A mother’s hope, a midwife’s duty

When a young mother showed up at the Victoria Jubilee Hospital (VJH) in Kingston haemorrhaging after a homebirth, Sister Marian Ramikie, the most senior midwife on duty, immediately sprang into action.

Having spent over five decades helping women bring new life into the world, with tens of thousands of deliveries under her belt, Ramikie knew all too well the gravity of the situation. The hospital was already managing three deliveries, but there was no choice but to handle this sudden emergency as well.

Seventy-four-year-old Ramikie, who managed the labour and delivery ward at VJH before retiring in 2015, issued directives to her juniors in a desperate race against time..

“I didn’t panic,” the registered nurse recalled in an interview with The Sunday Gleaner last Wednesday ahead of today’s observation of Mother’s Day.

“I got together the things that I needed to control this patient, who had come in off the street with her postpartum haemorrhaging, because most patients die during that period if you are not active and know what you are doing,” she said.

Ramikie and her team were quick, she recalled, rolling up their sleeves to measure and record vital signs, assess the degree of the woman’s bleeding, administer medication to help contract her uterus and deliver intravenous fluids to counter blood loss.

Amid the controlled chaos, Ramikie did more than just stabilise her patient – she offered reassurance, explaining the process to calm the woman’s nerves, keeping her awake and panic at bay.

“We had to let her know what was happening to her and what we were doing to help her,” she said.

They had done the groundwork to stabilise her, and with the doctors she had called for now arriving, the woman’s life was saved. Later, she returned to express her gratitude, bringing a gift as a thank-you. It was a moment Ramikie would never forget – a close call, but a success nonetheless.

Deep-seated passion

This was just one of many such encounters in Ramikie’s long career, a career born from a deep-seated passion for midwifery. As a child, she was fascinated by home births, having been surrounded by district midwives and family friends in her hometown of Highgate, St Mary. Her elder sister, a registered nurse, was another early influence.

Since 1972, she has specialised in that area of healthcare focused on women’s health, particularly during pregnancy, childbirth, and the postpartum period.

“At that time, they used to go into the homes and deliver these babies. I used to think, ‘wow, I would like to do something like that. I would like to care for labouring patients and I would like to see the baby being born’. So I just decided to go into midwifery,” she said, adding that she eventually sought training to become a registered nurse.

“But I just love the midwifery part of my job and so I stuck to it. I love my labouring patients, to see my babies being born and cared for after birth,” she told The Sunday Gleaner.

In 1991, Ramikie’s dedication took her to New York City, where she worked in general nursing before returning to VJH in 1994. After spending seven years, she again headed north. It was during this stint in Miami, Florida, that she got the break she sought – the opportunity to work in labour and delivery in the US.

“It’s a career that I really love. I like to be with the mothers. I like to see the babies delivered healthy. That’s what I love. I like to speak with mothers when they are in labour – to educate them on how to relieve their pain, and at the end of it, to see a baby showing signs of life and healthy. Caring for mother and baby, that is what midwifery is all about,” said Ramikie, the mother of two boys.

With more experience under her belt, Ramikie returned to Jamaica in 2006 and resumed working at VJH – the largest referral maternity hospital in the English-speaking Caribbean.

“That is telling you how much I love my labour patients and babies,” Ramikie said with a chuckle, recalling an average delivery of four babies per shift.

Peak of the ‘crop season’

In the peak of the ‘crop season’ – from August to October – the number of deliveries increased.

She recalled having to put together a makeshift cot in one instance, when the hospital was over capacity and no beds were available for an expectant mother in labour.

“We had a lot of patients being delivered at the same time in our delivery area, about three or four and this mother, while in labour, was waiting for a bed. I said to them, ‘Listen to me, she cannot wait. This baby is coming right now and she has to be delivered’.

“What I did was to make a makeshift bed. I got some sheets and pillows and some other things and placed them in an area where I felt she would still be comfortable. I delivered that baby and asked one of my nurses to look after the mother while I made haste with the baby to premature care,” she said.

Months later, the woman returned to thank Ramikie, who she felt saved both her and her baby.

“Sometimes mothers walk up to me and say, ‘Nurse, you know your baby deh university now’. I say, ‘Okay, that means I did a good job with delivery then’,” Ramikie added with a smile.

But not all of her deliveries ended in tears of joy, Ramikie recalled, as her tone dipped. She lost one.

“This was a very big baby being delivered and there was a little difficulty getting the baby out on time. We called for a doctor, [but] when the doctor came, the patient could not be taken to the operating theatre for Caesarean section because of where the baby was in the vagina. So the baby came out dead,” she said.

“It was a traumatic time for us because this lady was looking forward to having her live child. Whenever you lose a baby like that, the staff is very traumatised. It has a negative effect on us when we see that. That is why we try to be so vigilant and so proactive in what we are doing,” she said.

It is equally traumatic, she said, having to deliver stillbirths. In both instances, patients are counselled by a senior doctor and referred to a psychologist. For the midwives/nurses, accepting that they did all they could helps with navigating the emotional impact, Ramikie said.

10 years post-retirement

Now 10 years post-retirement, Ramikie remains active in the field, still scurrying through the blue halls of VJH, three days per week, where respect remains at its highest for her.

In a separate conversation, Sister Dawn Williams Gordon, the hospital’s current ward manager of labour and delivery, noted admiration for Ramikie, sharing that she hoped to stand as tall as the revered midwife in her management of the unit.

For Ramikie, her time as head was also spent mentoring her juniors.

“I like to do a lot of teaching with my younger nurses and students. I teach them procedures and professionalism because in doing all of this you have to maintain professionalism and ethical behaviour. You deal with people one on one. The same personality that fits this patient doesn’t fit the next one. You have to remember that, but I really enjoyed my time with them,” she said of her colleagues at the hospital.

kimone.francis@gleanerjm.com