara came running in with a tiny baby wrapped in a metallic survival blanket like people are given when they finish a marathon.

You can imagine how huge they seem when they contain a 1kg infant — it's all blanket and hardly any baby.

She placed the baby under the warmer and told me that another one was on its way. By chance she had been walking through the ER and seen two tiny babies being weighed, she recognised that they were seriously unwell so told the staff to bring them straight to Neonates where we could care for them better. 

Another set of twins! These babies had been born at home three days before but were premature and very small.

They had temperatures of only 32 degrees when they arrived and their blood sugars were also dangerously low. On the plus side they were breathing well and had already survived a few days in adverse conditions so we were hopeful they would make it.

The CO continued to check on the babies already on the ward and I stayed with the new twins to try and regulate their blood sugars and warm them up. Once they were more stable we found a bed for their mother and officially admitted them to the ward — they became our third set of twins in that room at that moment — lots of small-small babies!

Update

I'm happy to say that all my twin babies mentioned above are doing well, their mothers have agreed to share this picture with you so you can see how cute they are!

This is them at around a week old — the first two babies are the small babies that came from ER wrapped in the metallic blankets, after a roller coaster first few days they are able to maintain their own temperatures and blood sugars and are slowly getting bigger and bigger. 

The baby in the middle is a little girl that was born premature a few days after the twins were admitted.  The last two babies are the ones that were born here with MSF, happily they are both breathing well now with no requirement for oxygen.

Their mother jokes with me that Ngor (the first twin I looked after while we waited for his brother to arrive) is really my baby and she is just looking after him for me. It's easy to come to work when you know such cuties are waiting for you!