Life in Thaiville - Baby delivery, third welrd style

[The Snark]

A fun little adventure that wanted to get written. There's some medical jargon to follow so you wusses can head on over to the popular hack and slash video game web pages.

A Thai friend who knew what a paramedic is got word and passed it along. A friend of hers was having a baby out in a village and would I go along and assist. What the heck. That's one way to while away a few hours.

I got crammed in the back of a truck and was introduced to the person I was supposed to assist. A nurse wearing that idiotic white skirt and blouse and even the silly hat. She spoke some English so we chatted it up. My concerns started ringing alarm bells when I was informed that Nursey's sum total delivery experience was she had watched a birthing at her teaching hospital. Hrrm. I go for more clues. Did she know CPR? Yes! Had she ever performed it? No. The more I delved the more I was uncomfortably coming to the realization she was going to come in as handy as a counterweight on a possum catapult if things went down wrong.

My consternation kept growing as we traveled. We were on a dirt road, apparently heading for Siberia via Tibet. As we climbed, now on roads the old mountain goat feels at home on I started doing some calculating as to our response time to a hospital. By the time we pulled into the village I had a rough calculation of 3 to 4 hours and I had this little nagging voice in the back of my head whispering, 'Dude, you just might do the airway gig OR the compressions for that long but Nursey is not in the cards for the other factor and you sure as heck aren't going to cope with an A bleed in the process'.

But I had done several years of paramed in Humboldt County Calif where men are men and sheep are nervous. I've had more that a few trips into the boonies where the chopper came to grab the patient and the unit went back to the barn behind a tow truck. Tough it out old bean.

I get introduced to the family then let into the inner sanctum of mom. Wrong. Everything is WRONG! Some missionaries had cruised the place in the recent past and extolled their wisdoms regarding medical whoopees. Mom was in isolation. Lying flat on her back on the bed as their instructions had been. All doors and windows shut and alone except for some elderly relative making her lie still and giving her something to drink now and then.

I yarded Nursey in as translator and read the riot act. I had her explain this was a job just like working the rice field. Mom is in charge. Being in charge she can do anything she pleases, move anywhere, and do whatever she wants to feel comfortable. Next I threw open all the doors and windows and invited all of Rabbits female friends and relations into the room. I then had Nursey give the breathing lecture and had to demonstrate myself the various positions mom could take to relieve discomfort. When I got to on my hands and knees all the women got to giggling.

It didn't take the women long to get a party going. Yes, bring in the food. I didn't happen to bring any general anesthetic along so mom can chow down all she wants. If she does the big spit later that's fine. Birthings aren't exactly neat affairs anyway. The gals got to laughing as mom tried out the panting and all joined in. Meanwhile the men outside were wondering what the heck all the laughter was about.

I was relieved a bit at mom. Her second kid, strong as an ox farm worker, and well into labor her vitals were normal and steady as a rock. I tried to get Nursey to give us an idea of the dilation but apparently some piece of equipment she had been trained to use wasn't present and she was not up to snuff in the ad lib and make do world of field medicine. Getting it across to stick her fingers into the cervix to measure sent her into a nervous decline.

That was about the time I discovered we only had the exam gloves I had scrunched into my field med pack, none near sterile. I wasted half the Betadyne I was packing to give my hands a pseudo surgical scrub, then got mom to render her genitals unto Ceasar and checked. HOLY MOLY. There she was, panting and laughing at over 3 fingers... around 9cm. Well into sharp contractions. Serious trooper! I also felt a smooth rounded object. Somebody wanted to get in on the party and was ready for the trip down the canal.

From there on it was pretty textbook. Mom liked the ultra low stool. We laid out clean cloth under her and I demonstrated standing behind her so she could lean against my legs. My next grope in her privates and no checking the cervix that time as somebody was in the way. Then mom leaned back and I had to work to steady myself and out she squirted. I got Nursey to relieve me so I could take care of business at the other end. It all seemed to come down so fast but it was one of those out of time things. I felt as if I had just got there but an hour and a half had passed.

I got the squirt onto mom's bare chest and skin and fussed a bit but tried to be unobtrusive. My training was textbook but most of my practical knowledge was birth without violence LeBoyer style. I resigned to loose another pair of Kellys for the umbilical clamp, got what vitals I could then just backed off to observe. Squirt had found a nipple and we had about 8 midwives in on the action. Very cool beans.

I took a break, went outside and informed dad and family they had a pooying. I put away 3 bottles of water then went back to do my chores. As I was delivering the afterbirth dad's curiosity overwhelmed him. He came in, took about 5 steps, saw the afterbirth and pure Hollywood B movie. He went over like the proverbial poleaxed steer, flat on his back. Grandpa came in a few moments later, took in the scene, snorted when he was told what happened to his son and went back out. A few moments later he came back in with a bucket of water which he unceremoniously poured in dad's face. The women were roaring with laughter.

