essentialmidwifery

Birthy Thoughts by Jane E. Drichta and Jodilyn Owen

“False Labor”: Misnomer of Grand Proportions–Jodilyn May 21, 2012

Filed under: Birthy Thoughts,Jane and Jodilyn — EssentialMidwifery @ 4:17 pm
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The language of pregnancy and birth showcase our society’s beliefs with perfect clarity. I can think of dozens of phrases that divide mother from baby, spirit from body, mind from health, and mother from inner knowledge. I want to look at just one phrase to showcase the way we approach these linguistic faux pas in midwifery care, and how we get to the bottom of events in pregnancy that can be difficult or seemingly in need of a cure.

We can attribute the language of divisiveness to many sinister roots and spend all day railing at The Machine and The Man–but why spin in circles when we can gain some insight instead?  Something I’ve learned over the years and hundreds of births: the roots lie beneath layers of asphalt, cement, cobblestone, and packed dirt. The energy required to dig them up and cultivate new soil and plant new trees is the work of modern midwifery. Meanwhile, we like to say we “forgive” those who have attached themselves to the practices that stem from these roots because that is their only paradigm and how they were trained. While that’s fair to some extent, each of us is responsible for lifting our heads so that we can partake of a broader vision. I know it’s not politically correct—but shame on all of us who are entrenched in one way of thinking, talking, and acting. And a double shame if that tunnel vision limits the experience of something so fundamental as the birth of a baby and a mother: the building blocks of any society. (And yes, this cuts both ways–midwifery care and homebirth are not the right fit for every woman.) What makes one person or another apt to lift their eyes and stretch their perspective or practice? I would call it holistic curiosity, and it should be taught in every medical and midwifery school. Actually, scratch that. It should be taught in every elementary school.

It is unfathomable to me that any person could witness birth and think only of the moving parts and mechanics of it, but there is where the roots of modern birth and the language and rituals that surround it lie. The medicalized perspective of birthing must work very hard to connect the parts that authentic midwifery honors as inextricably bound together. There are wonderful OB’s and OB nurses who see the whole woman—this is really not a message about them, it is a message about the environment, language, and curiosity that we surround ourselves with.

Back to the misnomer we are looking into: “False Labor”. This term is typically applied to bouts of contractions a mother has between 37 weeks and the onset of rhythmical contractions that get stronger and longer and culminate in birth. A contraction is an activity of the muscle. A mother cannot make her uterus contract the way we can flex our biceps. The uterus contracts in response to internal stimulation—be it from any of several maternal or fetal hormones, movement from the baby, an orgasm, or changes in the lower neck of the uterus called the cervix.

The idea that the body would generate activity, heat, and motion for false purposes is nothing short of absurd. Every contraction has a purpose. Each one massages baby, helps baby adjust its position in the pelvis, and stimulates receptor systems for hormones we need to birth our babies. Emotionally, contractions pull us inward and force us to spend time with our bodies and babies. They pull our attention from the world, the clock, the to-do lists. They teach us lessons about control and surrender. Often times in our busy lives it is the norm to be in a state of disconnect with our bodies. Mothering needs us present in our bodies. It demands that we feel and sense and respond to these feelings and sensations in order to ensure the very survival of our species. Contractions that come and go, sometimes for nights on end, and in fits and spurts help us acquire and practice these skills.

“False Labor?” I don’t think so. The body is wise and begs the mind’s attendance in this wisdom. A provider who looks a mother in the eye and tell her that this wisdom is “false”, and demands that she separate her wise body from her knowing sense of her truths does not see a whole woman in front of her. Midwifery care, at its very best, does not get lost in the mechanics, but honors the wisdom of the whole mother and her baby. It sees them work together in harmony to bring about motherhood in its richest, fullest sense, and babyhood with the right I wish every baby on this planet had—the right to a mother who has integrated her body and mind and honors her senses, her knowledge, her gut, and her heart and can be present for her baby. “False Labor?” I don’t think so. The next time we meet a mother who is contracting in these patterns, we can stand in awe at the integration of mother and baby, spirit and body, mind and health, and mother with her inner knowledge—and know, with absolute certainty, that there is nothing false about it.

 

More Vbac Stuff-Jane April 18, 2012

Filed under: Uncategorized — EssentialMidwifery @ 1:29 am
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I’ve been doing a lot of sitting on the couch lately, working with a set of premature twins in my neighborhood.  They are sweet and cute and screechy and vomit-y, and all the things that you could reasonably expect little people to be.  It also means that occasionally, between physical therapy exercises, massage, and wiping spit-up off my shirt, I get to watch some CNN.  Like many people, both men and women, who I hang with, I was shocked to hear Democratic strategist Hilary Rosen’s comments regarding Ann Romney and her decision to stay at home with her boys, rather than work outside the home.  Now this is not a political blog, and I won’t go into my own personal beliefs here, although I will say that I value good manners from all parties. What struck me, and seemingly much of the rest of America is the fact that once again, women are being divided, and once again, we are doing it to ourselves.

This lack of cohesiveness is certainly nothing new in feminism, and regrettably, it is nothing new in the birthing community.  But, you know what they say about familiarity, and I am certainly feeling a bit of contempt right now for a situation that’s a-brewing in the Seattle vbac community.  Let me tell you a story:

Once upon a time, Dear Ones, there was a little community hospital. It didn’t have a Level III NICU, but it had nurses who would gently love your baby to sleep at the desk, if you needed a nap yourself.  It didn’t have flat screen tvs or a bath tub in every room, but the rooms were large enough to stroll around, and the showers were big enough for two.  There was an ob group there, and a few independent nurse midwives who had privileges, as well as a family practice doc or two for variety.  They had nurse anestethists, rather than dedicated anesthesiologists, and all seemed to work very well for a while.  Oh, and they did vbac.  Lots and lots of vbac.

But the only constant is change, Dear Ones, and progress must be made.  The flat screens went in, and the ob group gradually morphed into another set of personalities.  The nurses still loved on the babies, most of the independent midwives eventually left, and an official CNM group was established.  Oh, and the vbacs went away.

You might think, Dear Ones, that this is the end of the story, that this is one more rant about how the opportunity to vbac is being slowly taken away. But no.  Actually, now the vbacs are coming back!  The obs are willing to accommodate vbac on a case by case basis, depending primarily on the reason for the primary cesarean.  They are especially fond of those reasons that are “non-repeating. “  In obstetrical language, this includes a breech baby, placenta previa, and basically any other condition where you had to schedule a c-section before the labor waves hit you.  It also helps if you have had a previous vaginal birth, have no underlying health conditions, like long walks on the beach, and are a Capricorn.  (Ok, that was a bit snarky.  You caught me.)

So you would think we would be celebrating, right?  After all, isn’t any vbac a cause for celebration?  Yes.  Yes, of course.  But I’m still upset, and I’ll tell you why.

While there is some statistical difference between the “success” rates of vbacs based on the initial section, it also really really doesn’t matter.  If the Big Bad Wolf of VBAC is uterine rupture, why does it matter how the scar got there in the first place?  If we are going to be scared of scars, let’s really commit to it.  Let’s be really really scared.  Let’s have a vbac ban that is honest.  Let’s not try to hide our own fear behind a colorful wall of half examined statistics and rupture stories our colleagues told us on the nightshift.  Nights are dark and cold, and even the extra cardigan in your locker can’t protect you from half buried truths, based on old school traditions and your sister’s scheduled repeat cesarean.

