essentialmidwifery

Birthy Thoughts by Jane E. Drichta and Jodilyn Owen

Kustom Dancing and Pranks on the Ward–Jodilyn June 30, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 11:14 am
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I rearranged my day today so that I could participate in a conference call via skype for a board I’m on at home…I only had to redial 6 times so I have to consider that a success all things considered!  I forced myself to take a nap in the afternoon which was nearly impossible considering the ruckus that is this neighborhood at almost any given hour…usually not a problem since I am collapsing at the end of a long day.  I went in for the night shift and things were oddly tidy.  It turns out there was just one birth today so they spent the day cleaning and straightening up.  A few of the midwives were headed up to practice their Kustom Dance performance and I tagged along, wanting to see it.  I wound up jumping in and learning the dances with them, it was quite fun and involved the use of brooms (which are thin twigs tied together), a 2 foot tall speaker, and a few doctors as well.

I headed back to the ward after dance lessons were over and showed off my newfound skills to the night crew, who were either quite impressed or quite entertained.  Hard to say.  I helped out with some of the babies in the nursery, removed an IV from a postpartum mom, talked nice with the new mothers and their families and then sat at the desk with the midwives for a chat.

Suddenly there were noises of groaning and pushing coming from down the corridor.  Everyone stood up but I was closest so I did a trot around the doors to see what was going on and there was one of the senior midwives from the day shift in mock-labor.  She started jumping and clapping and laughing.  I found out later that she regularly pulls pranks after the night shift gets settled in.  Apparently she is quite skilled as the midwives told me they fall for it every time.

With everyone settled in we retreated to the lounge to watch TBV (Television Blong Vanuatu aka the local station).  We got the news, the sports, and the weather reports punctuated by public service announcements on a variety of topics.  Then came on a drama by the local kids community center for the arts, the troubled, the youthful masses yearning for direction and positive influences.  It was the perfect combination of Law and Order type mystery and action and sexually transmitted disease/domestic violence education.  That’s right, cops and robbers meet “use protection when you sleep with another woman instead of your girlfriend.”  I kid you not, that was the plot.  It was actually quite compelling television and very well acted.  So kudos to the kiddos who are involved in the performance arts instead of trouble!  There is the somewhat familiar character trait of yelling at the TV during the program here (familiar if you ever had the distinct privilege of watching TV with my grandmother).  I joined in the yammering and vociferously encouraged the teenage girl who had landed a job singing in the local bar to stay home like her parents were begging her to, because all that is out there waiting for her is “Chlamydia Chlamydia, Chlamydia!”  This got me approving looks and a slap on the back from the doc.

With only one baby arriving today, in a place that averages 16 per day, tomorrow is bound to be busy busy…and if not, I will grab a broom and practice my kustom dancing : )

 

A Smartly Dressed Man, Walking his Goat–Jane

Filed under: Jane,Uganda — EssentialMidwifery @ 8:05 am

We came upon this gentleman, on our walk to Shanti today. This was after we passed the gigantic cow, three undoubtably killer roosters, and the feast-for-flies snake carcass. The Ugandan people are so tidy. How they manage to walk these red dirt roads day after day and still remain dust free is completely beyond me. Heck, even the goats seem to manage it.

They are also friendly. Very friendly. No carefully cultivated Northwest ennui here. Greetings are ritualistic and can last several minutes. Every single person greets you with a large smile, asks how you are, tells you how they are, asks after your brother’s health, your sister’s husband;s roommate’s dog’s health. It can last minutes. Long, happy, sincere minutes. Its like Disneyland. Everyone is on their best behavior, but at that moment, its all real.

The kids are the best. The chase you down the road, screaming,” Muzungu! Muzungu! ” and won’t stop until you smile, shake their heads, and wish each and every one of them goodbye. I can see why Madonna wanted to take them all home with her. Some of them even kneel. Seriously. Its what I always imagined my life could be. We high five them and say a few jumbled up words in Ugandan, and life goes on.

I will say that I am very very pleased with the lack of intense poverty here. In this area, at least, there are no 80′s Ethiopian kids, with their big bellies and even bigger eyes. Everyone seems reasonably well fed and happy. There are many schools, even if they are not free.