As I rode back down the mountain it was good. I'm past it now and that would probably be my last birthing. A really wonderful way to take my leave of that part of my profession. I met mom and dad by chance at a salat quite some time later. I didn't recognize them but they recognized me. A young girl materialized at my side, took my hand and grinned up at 'her uncle'.

[Thanyaburi Mac]

Great tale of life in NE Thailand, thanks!

Mac

[jack71]

another guy writing a book

[krisb]

Hang on, hang on, at what point did you stop off to grab a few Leo's?

How can you possibly be expected to be a Thai Issan Midwife without Leo's?

P.S, how much did you get paid for these stories?

[Seastallion]

A few things don't add up here (and previous posts)

I have enjoyed the waxing lyrical on the past 3 posts, but I'm beginning to feel there is an element of fantasy in the OP's writings.

OP, if you are writing fiction, please declare it, otherwise be prepared to face scrutiny.

[The Snark]

A few things don't add up here (and previous posts)

I have enjoyed the waxing lyrical on the past 3 posts, but I'm beginning to feel there is an element of fantasy in the OP's writings.

OP, if you are writing fiction, please declare it, otherwise be prepared to face scrutiny.

Scrut away, old horse. For what it is worth, (satang on some of the forums nowadays), I have no reason to BS. If anything I tone it down. But, and I'm not accusing you, I don't brook trolls gladly as the saying goes.

So, as the rock man suggested, paraphrased, I feel some negative vibrations from somewhere. Don't go getting yourself all wrapped up in a jamb so out with it. But lay it on me easy like.

[David48]

Fact or Fiction ... I enjoyed that read ...

[Mossfinn]

Fact or Fiction ... I enjoyed that read ...

yes I finished the post too.

[Morakot]

Excellent story!

[The Snark]

It is odd to me the doubters and the trolls that haunt forums. I've received some nasty PMs and so on over the years. The above incident was, to any field paramed, normal , and it appears my writing style caused it to be questioned.

But anyway, let us compare. A pro mid wife is handling a birthing back in Calif. Friend of friend thing I come in as experienced paramed. Midwife is sharp, on the ball and covering the bases. My first job was cleaning up the feces. Mom had emptied her bowels big time. Sort of a good idea to not let baby squirt into a huge pile/puddle let alone it makes things yukky stinky.

Midwife wants running vitals. No prob. I get to listening to mom. Furious. Expressing pure hatred for her boyfriend that caused this situation. The F word gets repeated about 5 to 10 times a minute. Mom also hates being preggo and hates delivering. As the baby crowns mom yells 'GET THIS THING AWAY FROM ME'.

Baby out and wrapped, Midwife and I start clean up and check up. Handing baby to mom she throws it away. Midwife catches it. Me heart in mouth as it could have gone right off the porch and 10 foot drop below. Get shot of that scene as fast as propriety permitted.

There. Is that any better for your doubters? A little more trauma drama? More realistic?

All experienced medics have their fair share of horror stories. Disembowlings, dismemberments, decapitations. Unsecured child through windshield and on and on. I prefer the ones that worked in my memory. The lighter side, to which I try to add my own light hearted writing style. Is that so wrong?

[Patsycat]

I like stories like yours, no fancy pants writing with big words or not to shock the masses.

[Crazy chef 1]

Hang on, hang on, at what point did you stop off to grab a few Leo's?

How can you possibly be expected to be a Thai Issan Midwife without Leo's?

P.S, how much did you get paid for these stories?

5 Leo's...plus one lao kao

[The Snark]

Hang on, hang on, at what point did you stop off to grab a few Leo's?

How can you possibly be expected to be a Thai Issan Midwife without Leo's?

P.S, how much did you get paid for these stories?

I think that somewhere between trying to get a derelict wino on his feet and the skin came off his hand like a glove, being introduced to a preserved liver in an advanced state of cirrhosis, removing the infant body parts from the front grill of a Ford pick up operated by an extremely drunk driver, and a close friend sacrificing his life forcing a drunk driver off the road who was traveling south in the northbound lane on a freeway I decided drinking is just plain stupid.

PS I don't get paid. Is this an offer? 5 baht a word?

[ATF]

If you're looking for a job I believe there may be one available in Pattaya because a certain paramedic that was called something like hammer is in jail for battering someone close to death.

[zzdocxx]

Nice story, thanks.

But certainly someone in that village must have had some experience ? After all babies have been born for at least a thousand years here on earth.

Also don't understand why the doubters, for heaven's sake.

[The Snark]

Nice story, thanks.

But certainly someone in that village must have had some experience ? After all babies have been born for at least a thousand years here on earth.