Even ACOG clearly states that VBAC is a “safe and reasonable choice for most women,” who have had one c-section, and even for “some women” with two.[i]  It says nothing about “non-repeating” conditions, although it does specify that a suspected big baby, carrying twins, or going over 40 weeks are not reasons for a mother to be denied a VBAC.  (It actually says denied a TOLAC-trial of labor-but that language is another post for another time.)

And, by the way, vbac is successful  75% of the time.[ii]  This is actually a better chance than an every day, run of the mill, first time mama, who has a 67.3% chance of a vaginal birth.[iii]  And by the way, in 1965, the C-section rate was only 4.5%[iv]  Just sayin’.

Jodilyn and I have said for over a decade that 99% of a vbac happens in the mind, not in the uterus.  The  research, the personal exploration, the soul searching, the intense wanting, means everything.  A supportive provider certainly helps, as does a partner who is on board.  But at the very end of the day, it is a mother’s journey.  She needs allies, certainly, but the journey is definitively her own.  She is the one who has to fight the doubts, and ultimately believe that she is not broken.  She may be a bit bent in spirit, but eventually most women can believe that most of the time, her uterus and her mind are strong.

So what does it do to a mother who is already working through her process, when she is told that not only does she have to live with the results of her c-section, but that she didn’t have the right kind of labor before her section?  And what does it do to her faith in the medical professionals who tell her that, when she realizes this is a completely arbitrary distinction?

[i] American College of Obstetricians and Gynecologists. (1999). ACOG Practice Bulletin No. 5: Vaginal birth after previous cesarean delivery. Washington DC.

[ii] Coassolo, K. M., Stamilio, D. M., Pare, E., Peipert, J. F., Stevens, E., Nelson, D., et al. (2005). Safety and Efficacy of Vaginal Birth After Cesarean Attempts at or Beyond 40 Weeks Gestation. Obstetrics & Gynecology, 106, 700-6.

[iii] National Center for Health Statistics

[iv] Taffel SM, Placek PJ, Liss T. Trends in the United States cesarean section rate and reasons for the 1980-85 rise. Am J Public Health 1987;77:955-9.

 

Finger, Airplanes, and Sutures: What’s in a Scar?–Jodilyn April 17, 2012

Filed under: Uncategorized — EssentialMidwifery @ 3:04 pm

OK—two disclaimers and an FYI:

1. If you get queasy this one might not be for you.  There are descriptions and even pictures of a small but significant wound on my finger included in this post.

2. I am fully aware that a finger and a uterus are different from each other, I’m using my finger in this post as an inspiration to consider uterine scars and how they heal.  I also talk a bit about airplanes and the scientists who understand why they fly—and I relate them to the scientists (physicians) who understand cesarean surgery.  You can ignore the finger and airplane parts and the rest of this will still make sense : )

FYI: there are some highlighted phrases in this post–they are live links, click on them to learn more!

For the rest of y’all….

It has been with a great deal of interest that I have observed my own finger over the last two months.  It all started with that magic moment I felt the lid of the tin can I was opening make a neat “pop” sound as it cut into the soft skin just below the first knuckle of my pointer finger on my right hand.  It was followed quickly by a series of thoughts in my head that went something like this:

Me:  “hey, I just cut my finger”

Me Again:  “wow, I think that’s my bone”

Me: “oh, my, that’s cool”

Me Again: “um, I think that’s my bone”

Me: “hmmm. I think I’m gonna pass out.”

Me Again: “Why would I pass out, remember the crazy things I’ve seen—way worse than this!”

Me: “yah, stop talking and lie down on the floor and put your feet up before you faint”

As I slumped to the floor, spine removed from body style, I quietly said to my husband, “Hey, I think I just cut myself really badly”.  Here’s a picture of the cut:

I went to the doctor.  This cut went through several layers of skin and tissue.  It was kinda nasty.  But, thanks to old timey medicine, I got it sewn up.  I had five interrupted stitches placed in this cut.  Here’s a picture of the stitches:

So sexy, right?!

Remember, this is just my finger.  But it’s my finger.  These little suckers throb like the dickens when they’ve been thumped, sliced, burned, or otherwise assaulted.  I found I needed my finger for all sorts of daily tasks, and anytime I put any pressure on it or near it I would feel the pull of the stitches and the associated burning.  Goodbye sleep, I tossed and turned all night for several nights trying to make my finger comfortable!  It was kind of rude.  But as I lay awake in the wee hours I started to think about the other scars I’ve known.  The scars that belong to these women we have loved through hours of prenatal discussions and long nights of labor as they walked the long path to birthing a child vaginally after a cesarean birth.  Of my own scar from my first birth, and how much that birth established me in this world.  And the two births I had where my lovely boys sailed right past that scar on their way to my arms.  I imagine them looking at it from the inside and I remember my doubts about whether or not that scar would need to be reopened in order for them to be born.  For the record, I was over 42 weeks with both of those boys before they were born.  My scar stayed closed.  It neither burst open on its own nor did anyone slice back into it to birth the boys.  That may seem odd at first glance.  I mean, let’s review.  See that wee little cut up there on my finger?  Why on earth would a few threads actually work so that my finger won’t split open every time I try to wash a dish in the future?  And why on earth did the scar on my uterus not split open just from carrying the weight of the baby, the amniotic fluid, and the placenta, let alone from the pressure of labor?

I’ve often challenged my father-in-law the aerospace engineer to really explain to me why a giant metal machine full of parts, baggage, and people would possibly stay up in the air.  He patiently explains things likes “fluid mechanics” and “aerodynamics” and, no pun intended, it flies right over my head every single time.  But here’s the thing:  if you Google “how does an airplane stay in the air?” you will get roughly two million, seven hundred thousand answers.  Rocket scientists are not gatekeepers.  They want to share what they know even though it requires sharing of scientific and often complicated ideas.  Amazingly, when, in the middle of the night, I wondered, “hey, how many stitches does it take to close a cesarean?”, and I googled it, the answer proved to be non-existent online.  I was trying to equate trusting my finger to work again with trusting a uterus to work again. Although I’ve had my own cesarean, and seen dozens and dozens of them, I don’t know even approximately how many stitches it takes to close up that wound.  I do know there are five layers of stitches (the wall and outer lining of the uterus, the rectus muscle, fascia, and finally the ones that are visible to close the outer layer). When I (just now) asked my OB friend for an answer he shared that he uses about seven lengths of sutures and extra if there is additional bleeding or a longer than average cut.  Each suture length is 18 inches long, making just over ten feet of suture material that goes into closing up the incision for a cesarean birth.  When you are thinking of that magic combination of the body’s ability to heal and natural surge towards health and the support for that process given by sutures, you might see in your mind’s eye why those layers of incisions come together so well.

The really important part of this discovery is not that the information is not readily available online, it is the kind of phrases I saw that are online.  In answer to my question, one many women seem to have posed over many a web site, you can find answers such as, “I asked my doctor but he told me there about 10 staples on the outer-most layer and since that’s all I can see it is all I should worry about”.  And then there is the physician who condescends, “Personally, I would not worry about this and would trust the surgeon to do the best and place trust for your best!”  Huh?  If the repair, recovery, and future strength and functionability of the organ which sustains and then gives us actual life is guarded more than the secrets of how to fly an airplane, it’s no wonder we don’t know if we can trust it!

