And Then She Breathed Her Last
This article was originally published in October 2018. We are republishing this story because we are focusing on newborn care in preparation for #GivingTuesday!
Born Too Early
The number keeps climbing: Twenty-eight. Twenty-eight children I have cared for, children eight years old and under, who have died while I have been in Nzara. The number increases in waves. Some die from malaria, pneumonia, severe anemia, and a large number die from complications from severe malnutrition. As soon as we get these sick children in the hospital, our battle is against the disease that consumes the young child’s body.
Resources are low in this remote village, and often we cannot identify the specific diseases we are battling against. A mother holds her dying child, whispering his or her name as family gathers round to say their last goodbyes. I have witnessed children fight death to the very end, and others let death overtake them as peacefully as a soft summer breeze.
But within this number of children lost, are patients with no medical chart, no disease, and oftentimes no name. Their fatal diagnosis is time: they were born too soon.
In South Sudan, it is nearly impossible to survive if you are born before 28 weeks gestation. In the remote community of Nzara, it is rare for a premature baby to live past birth before 30 weeks of pregnancy. Often, these little ones are forgotten by everyone. They usually die nameless, never to be known by their family, the only mark of their existence the memory etched into their mothers’ heart. Premature birth is common here. The biggest culprit is usually malaria but many times we never know what truly causes it.
I first felt her little head moments after her mother walked into the clinic in agonizing labor. As I examined the feverish mother, it was clear that she would deliver her baby soon. The mother was only 4cm dilated but was battling strong, infectious contractions, and she was only around 26 weeks along. Her baby was small enough that she wouldn’t even need to become dilated to 10 cm before giving birth. It was clear that the contractions were being caused by some type of infection, so the midwife and I started the mother on powerful antibiotics in a vain attempt to stop them.
Before this mother came into the clinic, I was almost ready to leave for the day. I had a sickening feeling that if I lingered a little bit longer, I would likely be haunted by events that were about to take place. I knew I had to stay. Twenty minutes later when she arrived, I realized why I had that feeling- the situation was soon going to be hopeless.
We were going to lose yet another baby to prematurity. One hour after the mother arrived in premature labor, she started to get desperate and frantic, indicating to me that she was about to give birth. The other midwife was extremely busy with other new arrivals, so I knew that I would likely deliver this child alone. As the mother got onto the delivery table, she gave a cry and the baby’s tiny head popped out, a second later the body shot into my hands. The other midwife stuck her head into the room, saw the tiny body draped in my hands, shook her head and said “too small” as she left the room to try to manage the clinic single handedly while I conducted the rest of the delivery.
The girl wriggled in my hands and gave a feeble cry, a soft sound loud enough to break me out of my shock. This little human had such fight and determination in her to live. Her mother and I couldn’t let her die without us trying our best to keep her alive. I started using the neonatal ambu bag on the baby to try to keep her lungs open to receiving oxygen. At first it was working. She wiggled around and would give little angry cries of protest. But after a short time I noticed my best efforts weren’t helping as the baby’s life faded. She needed so much more than the clinic had to offer.
I continued to breath for this tiny girl as a battle raged inside my head. I knew my efforts to save this baby were miniscule to the amount of care she really needed. Back in the United States this preemie would have a good chance of surviving because of her stubborn will to live. But here in one of the most remote places in the world, a will to live is not enough. In an agonizing moment I realized it was time for me to stop breathing for her. I had breathed for her for nearly 30 minutes with no improvement in her condition and I saw her deteriorating. In the diminishing light of day, I placed her little body on her mother’s, so the mother and daughter could say their goodbyes to each other.
After I gently cleaned the mother up, the mother handed me her daughter as she hobbled, defeated, back to her recovery cot in the maternity room, laid down and covered her head. This mother came in labor without any family with her. She was in agonizing pain for several hours, birthed a baby who was too young, and couldn’t stand to watch her baby die. I learned in this moment that it is the custom for other family members to hold the dying infant until they died, but when there was no family around oftentimes the infant dies alone. I had the privilege to bring the beautiful baby girl into this world, and was given the honor to hold her as she left it.
My husband Martin came to the clinic to walk home with me after a day’s work, like he does every night. I didn’t have to say much, just showed him her tiny body, now only taking a gasping breath once every minute or so. We went outside to sit and watch the sun set as I held her to my chest. As I quietly sung Annie Lennox’s “Into the West”, the baby took her last breath. I put my stethoscope next to her chest. Her heart, meant to beat for a full lifetime, was still slowly pumping. I whispered to Martin “it is going to be soon.” Fifteen minutes after her final gasp of air, her heart beat one last time.
I laid her lifeless body down in the now dark delivery room and positioned her body for burial in preparation for the mother’s family to take home. I was alone in that room, struck by the peaceful silence in a space that once held her fleeting life. I said my goodbyes, stroked her cheek and whispered, “I’m sorry we couldn’t do more, little one.”
Sarah Rubino shared this song at the end of her story.