Also don't understand why the doubters, for heaven's sake.

Birth happens. It wasn't until the late 1700's in Europe that doctors decided to get into the game. Midwives, many with exceptional skills and insight, do the vast majority of birthings in the world to this day. The modern delivery in a hospital is entirely arranged for the convenience of the doctor. The comfort of the mother isn't even taken into account and the normal delivery position, lying on her back, is the worst position for aiding delivery. Squatting, gravity helping, thorax and abdomen compressed aiding the push, is the most effective. But would require a doctor to crawl on his belly.

Most parameds that assist births in the field do just what I did. We are on hand in case a problem arises. The mom does the lions share of the work, a competent midwife handles the incidentals, and we are there only for intervention in case of complications.

[zzdocxx]

That's what I'm asking, why call you in from 4 hours away to assist ?

Or was it sort of a fun field trip, and was there a midwife there also ?

Or these were some friends and just wanted you to do the honors ?

Anyway glad everything worked out !

[The Snark]

That's what I'm asking, why call you in from 4 hours away to assist ?

Or was it sort of a fun field trip, and was there a midwife there also ?

Or these were some friends and just wanted you to do the honors ?

Anyway glad everything worked out !

I've had this happen quite a lot. A stigma attached to 'Modern Medicine' that if some expert in a field is present, things will usually be wonderful. We are educated. We know how things work! Blah blah blah. From the paramed point of view, should a problem arise, we have a number of procedures and tricks to sustain patient viability until persons of greater training can get involved. A 4 hour response to a hospital is or can be a very sticky situation depending on the nature of the problem. Our interventions are usually a level above the training of a midwife but we can mesh and overlap with ease providing a given level of expertise is used by both. On the more trivial end it ranges from irregular infant vitals to retained placenta to prolapse working all the way out to a code blue.

It helps to think of the emergency medical operation as links in a chain and none an end all be all unto itself. Each link hands the patient up the ladder to the higher level of training. Often the lower links are stop gaps, simply maintaining patient viability. So a paramed at a birthing is expertise that can bridge the gap between midwife and acute care at a hospital should the need arise.

It should always be kept in mind by everyone, and this cannot be stressed enough, that the entire chain of the medical profession often relies up the average person on the street. From completely untrained making the emergency call to a CPR cert doing CPR or the Heimlich on up, the upper links in the chain depend upon those initial steps to deliver a viable patient to them. The entirety of the medical world with all it's advances and exotic equipment is useless and helpless in the event of a sudden trauma in the field without the first responder.

Remember the three golden minutes between a persons last heartbeat and permanent damage starting to occur. It's the first responder starting CPR that enables all the rest of us to do our jobs. And also, ALWAYS remember, if you are called upon to do CPR, the odds are it will be on a close friend or family member. Learn it, love it, live it.

I am more than happy to explain emergency medical procedures and clarify any questions any may have.

[The Snark]

PS Allow me to give you an anecdote of one of my saves. Off duty I was walking through a parking lot at a supermarket when I heard a freak out. Someone in extreme distress, the timbre and tone of voice that makes the hair on the back of your neck stand up. I detour over to a camper with the back door open. A woman stands in the camper holding an infant, tears streaming. Oh GOD OH GOD OH GOD!!!

I informed her I was a paramedic. Before I could say anything further she almost throws her baby into my arms. Okay, assess. Take the time to collect your thoughts. 10 seconds and three deep breaths. You remove the rattle snake or live electrical wire or your body and that of your patient from high speed traffic before taking action. Avoid tunnel vision and 'red light fever'!

Baby is as cyanotic to the max. Deep bright blue. Okay, no oxygenation. Why? I plop my butt on the ground where I stood, maneuver the baby and GENTLY see if I can get a puff of air in. Yup. No problem. Wait a few seconds and give another. Cyanosis starts diminishing almost instantly. I am maintaining an airway with one hand around the neck so my fingers rest on the carotid. That doesn't work all the time with infants and I may have to shift to feeling for the brachial pulse under the upper arm.

As I am doing this, sitting there, hey everybody! What were you taught in CPR class? A, B, C, and.......... Airway, Breathing, Circulation and Do you want to do this for the rest of your life or just maybe it would be a bright idea to activate the EMS???

I was relieved of the D as someone informs me 'An ambulance is on the way'. Okay, cool. I can narrow my focus. Pulse is around 140 and very thready. The baby is not taking breaths on his own but I can easily get air into him. About a minute passes and I've got the tyke pink. Now I turn into an . I pinch the paby's butt HARD. Eyes open and it takes a gasping breath. Another half minute and I've got control. Breathe for the kid every ten seconds or so, give another good hard pinch, wash rinse repeat. I'm pumped on adrenaline. I could cruise for several hours doing this. I hear the ambulance. Keep the kid pink. Keep it's eyes open.