As two wise women, in their upcoming book The Essential Homebirth Guide have been known to say, “The Big Bad Wolf of the VBAC question is uterine rupture”…but what is a big bad wolf?  A mysterious allegorical shadow that gains darkness when we think about it because what we can’t define, we tend to fear. Fear is not released just because a very nice person in a white coat pats our backs and coos, “ah, don’t you just worry your pretty little head about it”. Understanding and knowledge allow us to let go of our fears.  Knowledge of how wounds heal, what to expect as your incision heals, and how it will all hold together during your next pregnancy, labor, and birth can put to rest a large percentage of the fear many women carry with them from one birth to the next.  A huge thank you to the prolific writer Robin Elise Weiss who covers all things pregnancy for about.com.  Click here and you can take a tour of photos of all-things cesarean-scar related.  And of course to the steady source of support and information, we turn to ICAN  at this link to get the frank details of exactly what occurs in a cesarean surgery.

So what’s in a finger?  And how on earth can we use my once sliced and now healed finger to guide us in our thoughts about uterine scars?  And what voice will we use to replace the dude in our heads who is going on about how we should just be nice girls and trust our doctors to do what is right?

Here is my finger today:

Here are some of the things I am doing every day with my finger: washing my hair, holding my toothbrush, typing, writing, pointing, carrying, chopping, sautéing, washing dishes, cleaning counters, petting the dog.  Also, I tend to feel my scar a lot and massage it and say nice things to it like, “thank you so much for healing, my life is so much easier now that you are all closed up!”  I couldn’t use my finger for all of the activities it was designed to help me accomplish for quite a while.  But now it is healed, and I get to use it again.

When I meet a woman who is considering a VBAC, and for example I met one yesterday and 3 last week, I look at my finger.   That scar and all of the tissue beneath it are really strong.  I trust it to do all of the activities it was designed to do.  I trust it for many reasons.  And now I get to add that I trust it because I got to watch how a combination of my body’s natural prowess at healing and some well placed sutures worked together to create a very strong bond where a wide open gap once existed.  And that is exactly why I carried and birthed two babies, both born a full pound to pound and a half larger than their older sister, without worrying about my uterus suddenly splitting in two.  The research backs up my observation and experience, and as midwives or a doulas, or whatever kind of birth worker label you want to slap on us, that is why Jane and I trust that the biggest worry in the room where a VBAC mother is busy being pregnant or birthing should never be whether or not her body, which has done the work of healing just like my finger, will suddenly split open.

And now a word about that booming voice and how nice girls oughtta act and show reverence for what the doc says.  There are a handful of hospital-based midwifery and OB practices around Seattle that require a mom planning to VBAC to have a visit with the “high risk” obstetrician to be “approved” for a VBAC.  They are using a variety of parameters to decide whether or not to allow a woman to labor and deliver vaginally according to her wishes (they are different from practice to practice).  They are not using World Health Organization recommendations, or the recommendations of their own agency (ACOG), or good science, or best practice.  They are not comparing the risks of second surgical births to a vaginal birth. They are using arbitrary lines in the cement, likely based on policy created by reactive attorneys for their hospitals (this is just the society we live in today—it may or may not be something that the OB actually believes to be true).  After all of the years of watching cesarean rates rise, and VBAC rates rise, then fall, and now slowly creep up again, we are down to waiting and praying silently for approval or denial that may or may not be grounded in the truth about a woman’s body and her baby.  Enough with the good-girls, it’s time to get smart and learn about what keeps your uterus from falling apart at the first contraction.  Join ICAN today, follow the evidence, get yourself with a midwife or a physician who looks at you as if you are capable, smart, and able to understand science and logic. Then celebrate your strong healthy uterus every single day. From my fully functioning finger to your glorious capable and monstrously successful uterus, may we all enjoy the thrill of knowledge and the confidence born of understanding the truth about how our bodies heal.

 

On Grandmothers-Jane April 2, 2012

Filed under: Birthy Thoughts — EssentialMidwifery @ 2:53 am
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There are as many kinds of mother-daughter relationships as there are mothers and daughters, and I for one, can’t do that kind of math.  I’m an English major. And when it comes to baby having, things get even more complicated.  I’ve had clients who couldn’t imagine giving birth without their mothers,others who didn’t call their mother until the baby was 3 months old, and everything in between.  Like most aspects of the client-midwife experience, it is certainly not my job to get in the middle of those sorts of things.  No good can come from that.

However, if the pregnant mama has the type of relationship where she does feel comfortable with her mother’s presence, there is magic to be seen at these births. Babies wash out of us, riding a primordial slip and slide of blood, water, and change.  A woman becomes a mother in one instant, a man a father.  And for the mother of the mother, she is suddenly thrust up the ladder a rung, Whether she is ready or not, she is now a Wise Woman.

So speaking to the grandmothers, even if you consciously reject the Wise Woman title, your soul knows better. You have undergone your own metamorphosis, brought on by your own baby’s labor.  Watching a person you love in pain, is incredibly difficult, particularly if that person is your child, The same cellular connection that existed when you nursed your baby, or held her as her teenage heart broke into a million pieces, or swelled with pride as she stood up for right, still exists. That fierce protectiveness that infused your every move when she was an infant?  Still there.  When she was small, you would have done more than died for her if anything threatened her safety; you would have killed for her.  And it might come as a surprise to realize that you still would.

But here, in the labor room, hopefully lit by candles and love, there is nothing to defend against, nothing to fight.  Mama Bear has to go into hibernation.  Watching your daughter discovering her own strength, to see her feel her own sacredness, is a journey all its own.  Just as she must surrender to forces larger than herself, so must you surrender your desires and expectations.  She will find her way, and you have to do nothing but get out of her way.  And it is so so hard.

For many grandmothers, this is the most they have touched their daughters in many years. But in labor, in some ways, you can almost go back in time.  You can embrace your child again, without reservation, hold her physically again as she moans into your breast again, looking to you to make it all okay.  And while you can’t take away her physical sensations, you can imbue her with the courage and fortitude that is hers by womanly right.  It is as if she grows up all over again, in a compressed amount of time, right before your eyes.  She begins small and frightened, moves through uncertainty and doubt, and then in one instant, as her own child eases out of her body, her confidence and self trust shine through again.

Grandmothers then too are ready to take their new place in their family’s world.  For your daughter was not the only one who was birthed into another form of self that day.  Welcome to the world, Wise Woman!

 

VBAC-less in Seattle February 17, 2012

Filed under: Birthy Thoughts,Jane — EssentialMidwifery @ 12:49 am
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It is no secret that Jodilyn and I are completely and utterly committed to vaginal birth after caesarean. We believe in the right to birth your baby vaginally, whether in your own home, a hospital, a field, hanging from a trapeze…you get the idea.  We believe in intentional birth, one that is the fulfillment of carefully considered thought and soul work, and not one forced into an impersonal mold by circumstances.  In short, we believe that everyone has the right to birth the way they see fit.

Only, what happens when you can’t? We have been so lucky here in Seattle, because while the actual number of providers doing vbacs has remained fairly low, there has traditionally been a nice mixture of types of providers.  We have homebirth midwives, hospital midwives, family practice doctors, obstetricians, and even a few perinatologists.  Unfortunately this has changed radically over the past year.

Hospital midwives who do vbac are in short supply here in the greater Seattle area, and getting shorter.  We have lost two major midwifery groups, and one extremely popular independent practitioner.  We now have only two hospital midwifery groups in Seattle  proper who do vbacs, and one of those are severely restricted due to insurance limitations.  While we do have many doctors who deliver vbac babies, they are, in fact doctors.  They may be delightful people, but they practice under many limitations, some self imposed, some practice or hospital based, and some pushed upon them by insurance companies and malpractice issues.  They are not midwives.

