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9-11-2010 (Saturday)

After a fairly good night’s sleep interrupted only occasionally by the sounds of brakes and then revving engines of the loud diesel variety, I awoke about 6:30 feeling rested. Sandra didn’t call during the night and my first night on OB call went by uneventfully. I got up and showered and prepared for the day. While sitting out in the kitchen area eating my breakfast Sandra appeared at the gate along with Angelita. This meant that something was happening and she was coming if to be checked again. In a little while Jane appeared at the window to tell me Sandra was having more frequent contractions that were stronger and longer and I could come over when I was ready to check on her. I finished my breakfast quickly and then went to see Sandra.

She was having some good contractions occurring about every 5 minutes or so. She was 5 cm dilated and she stated she was having a lot of rectal pressure. I told Jane and Sandra about my experience with a patient I was driving to the hospital when I was a second-year resident. The second-year resident was the obstetrician for an unwed mother’s home located on the south side of Indianapolis. Usually, when I would go to the home for the prenatal checks, if one or two of the girls were ready to deliver, I would transport them back to the hospital more on the north side of downtown Indy and then deliver them. This time one of the girls was having some pretty good labor and I told her to get ready and I would take her to the hospital after I finished checking the other girls. In downtown Indy at a stop light she suddenly announces to me, “I feel like I am going to poop my pants!” I calmly reassured her that rectal pressure was common in labor and just to relax and let it happen. So she did…all over the front seat of my car! She left me with half of the seat covered with slimy green diarrhea. When I got to the hospital, a co-resident took the patient to the labor room and eventually delivered her while I spent the time trying to clean the front seat of my car. My residency director told me, “Any one stupid enough to tell someone to go ahead and poop in your car needs to repeat a year of training.” Jane and Sandra found this story to be particularly amusing.

On the serious note Sandra was leaking more amniotic fluid and it was greenish suggesting meconium staining. This can be a signal that the baby is not tolerating labor well and could be in distress. Jane and I obtained an instrument I could use to rupture the bag of water that was in front of the head. I suspect the leak was occurring from higher up around the baby. Upon rupture of the bag of water and lot of meconium stained fluid passed. We found a fetoscope and the heart rate was steady at about 150 and strong. Sandra then started having more aggressive labor . In about 20 minutes she had progressed out to 8 cm and I listened to the baby’s heart completely through a contraction phase finding no changes, no decelerations that would suggest fetal distress. We then took Sandra to the OR to prepare her for delivery. She has spent most of the labor time standing and walking. I have yet to hear her cry out because of the pain. She obviously is having pain but is tolerating it very well.

About 9:45 Sandra delivered a very healthy, screaming little girl. I guessed the weight at about 7 pounds. There was no evidence of any fetal distress and I think the little girl just needed to poop. When I laid the baby on Mama’s belly she cut loose another healthy poop. Angelita just shook her head and said, “Shameless.” We had a good laugh. What a thrill to deliver a baby again! This was a huge stroll down memory lane for me and surprisingly I had not forgotten anything about obstetrics. This birth was the first for Clinica San Lorenzo. Sandra said afterward, “This is a dream come true.”

Father, what a morning already! You blessed us with the arrival of a new life You created in Sandra’s womb. What a blessing indeed! Thank You for protecting Sandra and the baby and for giving us an uncomplicated event. Your arms of protection and love were very evident as we felt them wrapped around us the whole time. Thank You, dear Father! Amen.

Jane and I were thinking about how the timing of this delivery was as good as we could expect. Had Sandra waited until Monday the whole process would have been quite the challenge. Our OR would have been occupied, Jane and I deeply involved in a difficult surgery, and the others would have had to stay with us instead of tending to the mother and baby. This way this event is the only event of the day and we were able to use the OR as a delivery room and give Sandra and the baby a safer environment. This has to be from the hand of God to work this little miracle into our schedule without disrupting a busy surgery day. Thank You, Lord!

Yesterday when Sandra was here for an exam and we determined she would be delivering most likely within the next day or so, Jane asked me what medications I would need for the delivery.  I told her it would be nice to obtain Pitocin to use after the delivery of the baby.  She gave her husband a prescription for two ampoules of Pitocin and to bring them with Sandra when she comes in for delivery.  Her husband was able to only find one ampoule.  None of the pharmacies had any Pitocin but they referred him to some person who had some.  Jane was telling me that the pharmacies have a difficult time keeping Pitocin in stock.  It is used by various people to induce abortions and usually the local abortionist or someone supplying the abortionist has a stock of the drug.  The husband purchased the ampoule of Pitocin from this person under the agreement that he would not divulge the person’s name.  The one ampoule worked fine and did the job we wanted.  That was all the medication Sandra received for the labor, delivery and post-partum stay.