I hear Doug, a senior of the local ambulance company, top flight paramed and a personal friend. Firm grip on my shoulder (always make solid contact with the person you are communicating with during an emergency). He says, "Whenever you're ready." I stay sitting there, giving the breaths and pinches for another minute. I'm showing Doug the procedure I've arrived at. Jim, Doug's partner appears on my other side. Between Doug and him they grab me under my arms and lift me to me feet so I don't have to pause my operation even for a moment. I walk over the the gurney, Doug takes his position on the other side. They rig the kid with an ECG, crack out an infant air mask, then slide me out of the scene. Jim and I pack the gurney into the ambulance with Doug attached to the kid and off they went without a moments break in the resuscitation.

No idea what was wrong with the kid. It spent 3 days in ICU then fully recovered. The local fire department had shown up and one of theirs drove the mom to the hospital and locked up her camper for her. Smooth as silk from first responder, mom getting help, to the ICU.

So count the links in the chain. Mom, got help. Me, CPR trained. The manager of the supermarket called the EMS. The FD showed, did traffic control, saw that there was a person of a greater level of training doing the medical, and flagged down the ambulance. 2 EMTII's meshed with second responder and took over. At the door of the ER the ER sup, an ER nurse, a respiratory therapist and 2 nurses from OB Gyn greeted them with an infant ICU. Doug handed over the baby just like I did to an OB nurse. Doc Ted, Ped. came in and ordered tests.

[seedy]

Nice to know there are people like you in the world.

Nice one !

[seedy]

Dbl post

[The Snark]

Nice to know there are people like you in the world.

Nice one !

That's what the EMS and response system is all about. A standard level of training across the board. As opposed to my other thread about Thai EMS.

http://www.thaivisa.com/forum/topic/777354-medical-major-rant/page-2#entry8690417

[seedy]

My Bro' in Pattaya works with Sawaan Buribon. The stories he tells !!!

[mitsubishi]

idiotic white skirt and blouse and even the silly hat.

Very ignorant and disrespectful of you that. I also thought your other little digs were uncalled for. Overall not a bad story though.

[The Snark]

idiotic white skirt and blouse and even the silly hat.

Very ignorant and disrespectful of you that. I also thought your other little digs were uncalled for. Overall not a bad story though.

Right. How rude of me. My sincere apple ogees.

Having been around the medical profession a tiny bit I wandered in the direction of a code blue called at a major top flight hospital. I peered in the door to view the usual chaos. (Code blue is pure chaos, the world over. Just coordinated.) A tight white skirt and happy hat is performing chest compressions, at about a 45 degree angle, on a soft bed. I was sorely tempted to 'bump' her and dive in when another tight skirt and happy hat does it for me. She shoves chest compressor to the side, hikes her skirt up to her waist, climbs on the bed, straddles the patient, and starts real chest compressions. Most of the other nurses were aghast at the display of shapely legs, panties and nicely curved bottom. A little while later that hospital relegated the skirt and happy hats to the non medical support personnel. The nurses now all wear utility scrubs. That nurse turned out to be a Singapore trained nursing instructor.

Bro, it's called saving lives. Throw the niceties out the bleedin window. There is no room for the foo foo when the feces comes down and in the medical world it comes down big time just about every day.

[The Snark]

Bump in the medical world. Literally give a hip or shoulder bump or other physical contact to relieve a person of a job and take over. During a code blue or other medical crises only the team leader and any doctors present should speak to minimize confusing or get wires crossed. Bumping a compressor or airway is very common. One of the team leader's jobs is to watch for improper procedures or someone getting tired and designate a relief person: 'Bump him/her'.

Here's you little comedy. I was working at a hospital as bio-med tech at the time, though the ER staff knew I was a paramed. I was at the ER when the ambulance brought in a code blue. The ER sup saw the chest compressor then me and ordered me to bump her. I did the compressions for the rest of the code.

And then the usual EMS critique is done. And word comes back to the administration. Personnel on the code were listed and their position. RN, LVN, RT etc. And there was my name and Maintenance for position.

The administration lost it. Wrongful death suit here we come! They stormed down to the ER. As luck would have it, Doc Van, super pro ER doc was on duty. The admins cornered him and shoved the EMS report under his nose. Doc looked at it and shrugged. They pointed at the vile miscreant. Doc Van chuckled, took out his pen and added beside Maintenance, CPR instructor, ACLS Instructor, NA as he mentioned to them I was the main CPR refresher course instructor for the entire hospital. The administrators left with a few snirks and suppressed chuckles, having clearly demonstrated how out of touch there were with their own hospital. Less than a week later the Director of Nursing got demoted to head administrator. One of her first official actions was to call me aside and hiss, 'You did this to me!!'. Then smiled and walked off.