And midwifery care IS the answer here.  If anyone needs the focused care and tender compassion of a midwife, it is the vbac-ing mother.  The long office visits, the search for answers from her last pregnancy, the wading through pages and pages of safety studies…these are not the exclusive territory of homebirth midwives.  It is the right  of ALL midwives, regardless of where they serve, to hold a woman as the tears come during prenatal visits, to flush with anger alongside her for indignities done, and questions left unanswered.  ALL midwives should be privileged to wipe the sweat from a laboring vbac-ing mama’s face, to bring her water, to sing to her softly in the tub.  And ALL midwives should have the opportunity to discover the humility and strength that  reside in their souls in a way that is only possible when they stand silent in the birthing space, the one solitary being who truly and absolutely believes in this mother, body and spirit.

It is honor beyond measure to attend these women in their most creative time.  And I am so sad for the midwives who are being denied this.  I want our sisters back.

 

The Quintessential Togetherness. January 31, 2012

Filed under: Birthy Thoughts,Jodilyn — EssentialMidwifery @ 7:13 am
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Well Harumph….

I’ve been thinking about the recent publicity regarding the rise in homebirth rates.  You’ll hear Jane and I repeating our mantra in our sleep, “relationship, relationship, relationship…it’s all about the relationship mothers have with their provider.”  Can the provider be trusted to provide continuity of care and individualized attention?  Can the provider be trusted to guard the space and values of each family they work with? Can the provider do their work without needing the spotlight,  a.k.a. can they in fact “catch” and not “deliver” ? Can they do it all while preserving the relationship most fundamental to humanity? Can they offer support, resources, and guidance without actually providing precise google-map type directions for how things will be, how long it will take to get there, and what roads parents will or will not take?  A midwife is constantly thinking “re-routing!” as she adjusts her services to meet the needs and wishes of her clients.  My grandfather used to point out (via drawings on napkins in restaurants) that the fastest way between two points is a straight line, but it’s not necessarily the right path to take.

Ok. Spoiler Alert:  I whole heartedly believe that the safest place for a woman to birth is where she feels safest.  Home.  Birth Center.  Hospital.   Riding a float in the Macy’s Day Parade.  What I’m about to say really isn’t about that, it’s about what I’ve seen and what I believe about why women are choosing homebirth.

The word “quintessential” is a pretty common  adjective.  It’s used to demonstrate the most likely or perfect example of something.  I was staring at the ceiling today, trying to take a wee break from studying (and by wee break, I mean a small interlude, not a bathroom run).  I was missing my friends and the strangers in Vanuatu who would never have let me sit at that table alone while staring at the ceiling.  I miss the togetherness of that culture. Which got me thinking about how we create close relationships.

I started to reflect on the births I have attended here in the greater Seattle area (because of course when I wonder about anything I have to wonder first if birth affects that thing and how exactly it accomplishes it).  The hundreds of them.  I see little flashes.  Early on, those first births as a hired and paid doula, where I was supposed to be smart about this stuff and know just what to do.  Running out to the waiting room to call a more experienced doula for ideas.  Learning to let the text book information sink to the back of my head and actually respond to the mother.  The way a woman’s face changed as she was pushing, and how time stood still and all I could see was the force of birthing.  More flashes of firsts:  The first time a nurse gave me (me!) the code to the nutrition room (oohlala) so I could retrieve some ice water (the sacred nectar of hospital birth).  The first time someone’s water broke on me (followed by two more times that same week).  The first time a mother I was working with went to the OR.  The first time I smelled thick meconium mixed with that metallic odor of too much blood which portends a massive hemorrhage which was also the first time I saw a mother and a baby in steep decline in the same moment.  The first time someone told me that they had attended a birth that seemed a lot like rape (I was notably judgmental about this statement and couldn’t believe that this woman was sooooo dramatic).  The first time I attended a birth that felt like watching someone be raped (after I finished throwing up I called the other doula to apologize and she lovingly let me vent).

The first time I went to a homebirth.  The first hospital birth after a run of eight homebirths.  The sheer terror I felt at the silence of that birth, at the language at that birth, so markedly different than the midwives I had just been over-exposed to.  Of the total lack of raw power and connection between the mother and baby during that labor.  The weird, unrelated chatting.  The way the staff spoke with the mother as if she was totally inept about absolutely everything.  The way they forced the baby to nurse without actually noticing what state of being the baby was in.  Don’t mind me, brand new person who never felt, heard, or saw anything in this world before, while I overstimulate you with all this rubbing, thumping, sucking, talking, and stuffing of your mother’s breast into your mouth while pressing on your head with a force most adults would not appreciate….

It’s clear they are doing their j-o-b’s as they were instructed to, but there was no consideration for the variables of humanity of the mother or the baby.  What about just watching as the mother explores her newborn in her own time, in her own way?  What about allowing them to teach each other about the comfort, security, and nourishment that mom has to offer and those incredible newborn gazes which suck us in and make us fall in love if the baby is in the right state and the experience is organic?

I have been to some stunningly beautiful hospital births.  But here’s the truth:  It’s not the same.  Even drug free and naked and vociferous, it is not the same.  And the reason why, I realized, as I stared up at that ceiling in anygivenseattlecoffeeshop, is the quintessential togetherness that pregnancy and birth so dramatically and eloquently demonstrate when left to their own devices.  Midwives know there is a mother and a baby.  We actually call them motherbaby.  They are a dyad.  Inextricable from one another.   The baby needs the mother for food and oxygen supply and comfort and love.  The mother needs the baby to help her come into her mother-self.  To see the power in her body and potential of life and the bulkiness of what it means to really really love.  To lose sight of the small stuff; the control, the management, the ability to shave her legs all by herself.

The language of a hospital birth separates mother from baby.  Blames the condition of the mother in any given moment on the baby.  Questions the mother’s ability to continue to provide nourishment and oxygen for her baby on this single day when she has been doing it to perfection for the previous 260-280 days of her life (unmonitored, without permission, without apology, without doubt). The baby is seen as an imminent threat, the mother as an unfit and incapable hostess.  The examples are too numerous to cite, just ask a doula for one or two and she’ll go pale and give you ten or twenty.

Motherbaby: Quintessential Togetherness.  Bound by blood and water, time and love.  She brings him life and security, he brings her motherhood—that gracious, spacious, place beyond measure where women are bolted to the basic cellular formula for the entire universe.  We don’t do it alone, we don’t do it separate from our babies in even one single way.  We do it together in concert with them in every single way.

I am a midwife now who sometimes attends births as a doula.  It’s a lot easier as a midwife.  The technical responsibilities are greater.  But I never have to listen to a provider try to crack apart a mother’s relationship with her baby.  I don’t have to think about what to say to try to help that mother find healing and strength and connectedness.   Everything I do is about promoting that relationship and sense of what is right for the two of them, at the same time, together.   Everything I do is about letting the mother’s sense of self and baby dictate what comes next.  My terms are not that she will follow my protocols or accept my rules.  My terms are that she seeks to understand what she does not, that she asks all of the questions that cross her mind, that she speaks her heart and shares her thoughts, hopes, fears, and desires.  My terms are that the two of them work through birthing together using all of the resources they want to.  Did you know that a mother and newborn know each other by smell within hours of life? They can pick each other out of a lineup with just their noses.  That is so incredibly intimate.  Who would ever mess with a system that provides for that level of connection?

