A New Life Begins

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Today my alarm went off at 6 am. I am planning on going to clinical with the students. For this morning’s breakfast we had sticky rice with coconut custard, little chicken & pork balls, fruit, salad, moo ping and eggs. We attended morning ceremony and headed to the hospital by 8:30 am. When we arrived at the hospital we were informed that 7 students were going to go to the operating room. The students are scheduled to see a laminectomy and a total hip replacement.

I decided to observe the labor & delivery room for the morning. This is the first year that we have students in the labor and delivery room for the whole week. Usually, students just drop in for a delivery and then leave. The staff and college faculty were very warm and welcoming. There were many students, some from BCNC and some from Chiang Mai University (CMU). Both faculty were fluent in English so that helped when reviewing patient cases. Today there were only 3 women in labor, the others were being monitored due to high risk pregnancies. Some of the high-risk complications included: pre-eclampsia, fetus with hydrocephalus, twins, pre-mature labor, and diabetes. We had two particularly interesting cases today. One woman had a congenital heart defect that was detected in her teens. As a result, she is very tiny and petite and suffers from chronic low oxygen (blue lips & clubbing of the nails). Her husband wants children so she got pregnant. Her first pregnancy was terminated by the doctor because he said it was not safe for her to carry the pregnancy. The second pregnancy was spontaneously aborted while working in the rice fields. She is now pregnant for a third time. She really wants this baby and is 27 weeks along. The ultrasound shows the baby is healthy. So, they are going to keep her hospitalized to monitor her and the baby. The second case was a mother, pregnant with her third child, carrying a baby with hydrocephalus. She was in labor and the doctors decided not to do a C-section. The plan is to have her deliver vaginally and when she is close to 10 cm they will tap the baby’s head to reduce the size for delivery; however, it is very risky and the baby may die. The CMU instructor said she never saw this before so I do not know if this is a normal procedure or not.



We saw one delivery this morning. Mom had epilepsy and was at 2 cms. She had asked if she could walk out to the waiting room to be with the dad. The CMU faculty noted her facial expressions during a contraction and decided that they should reassess her before she went to the waiting room. Well, she was 7 cm and soon to deliver. The mom went from 7 cm to delivery in 30 minutes. She made no noise until it was time for pushing and even than it was only a moan. Apparently, she was perceived as being dramatic. My students were able to assist with the newborn assessment. Both mom and baby were doing well by the time we left for lunch.



Some of the things we learned today in labor & delivery included:




• Women labor in silence, or very quietly, WITHOUT pain medication.
• C-sections are avoided as much as possible.
• Fathers and visitors are not encouraged to be with the laboring female. The patient can walk out to the waiting room to visit the father but they do not want family in the labor room.
• Patients labor and deliver in a ward setting. No privacy except for curtains but curtains were rarely used.
• Nursing faculty and students provide primary care to patients and deliver the babies and assess the newborns. MD only called in if high risk delivery. MD just stood off to the side and observed the delivery.
• Episiotomies are very common. Little lidocaine is used in the procedure.
• If the patient pushes an hour without delivering, a C-section is performed.
• Pitocin is added to IVs when patients reach 3 cms
• You where sandals in the unit as well as a gown, hair net and an added face mask for delivery.














We all ate lunch at the hospital canteen. Today I had my son-in-law’s favorite dish, kow min gai. It is jasmine rice, chicken and a chicken soup broth. It was very tasty but I could not eat a lot. The students talked me into getting an Oreo milkshake which was very good but after a few sips I had to give it away. It was just too much for me today. Following lunch, we went to the Alternative Medicine Department where we learned about acupuncture and Thai massage. It turned out to be a very interesting session. The doctor asked me to stick out my tongue. Then he touched 2 points on my arem.He quickly came to 2 conclusions. 1) I have high cholesterol and 2) I do not exercise. Looking at me I think anyone could come up with that diagnosis. The doctor, who was an MD before studying acupuncture, said if you are not a doctor the length of study for this field is 5-6 years. He has been specializing in acupuncture for 18 years. He spoke with us regarding the philosophy, technique and benefits to acupuncture. We saw 3 people being treated: Allergies, Low back pain (most common disorder treated), and insomnia. One of the students suffers from chronic ankle pain so the doctor used her as an example. You can see the picture of a needle in her ankle. She said her feet were tingling and that by the evening they were feeling pretty good. Everyone received a 30 minute Thai massage so by the end of the afternoon session, we all felt like rag dolls.



Prior to dinner, most of us took a quick nap. Dinner was served at BCNC. We had salad, Tom Yum Gai (too spicy for some of us to eat), rice and vegetable stir fry. Kuhn Jeb and Kuhn Fung made Thai lemon tea colored with the purple flower. Following dinner we had our second class. We had a good conversation about the students' cultural experiences in the hospital. Students are learning a lot and appear to appreciate the experiences. We then addressed course content. Students were engaged and fairly open about the topics addressed. Today was a good day as much was learned by all.

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