After about 4 hours of recovering from the delivery we loaded Sandra, her new baby, the baby’s aunt and grandma into Jane’s car to take them home.  This gave me a tour of another area of San Lorenzo.  Jane and I then came back to the clinic and plan to lay low for the rest of the day.  She plans to fix dinner tonight and basically do nothing else.  Tomorrow we will go to church in the morning and then take it easy for the rest of the day.  I will be getting my surgical scrubs and other things ready to take to the locker room next to the OR for the week.  Church is about a 100 foot walk from the house where I am staying to the ministry building where church will take place.  The little church that meets here is growing and it is neat that Jane’s clinic can provide space to allow a church to thrive and grow.

6:45 PM.  Jane and I just finished dinner.  Jane exhibited her cooking skills quite nicely with a meal of baked chicken, fresh green beans and steamed cauliflower.  We had a good conversation and did some brainstorming on what we envision needed if Jane were to pursue obstetric care.  We talked about the prenatal care, the medical records to monitor the prenatal patient, labor and delivery care and all the supplies and medical records for that as well as the resources needed to care for newborn babies.  This is the direction Jane wants to go eventually but wisely is using caution and making sure this is thought out and well planned before starting an obstetrical practice.  Providing obstetric care here would be a great asset to the community and would make a significant impact on the health of childbearing women.  I keep reflecting on my thoughts expressed at the beginning of this trip when I read Isaiah’s response to God, “Here am I.  Send me.”  Is God preparing me to answer a call to come here more?  This makes me wonder.  Did God orchestrate this delivery to get us thinking more seriously about providing obstetrical care at Clinica San Lorenzo? 

Father, I am developing a greater understanding of what is needed here at San Lorenzo and also how might I play a role in that.  I feel a tug in my heart to spend more time here.  However, I have many responsibilities I have to shoulder back home and I am torn as to what I might be doing with the rest of my life.  Lord, I want to serve You and walk with You.  I trust You and rely on Your input into my life.  Lord, let’s continue to talk about this as I want to explore Your will and follow that in my life.  I pray for insight and wisdom and courage to make the decisions I need to make. 

 Father, thank You for this incredible day.  Thank You for allowing us to care for Sandra and to be the first to see her little baby girl come into the world.  Wrap Your arms of love around Sandra and her family and especially that precious little girl.  Help Sandra and her husband to raise their children in the way of the Lord so they will learn and follow a lifetime of trusting and obeying You.  I pray for Jane as she thinks and plans for the future here at San Lorenzo.  Help her develop the services You would like her to provide here for the people of this area.  Give her the insight and wisdom she needs to do the right thing, make the right decision on this.  I pray for provision of the necessary people with the right skills to create a team that provides the level of care needed.  I pray also for the support of others who give advice and financial backing so Jane can accomplish what she has been called to do.  Lord, this is all to Your glory!  Thank You, Father.  Amen.

 I plan to spend some time reading in God’s Word tonight and even though it is still relatively early in the evening I think I will go to bed and spend my time reading there.  We have church at 8:30 in the morning tomorrow.  I did enjoy the opportunity to talk with Phyl on Skype tonight.  We had a good chat.  It is so nice to be able to talk like we were on the phone.  I also talked with my daughter, Darcy, and want to connect with another daughter, Kim, as she is on Skype as well.  I would love to bring them along with me to participate in the mission work here.


1. Darcy Clawson - September 11, 2010

That first story….ewwwww! I am glad that Sandra and baby girl are doing well. Who knew you would be back doing OB! Your time down in E is never boring. 🙂

2. Lou Ann - September 11, 2010

What great stories!! I love your writing style and all the details you share. Tim and I are praying for God’s hand to be upon you this week.

3. Shelly Brown - September 11, 2010

What a great day! Glad things went ok. Always stories to tell.

Gary and Darlene Monteith - September 11, 2010

Marv as Gary and I read through your journey we see how much your journey means to all these women. I was so happy when I found out God had supplied your doctor. Now 24 surgeries scheduled and probably more. These women will have Dr. Jane’s and your expertise to help them. You are doing God’s work and he blessed you with the delivery of a new born. Sandra did so well. The pictures are wonderful. You and Jane are so excited. God bless you all as you go through this next week. I know he will bless you in many ways and guide you both through the surgeries. Thank you for telling us your story.

4. Kent Brower - September 11, 2010

So neat! All, working out so very well. I liked your story, I think even I wouldn’t tell someone to poop in my car! 🙂 lol ! Praying for your rest and week ahead!

5. Tom Beckner - September 12, 2010

Does anyone have a medical dictionary I could borrow??

Thanks for all the encouraging news, Marv. What an opportunity to be a part of the first Clinica delivery!

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