It’s no wonder there’s been a 30% increase in homebirths of late… faced with the opportunity to spend the prenatal clinic hours with a provider who wants to promote and support that togetherness, faced with the opportunity to stay as together as they’ve been for the entire pregnancy during birthing, faced with the options that matter so deeply.  The decision isn’t the quick or the easy one, but it is clear why, for so many women, it is the right one.

 

Once Upon a Time: How Stories Matter in Birthing and Book-ing September 20, 2011

Filed under: The Essential Homebirth Guide — EssentialMidwifery @ 7:39 pm

Hello, Blog!  Its been a while, and we missed you.  I know you won’t take it personally, its just that we have been super busy writing The Book.  One of the reasons we even decided to do this was to give homebirthing families  a voice.  Its not so much that this population is marginalized (Well, ok.  Maybe a little.  We just don’t tend to lend a lot of credence to that sort of stuff.) And it’s not that homebithers have any trouble screaming their truth from the mountaintop.  We all love Truth and Mountains.

It’s just that words matter.   What we say and how we say it, can profoundly affect a woman’s birthing experience.  To recognize and embrace this sacred responsibility can be both awesome and terrifying, and we hop we never take it lightly.  Yet, it is also one of our greatest tools, particularly during the prenatal time, and if used effectively, can help a mother access her internal strength.  Stories can help a woman come to informed decisions regarding her care, make it easier for her to picture her ideal birth, and strengthen our relationship with her.  So pull up a chair, stoke up the fire, and settle in for a spell.  Once upon a time…

The most lovingly effective midwives have always used stories as teaching tools.   Why?  Because most midwives are also parents, and the habit of imparting knowledge and wisdom (along with a few cautionary tales about wolves and such) through story is second nature.  Stories are simply more interesting that cold facts.  They deal in truth, and even though the details may be fictional, our human hearts recognize and respond readily to truth.  Children (and adults who allow themselves to shed their worldly cynicism and overgrown, carefully cultivated sense of irony) know this instinctively.

One short foray onto any internet birth forum will show that woman learn more from each other’s birth stories than almost any other source.  We are not even entirely sure how women gave birth before the internets. Mothers are eager to both hear and share their children’s births, and the right story at the right time can have a powerful impact. Midwives, too, are not immune to the lure of birth stories; after all, they have everything!  Intrigue!  Drama!  Heck, they began with SEX!  But, to quote Obi-Wan Kenobi before he led Luke into t he Mos Eisley cantina,  ”We must be cautious.”

Of course, we try to remove all identifying details from our stories, but there are deeper moral questions to examine beyond a potential HIPPA violation.  What are our motivations in sharing this story?  If it is to encourage or educate, that will come through. But we must beware of processing externally with our clients.  Some midwives spend far too much time in an appointment talking about their latest exploits, sharing the nitty gritty blow by blow accounts of recent births.

This is inappropriate, and can even serve to make the client feel unsafe.  After all, if the midwife is talking about this birth with them, how can they be assured their birth will not be similarly dissected?  This is particularly true when the client is close to her own birthing time.  And if the story does not have a happy ending, then that is now written on the client’s heart; she cannot unhear it, and it may become a book on tape, playing in her head during her own labor.

Worse still is the midwife who shares birth stories to build up her own self-esteem.  Perhaps she is particularly proud of the way she handled a difficult birth, and wants to be recognized for that.  Or maybe she simply wants to reassure her clients that she knows how to handle an intense situation, such as a shoulder dystocia or postpartum hemorrhage. (Sometimes clients, especially in an interview, will ask for these sorts of examples, and in that case, it is appropriate to share briefly) It is so tempting to make ourselves the hero of our own story, riding in on a white horse, a syringe of pitocin in each holster, saving the day. But the role of hero is already filled, by the mother.  We are merely part of larger supporting cast.

It is not our clients’ place to debrief with us, however close we have become.  Midwives should always have their own support systems in place, whether that is a formal peer review to discuss difficult cases, or a chat with a colleague over coffee.  This is ultimately more satisfying anyway.  Good midwife friends know just what to say, and what questions to ask.  The story becomes a way to draw closer to each other, and maybe learn a thing or two.  The birth of a child now becomes larger, with the telling of the story.  It has strengthened relationships, and expanded a community.  And it doesn’t get a lot better than that.

Human beings will always be storytellers.  It is how we know who we are, and from where we have come.  Heck,  when Arthur Australopithicus walked into his cave with a rabbit for dinner, we are sure he spread his hands, threw  a stick on the fire and began, “So there I was.  Surrounded by bunnies…” Stories can warn, educate and inspire, and midwives are in a unique position to harness their power.  A story told with kind intention and respect can motivate and inspire, and that, in the best of all possible worlds, is the ultimate purpose of a midwife.

So, this was all a long-winded way of saying that we need your help.  Below is a list of sorts of stories that we are hoping to get in The Book.  We can use your name or not.  We will probably edit for space, but you trust us, don’t you?  Feel free to write-up a paragraph or two in any or all of the categories.  However, if you could send them in separate emails, that would be great.  We divide out work, and that would just be happier for us.

And please spread this far and wide, to anyone you think may be interested.  We’d love a cross-section geographically.  Your voices are important.   We want to tell your Truth.

1.   Who did you get most of your support from. regarding your decision to birth at home?  Partner?  Family?  Midwife?  Online Peeps?  How did they react?

2.  Did you have any complications with your pregnancy, birth, or postpartum?  Pre eclamapsia?  hemorrhage?  Shoulder dystocia?  Postpartum depression?  Anything at all.  How was it handled by your provider?  How was it different from traditional allopathic care, or was it?  How did you react to these complications emotionally?  How do you feel your midwife handled them?

3.  Did you have any communication problems during your care?  With your midwife?  Your partner?  Your mother?  How did you resolve them?  Did you have any conflicts regarding homebirth?

4.  Did you have any special circumstances with your homebirth?  (Note that this is different in our minds from ‘complications.”)  Vbac?  Twins?  Breech?  Tell, tell, tell!!

5.  Straight up homebirth stories.  The good, the bad and the ugly.  Bring it?

6.  The immediate postpartun hours.  Did you fall in love with your baby right away?  Did it takes a few minutes, hours, or days?  Were there complications in your delivery, and how did they affect your bonding process?  Were you triumphant, exhausted or giddy?  We want folks to know all reactions are normal!  How about repairs?  Did you have one?  How was your recovery process?

7. Did you transfer?  How did that go?  Did your midwife discuss transfer beforehand?

8.  And finally, how did homebirth change you as a person?  Did it affect your philosophical, political or sociological views?  Are you more of a feminist because of it?  Less?  Do you see how you birth as a basic human right?  Part of the right to privacy?

Thank you all for your help!  We can’t do this without you!

 

 

 

 

 

Rainy Finish….–Jodilyn July 31, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 3:49 am

I was hoping to finish up with a few days of sunny roaming and snorkel adventures but the weather beat me to the punch.  It has been raining—tropical flash-flood kind of raining—for days now and there is no end in sight.  I have to say that in the moments that the rain stops, the air is 98% wet so that just adds to the experience.  I decided to own up to my Seattle-self and head outside anyway.  I took my rainbow umbrella and strapped on a backpack and headed out for some adventures of the not so sunny variety.  In spots the water ran over my feet and not only was I combating the slip of my foot against the flip-flop, but my flip-flop against the ground.  A double slip is slow going so I took a note from the locals and carried my flip-flops.  My bare feet stopped the slipping action and with the newly found traction, I put some distance between myself and my room.  I took a long walk and then met up with a friend and hopped a bus to a beach way out of town.  We happened to find a bus full of people going there anyway so it was a super cheap ride, if a bit more of an olfactory adventure than I was seeking.  I made like a dog and stuck my nose out a window and panted for fresh air.

