Notes from Guatemala: Window into delivery

Here’s the second installment from our amazing Saving Mothers volunteer Jackie Candido, writing to us from Santiago, Guatemala about her experience at the Hospitalito Atitlan.

An OB patient arrived at the Hospitalito today for rule-out labor, and it was like Christmas for the Hospitalito gringos.  Anjie, our UVA med student, is dying to do her first delivery.  Isobel, our nurse educator, is dying to pick my brain about all things OB.  And I, our only experienced maternity care provider at the moment, am dying to feel useful here. 

Matt, our ER MD, however, was less ecstatic, as he seemed sort of terrified at the prospect of managing a labor patient (he admits that at home in Kentucky, his goal is to transfer “pregnant women out of the ER and onto the labor floor as quickly as humanely possible.”  He may have thrown some more colorful language in there as well, but I´ll try to keep it clean here.) 

So brief SBAR on this patient: 28 year old G3P1 (1 prior NSVD without complications, 1 first-trimester SAB) at 40 weeks and 1 day, presents to clinic for routine prenatal visit and reports feeling occasional painless contractions.  Denies leaking of fluid, denies vaginal bleeding.  Denies complications with the pregnancy.  Clinic sends her down the hall to us for evaluation and to rule out labor.  FHR Category I, mild contractions every 6-8 minutes. 

Matt examines her and reports that “she’s maybe 4 centimeters?”  (I’m sorry Matt, not likely). At my suggestion, we had the patient walk around for 2 hours and then reexamined her.  "Actually I think she’s now only 3 centimeters, but she lives far away so maybe we should admit her," says Matt.  I look at this smiling patient and she tells me “no tengo dolor.” Ok. Not in labor, please go home and come back when the pains get worse, thank you for coming to the Hospitalito for all your maternity needs. 

As this was my first maternity experience in Guatemala, I have to say I was shocked at how SIMILAR it was to the US.  I think some aspects of pregnancy are universal.  For example, this patient and her husband both repeatedly asked me when I thought the baby was going to come, how much longer, how many more hours, how many more days?  Si

nce not a shift goes by in NY without full-term women presenting with the same inquiries, I had always assumed this was some sort of “impatient American” (or maybe “impatient New Yorker”?) thing.  But perhaps this is just an “impatient pregnant woman” thing.  No judgment, as a G0P0 I know I can’t relate to feeling 1,000 pounds, sweating constantly, getting short of breath with the slightest exercise, and having on-again-off-again Braxton Hicks contractions while an 8-lb human being karate kicks at my uterine wall (well, maybe after a particularly big meal, if you substitute “pasta bolognese” for “human being”). 

This particular patient and her husband both seemed shocked to learn that it’s totally normal for a baby to come up to 3 weeks before or 1-2 weeks after the so-called “due date.”  This also seems to be a universal issue with pregnant women. I have to wonder, is prenatal education just nonexistent anywhere in the world, or is it just that NO ONE ANYWHERE EVER seems to remember this tidbit from their prenatal visits? 

Women’s Health Care Providers of the World, I call on you now to join me in my campaign to ABOLISH THE “DUE DATE.” In it’s place, I propose giving pregnant women a “due month,” consisting of gestational ages 37-42 weeks. Maybe giving pregnant women a more realistic time line will prevent them from wanting to jump off a cliff (or shove 6 Misoprostols up their lady parts) the second the clock strikes midnight on day 40+1.

In the meantime, I anxiously await my first birth at the Hospitalito.

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