Umbrellas in hand, raining pounding down and sideways, we walked the length of a long beach, crossing a small river that was knee-high and about 20 feet wide that had broken through the beach to get to the ocean.  The ocean water was pulled up the river and the river water was rushing out to the ocean at the same time—it was so strange to feel the fresh and the salt mixing in warmth and cold and the dark sand churning all made for an interesting crossing.  We got down the rest of the beach and gave up on the umbrellas, we were soaked through head to toe but having a great time.  We walked back and were about to head back to town to dry clothes when we spotted a beach bar through the rain.  When it is raining that hard forms appear as blurs coming out of hazy clouds of water.  Also, I had taken my glasses off which tends to add to forms appearing as blurs coming out of hazy clouds of water.  So I was double blind but still “discovered” this little gem.  We went into the bar, which was without walls but had one solid roof and comfortable chairs.  Fans were whirring from the ceiling which helped to dry us out a bit.  We ordered drinks and decided to throw down 200 Vatu (about $2) for a game of pool.  We played, much to the chagrin of the locals who do know the rules, with no rules.  We knew someone should be stripes and someone solids but the rest was all-in and after numerous failed tries I settled on turning the cue around so the thick end was my shooter and I could slide it into the white ball to make the solid go where I intended it to.  It wasn’t fail-proof, but the game did eventually end.  We sat for a few hours, watching the ocean and the rain and meeting other tourists and locals who wandered in.  A group of 10 rowdy Aussie ladies in their late 50’s and early 60’s came in.  They were clad in bikinis and short shorts regardless of body shapes and sizes, many with tattoos or sharply colored hair, or both.  One was a chain smoker.  They ordered drinks and pondered the weather.  They had come because they heard that the owners of the bar will strap an inflatable seat behind a boat and zip across the ocean waves, giving the riders an experience or two in bouncing, jolting fun.  We chatted with them and found out that they are the Worlds Masters Women’s Basketball Champions—even with their lack of height, a guard who can’t give up the ciggies, and age, they have conquered the court for the past 15 years together and won the big game this year.  There was supposed to be a tournament in Samoa but it was cancelled and the ladies decided to go on holiday together anyway.

The rain paused and two of them went to plead their case with the young man who does the towing.  He didn’t need to be asked twice and they all jumped in the ocean and swam out to the boat.  The ladies hauled themselves into the inflatable in a most unpolite way which I won’t share, but we were hooting for them and cheering their efforts to get into the floaty vociferously.  They waved in appreciation for our cheers and off they went.  The screams that came forth from them as they bounced and whizzed across the ocean, as the driver slowed his boat and turned it and then hit the gas were something else to hear.  Two by two they went into the ocean for a ride, and two by two they came out asking for a drink and wondering out loud if there were massage therapists or chiropractors in town.

We took another walk down the other direction and passed some houses under construction.  One of the locals pointed out that it is a terrible place to live and some Australian suckers will be the first under as the reef here is very close to the shore so will not provide any kind of break for a large ocean wave or tsunami.  I think there is a really good rule here, if you are ever visiting or considering land purchase.  If the locals aren’t doing it, neither should you.  If you don’t have to relocate an entire village of shacks and lives to build your waterfront home, there is probably a really good reason.  If the only trees standing in the area are very very tall coconut trees, there is probably a really good reason.  I expect stucco, fancy counter-tops and landscaping will all be washed out to sea with a few good storms.  The same goes for the little cultural nuances—women get dressed in clothing that covers their bodies here and with the exception of the downtown strip and the tourist beaches, we should do the same.  If you are listening to music in earphones while walking, it is socially impolite to wear both earphones, so only use one.  And on and on I could go, but I won’t…

I was fighting a cold but it won—as soon as I finished my last shift at the hospital I must have relaxed.  After two months with no illness—not a fever, or an infection, or any stomach problems at all—I have been beset upon by a common cold, which I find altogether very rude.  After the rainy day adventures I was really ready to be dry and nap.  So I did.

I came here to work hard and I actually did that in much better ways than I imagined I would have.  I think I used the minutes here well.  So with my last two days I am going to relax hard and enjoy the people and the weather, whatever it happens to be.   I did look for souvenirs to bring home with me for family, but they don’t make anything here per se, other than Kava, which I am not bringing home.  So I am coming home mostly empty handed, with memories of  Vanuatu and the mothers, the babies, the midwives, doctors, nurses, and students, the children of Chicken Road and the locals and vacationers who struck up conversation with me as the souvenirs of my heart.

I am ready to come home.  I don’t know what is coming next.  This experience has grown me.  I want to pause.  I want to think about what kind of life we want to have.  I am in no rush to jump into work.  I want to spend time with my people and push a button and watch ice come out of my freezer.  I want to hear Julia and Jeffrey laughing and listen to their stories.  I want to spend time with my husband and see my girlfriends.  I want to write a great book with Jane and share the lessons that so many mothers have taught us.

Thank you all for joining me on this little journey to the South Pacific…Jane and I will continue to post updates here as to the progress of the book-o and the bits and pieces that come with it.

Signing off from Vanuatu (that is, if I can manage to get the internet to work so that I can sign on and post this!)

 

 

My last, last day. –Jodilyn July 28, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 5:05 am

After what was supposed to be my last day I felt I could not leave on that note so I made a last, last day out of yesterday.  The jokes are flying already that I can’t be gotten rid of.  It is hard to leave.  Happily my last last day was a quiet one with one wonderful breech birth.

Mom has two girls at home and was hoping for a boy.  Baby had been head down until labor started so we count that as one “surprise” breech even though we had some time to prepare before the actual birth.  The birth was, to say the least, felt quite strongly by the mother.  The mother’s power, to say the least, was felt quite strongly by a string of relatives and workers, myself included, who bare the marks of her strength and pain all over our bodies today.  I am covered in bruises the size of fingerprints, scratches and red reminders of her grip from my neck, down my left arm and down the left side of my back.  A doctor was doing the actual delivery and I was in there as part of the team.  I made myself as useful as possible which seemed to be at her side, helping support her legs and rub out the cramps between contractions and as a foam brick for her squeezing, pushing, pulling, gripping, and general wrestling during them.  I spoke gently to her, washed her down with wet cool gauze, and watched the birth unfold.  Baby was in a cock-eyed position.  His rump was born and the body came well and then the head seemed to be hung up.  The head OB came in and saw the mother in her fits and announced to the room that although it might look like she is being uncooperative, she is really just in so much pain and her behavior is a reflection of this.  Well said, doctor.

He did some work on the baby’s head position and baby was born, not looking awful but not great either.  The baby was just kind of stunned by the whole thing.  They took him immediately over to the warmer to help him get started and I was watching the baby so was stunned and surprised myself as I was pulled into a massive bear-hug from the mother.  She was clutching me to her and whispering sweet-nothings in my ear.  I hugged her back and whispered back about how amazing she was and she did it and all of the great things we say to each other upon the birth of a baby.  Baby gave a good cry (hooray, because otherwise I was going to have to have a third last day) and was shortly skin-to-skin with mom.  His poor head had been squished and his forehead and skull in that area were flat as a chalk board.  We know the skull will mold, we just usually see it in the other direction.

An hour and some change later I took baby for a float in the baby tub and clearly his left eye had been squished as well and he spent most of his bath winking at me as he tried to keep that eye open.  He was playing with his toes, his legs still folded neatly up against his chest in the position he had decided to be born in.  He finally got the eye open and then stared at me and went cross-eyed a few times before everything straightened out and looked as it should.  His personality was so evident and full.  I had a great time with him, getting him dressed and singing to him while mom got settled in.

After he was safely tucked in with mom I went to check on the twin’s mom, who had been readmitted for twin 2’s rash.  I have been checking in with her regularly and went to say goodnight two nights ago.  She told me she was really not feeling right herself and there was a terrible smell coming from the uterus, and asked if it was normal.  We had a long talk while I got all of the details regarding the color, odor and feelings.  It sounded to me like an infection.  I went to go discuss with the night shift midwives and they said they would put a note to have her checked in the morning as even if they took a swab at night, it does not go to the lab until the day time.  One of them said that she is always going to the shower and complaining and kind of blew her off. I went back to mom and told her that they were planning on doing a swab in the morning and that if they did not do it she should ask, keep asking, and get really demanding and cranky if they do not respond.  I gave her the only lecture any of us ever needs when it comes to our health care—that we are our own best experts.  Whatever the professionals know about medicine they do not know our bodies and our lives the way we do, and if she did not feel right, she needed to follow up with that until she found an answer that seemed correct to her.

I went in to check with mom to make sure they had done the swab with her today and she looked so much better, sitting up where I had only seen her lying down, and her color looked better.  She told me she had been looking for me to tell me that she pushed until they examined her and they found a piece of gauze that the doctor left inside of her a week ago—so no wonder she looked like she was getting an infection, her body was yelling at her!  She felt so much better and was so happy to have that healthy feeling back again.

I said goodbye again and promised to come back on Monday to say goodbye again.  I took bunches of pictures of the hospital and Chicken Road and some of the kids climbed inside a big box and wanted their picture taken so I did that too.  I got a few shots of the dog that wants to like me but has chronic low blood sugar crankiness, and some of the chickens that follow me every day.

My flip flops have gained 1987 Toyota Camry status as they have about 100,000 more miles on them than they should and they just keep going.  I took them for a long road trip and walked to some of my favorite spots to snap photos.  I then walked way out of town to the WanSmolBag Community Center/Theatre and purchased 3 seasons of Love Patrol on DVD.  The finance lady is one of the stars of the show so I got to get my receipt from her.  I tried to play it cool but in the end offered to send her a picture of us watching Love Patrol at home in America and she was really excited about that idea.  I was really excited to meet her.  It was hot and humid today and it only got worse on the walk back to my room.  I was not unhappy to see some clouds roll in and feel a little cool rain on me as I walked.  It did not help the fact that I was walking through steam except in the seconds that the drops hit my skin—I tried really hard to enjoy it as I hear terrible things about the weather at home and expect to be longing for the heat soon.  It didn’t really work.  Weather, like birth, is something that is hard to really understand with our imaginations and you kind of need to be in it to really feel it.

 

So not my kind of day, but mine nonetheless. –Jodilyn July 27, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 6:30 am

Here’s the thing about swimming in the morning.  I swim a gazillion laps and then I put on my glasses and kick a gazillion laps with the kickboard I toted here from home.  And every morning there is some Australian or French or Chinese man sitting in his shorts outside of one of the rooms that has a door that looks out onto the pool.  And every morning that man, whichever man is staying in the room apparently reserved for men in Vanuatu who smoke in their shorts in the morning, sucks away on his cigarette as if it was the last cigarette in the South Pacific.  He is partially obstructed by a small palm tree and about 20 feet away from the end of the pool.  He blows his smoke up and it puffs around him before the wind catches it and takes it away.  And he continues on and on with this morning ritual while collecting his thoughts for the day.  And I swim back and forth and kick back and forth dozens of times, trying to dump my thoughts from yesterday.  And we stare each other down from time to time, until he has to go get ready for his meetings, and this is our little dance.  I’m the only one of us that knows I have been doing this for almost 8 weeks with other men who have the same morning routine as he does.  This morning there was a new man with new shorts and new cigarettes and new thoughts.  And this morning there was me, back and forth and back and forth, unable to banish the thoughts in my head from yesterday so trying to let them just melt in to the ones that stay around for a while.

Yesterday was my last full day shift.  Two midwives and a student came from New Zealand and we had a new crop of nursing students in and they were all integrating themselves into the schedule and the workings of the place.  From 7:30am until 5:30 pm we had eight laboring mothers, eight births, eight postpartum routines, two of which were anything but routine at all.  I was with two women who had lovely births and I taught some new nursing students through them.   They have to observe 5 before they can participate and I had much teaching to do as the male student was abrupt and harsh with the moms and I had to beat it out of him.  Which I kind of did.  OK I totally did.  I figure I am leaving before long and would rather give it to him straight than wonder if I should I have been more direct with him about respecting these women and their process and their babies.

The female student was seeing stars by the end of the first birth and just wanted to talk and talk about it.  I had her deliver the placenta with me and then I gave her The Big Placenta Tour and told her to stand there and play with it and get to know it, fold it, open it, turn the membranes inside out and back again.  She followed me all day long asking questions and translating for me when mothers had no English.  She was a lot of fun but I missed my old students who know my ways already and who I have developed friendships with.  I saw one of them later and we hugged and chatted.

I went to help out at a premature birth.  I will have locked in my mind forever walking in and meeting the mom and the aunties and watching them smile and laugh and rub her belly.  She had just been to have an ultrasound to determine dates—she was already almost fully dilated when she came in to the hospital.  By records she was just 24 weeks, by scan 25, with the baby estimated at 870 Kilos.  Very tiny.  Too early.  We had a quiet consult in the corner, reading the scan (which is not an ultrasound report as we know them but just notes on a blank page from the doc who did the scan) and staring at each other.  We had a sentence exchange.  “I hope it is more like 26 or 28 weeks.”  “Me too.”

Even here where the death of premies is what normally happens with premies, I was relieved to be with the midwife from New Zealand who has been such a mentor to me and to see her working it out in her mind what our options might be for saving baby.  We planned…if baby looked like it had a chance we would take one path and if not then straight to the mother so that she could hold the baby while it died.  We were prepared to protect them and keep them together, something that is not automatically considered as an option here.  The baby was breech.  We called in a doctor to come do the delivery as is protocol for premies here.  I don’t want to go into the details which feel private for the mother and baby and are frankly horrific in many aspects.  I watched the aunties faces as they realized what was happening.  We did our best to prepare them but the truth is, a person just can’t face it until it is upon them, and until there is death, there is life.  It was an agonizing birth.  The baby was stillborn, it’s little body not able to withstand the birth or life unsupported by the unique environment of the womb.  We carefully wrapped the baby up, leaving his hands and face exposed for the mother, leaving the blanket loosely wrapped so that if she wanted to she could explore the curves and limbs of the child she had felt moving within her for all of the those weeks.  I heard the NZ midwife behind me whisper, “We are all mothers here.”  I gave a brief nod and felt a tear slide down my cheek.

The mother’s mom came in, having left work to come and be with her daughter as she birthed.  She was paralyzed in the doorway and I gently placed a hand on her back and helped her in the room and eventually over to her daughter and grandchild.  As I got her to the bed I heard screaming from the other half of the room and walked calmly but quickly to see what was going on.  I saw a mother in there alone, she was obviously going to push her baby out.  I took a breath and shook out my body and went in.  I was instantly surrounded by students and more importantly the utter life-force pouring out of this mother.  She was power incarnate as she leaned back on her elbows, arched her back and pushed.  My heart was still with the mother on the other side of the room.  I needed my whole self there with this mother.  I was responsible for her and the baby and these students.  The newly arrived midwives came in and observed.  The birth was beautiful; the baby was perfection and acted just like we hope babies will through birth.  It found its way out and I swooped it up to mom as it let out a screaming opinion of the whole experience and then quickly quieted as the thump of its mother’s heart was felt and heard beneath her ear.  This was baby number three—the first girl after two brothers, and she was welcomed mightily.  The mother held on to that girl with gusto.  I was lost in the joy with this mother and the memories of my sister-in-law having her first girl and one of our clients having her first girl and all of the girls we have welcomed and celebrated.  And there was my experience here in a nutshell.  Whatever is happening in one moment, life will pull you forward into the next without a thought for whether or not you are ready.  At home we pause and gather energy for the next big thing.  Here we are whisked in whirpools of loss and sorrow, joy and triumph, shaky knees and power.  And it just keeps going and going until the whistle blows and someone else comes and stands in your place to give you some reprieve for a few hours.

We had 10 minutes before we had to move one of the moms and babies and it looked like the laboring ones would wait that long so we all ran to the lounge to get some food in.  The NZ midwife said to me, “Lunch.  Now.”  I have learned to trust her sense of timing and bolted to the fridge where I put my lunch.  I didn’t think, I just fueled up and hustled out to get the mom and her baby settled in.  The mother who lost her baby was given a bed near the midwives’ desk where higher risk mothers go.  There are only 4 beds in that room so it is a little easier.  She was alone in the bed staring at the mother across the way who was nursing her baby.  I went in and sat on the bed next her and held her hand and she cried and cried.  I told her what a strong good mama she is and rubbed her forehead softly while she closed her eyes.  I stayed with her until she fell asleep and then quietly took my leave.  The other mother was crying and smiling at me.

I went to check on the delivery room to see what kind of activity was going on.  I sutured a mom while next to us another was birthing.  She was attended by the newly arrived New Zealand team.  I heard pushing for a while.  Too long by Vanuatu standards, too short by American.  I peeked.  Bleeding ahead of the baby—she would have some deep tears.  I went to the front desk and told them I just want them to see that it is not me in there to which they chuckled because they know I am paranoid about this whole issue, even though I have seen it happen to mothers when I am not the midwife with them.  I went back to check.  Still pushing.  I caught my favorite doctor and told her I felt something was not quite right and that maybe one of the hospital employees should be in there with the visitors.  She came in with me, took one look and lifted her eyebrows in her way that means, “you are right, Jodilyn.”  She left the room and I stayed in the back, watching.

Baby was born quite floppy and they started mild “hey, wake up baby!” activities that were unsuccessful.  I had already put together the bag and mask and set them out for them—I have had long discussions with a variety of people about this kind of thing.  Am I intuitive?  What does that mean?  I might just be putting together bunches of tiny bits of information and compiling them all like symptoms into a syndrome, or I had a funny feeling, or whatever we are going to call it.  I just knew this was going where it went—although I can’t say I imagined the final outcome, I did think they would need to resuscitate.  They brought the baby to the table and I told the student how to place the baby as she put the baby backwards, which is exactly how a person would place the baby when we put babies down, but this was one to work on and not to admire and coo with.  She turned her around and they got the resuscitation working.  The baby had a good heart beat.  I have learned here to palpate the heart beat instead of listen for it as it is faster.  So I felt then listened.  I left them to it and went and got the NZ midwife who came in and called the shots thereafter.  After 15 minutes of bag and mask the baby started to breathe on her own but it looked reflexive in nature and she had no tone in her muscles, did not open her eyes, and continued off and on to stop breathing.  I ran around the ward finding the doctors we needed and they came in and tried to get IVs going.  She was finally stable enough to move—although still had shown no sign of life beyond heart and lungs.  In the nursery I watched her—clearly having seizure after seizure for quite a long time, longer than I care to say, until the medicine came which stopped them.  One of the mothers who has been in the Nursery with her baby for 5 weeks now is the most amazing peer-mentor.  She did not let a second pass before she placed her own baby in his incubator and went to show the dad how to open the arm slot and hold the baby’s hand and stroke the baby gently and talk to the baby.  She was amazing.  I have seen her doing this with parent after parent.  She is stunning, so full of compassion and gentle, easy companionship with the other parents in there.  Their babies come and go, some live and others do not.  She never waivers in her steady and soothing presence.

I spent the rest of the day doing births, getting moms and babies settled and running back and forth between the nursery and the mother to give her updates.  I happened to have my camera there and took some pictures of the baby with the dad holding its hand to show her.  This seemed to really soothe her.  I assisted with her suturing which was extensive and I learned a new technique that was very cool.  I will probably never need it at home as our women just don’t tear like that but I am glad to know it.  At the end of the shift there were three babies who needed shots and to be put on the scale and all of the baby things we do.  I happily busied myself with them, feeling their good weight and tone and enjoying the way they stared at me as I talked and sang to them.

I sat at the desk and talked and laughed with a midwife and my OB friend.  I am very good with punch lines here.  Probably because the things they talk about are so funny.  There was discussion about the men in the Mobile Force here.  They tend to wander.  They tend to have many women in love with them.  My friend said, “ah, it’s the uniforms, hmmm?”  “Oh the uniforms!” said the other midwife, laughing and with a dreamy look on her face.  “They are too Mobile in the Mobile Forces.”  I stated.  “Oh GAWD Jodilyn!!”  Laughter and laughter rang out as the midwife held her head in her hands, shaking it and staring at me.  The thing is that things I say have stronger nuances in Bislama than in English and I am always phrasing them wrong so it is easy to keep them entertained, which we have all decided is my actual purpose here.  We stayed past our shift unwinding together.  It was good.

Meanwhile in my neighborhood the party rages on…the trash is piling up under the trees where it will be burned when the piles get too high.  The dogs are hardly able to move as they are clearly the beneficiaries of all of the fair food that is dropped in part or in whole around the field as people walk and eat or sit on the ground and leave leftovers.  Even the dog I have a tenuous understanding with gives me happy eyes and rolls over to show me his full belly when I walk by in the mornings.  If I come here again I am going to bring a box of MilkBones so I can keep some in my pocket for growling dogs and grunting beady eyed pigs…maybe they aren’t mean, maybe they just have low blood sugar.

And now I am sitting outside on a windy day, the palm trees making a racket, the clouds fighting their way in, my laundry rippling on the line.  I am headed back to the hospital to check on the baby and to take pictures as I told them I would make a web page for students or midwives coming here so the learning curve might be a little less steep.  There is nothing that can really prepare a person coming from the modern westernized world which I think is a really great thing—getting knocked out of the comfort zone and into this reality or any reality outside of ours affords opportunities I am so grateful to have had a tiny slice of.   But a few pictures and some words about some of the nuances might help a few future visitors a little bit…

 

 
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