We delivered the donated supplies to the midwives today. They were appreciative, but not overly so. They seemed a bit standoffish, which I guess I would be too if some muzungu walked onto my turf for a short time,and started rewriting our policy, lecturing us on obscure foreign practices, and generally tried to take over. I will have to really be careful and purposeful in my interactions with them.

Ugandans can be polite, but they are also blunt. Today I was asked if I were pregnant, if I was planning more children, if Anna was my only, if my husband still loved me, what his job was, what our religion is, and why it was that American women aged so much faster than Ugandan women. My daughter was also told that while she was beautiful now, it would only be a short time before she was fat like me. Oi. That’s laying it on a bit thick, Ladies.

NEWSFLASH:  I was about to publish this, but I have to share what ishappening to me right at this very minute!  I am sitting in Read Uganda, partaking in their very slow internet, when all of a sudden, I am hearing Dolly Parton’s “Jolene.”  Apparently, in the time I have been sitting here, a tent has been set up, microphones have been plugged in, and there is now an honest to goodness hoedown happening right outside.  People are a hootin’ and a’hollerin’, and it is just fantastic!  But the best part is, they have played “Jolene” three times now.  Oh b

　

 

Kasana Beats Seattle!- Jane

Filed under: Jane,Uganda — EssentialMidwifery @ 7:24 am
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I can already tell this trip is going to be all about the people. While the work here is absolutely vital, it is the so bound up in the personalities of those who live here, that is would be a huge disservice to try and separate them. Shanti Uganda is a new endeavor, not even two years old, and is just now beginning to live as a separate entity from those who created her. That she exists at all is rather amazing, as this gentle model of women centered care is hard to find anywhere, let alone in the wilds of central Uganda. Their goal has always been to keep the best of North American out of hospital midwifery care, the empowerment, the respect, the love, while operating within a strict medical framework straight out of 1950s Omaha. Its a paradox to say the least.

 

Anna and I walked down to Shanti this morning for Orientation, and to meet the midwives and staff. It was allegedly a 20 minutes walk, but our inability to follow a hand drawn map, coupled with the same beauty everywhere we turned, led to a much longer trek than we expected. I suppose there are worse things than a few miles of hike after a hugely long plane ride.

 

Shanti itself is absolutely gorgeous. The compound is made up of three buildings, one of which is the traditional circular thatched roof structure with no walls. Its exactly like the kind they have at Woodland Park Zoo! This is where the Woman’s Group makes jewelry and bags to sell. This micro-economic group is for HIV positive women, and enables them be self supporting and raise their families. Its a selective group, and the women have to go through a rigorous training program. Their stuff is gorgeous. I’m going to suggest they start making baby carriers, because us crunchy Seattle folks would pay a fortune for them.

 

The other two buildings are the same thick walled mud construction as our house. They are painted bright yellow, and have the most gorgeous stained glass inlays. All the woodwork, including the doors, and built in cabinetry are teak, stained a medium brown. The craftmanship is beyond anything I’ve ever really seen in a birth center. The two labor rooms are private, set off by themselves in one building, and the beds are huge. The other building houses the post partum beds, and also doubles as a clinic space. I’ll try to get some photos up soon, but, as I said before, there is a distinct lack of internet here, so this is easier said than done.

 

There are two Ugandan midwives on site at any given time. This is important. Its impossible for outside labor to sustain a venture such as this. It takes jobs away from the local economy, and is generally, I feel, a little colonialistic. Right now, things are a little slow, so I haven’t been needed for any actual hands on babymama work. Apparently, though there are five women in dates, so hopefully I’ll get to see some birth soon. This is definitely not a high volume birth clinic. Its more of a way of life.

 

Its also definitively not a student placement. These midwives are not teachers, and you are definitely expected to make yourself useful. Today Kristin and I sat down and came up with a list of projects for Anna and I to accomplish while we are here. She would like me to review their policy book, with an eye towards making it more motherbaby friendly. She would also like me to teach a workshop on water birth, and one on immediate postpartum care. Starting July 1, however, they will be a midwife short, so I will be spending all my time on call. Hopefully there will be some great birth stories to come out of that.

 

Anna is working with the Teen Group, doing some beautification projects, including making candles. She will also be working with the groundskeeper, Cato, harvesting the herbs. Oh yes, did I mention they have an organic garden? And that the place is run on solar power? And that they collect and reuse rainwater? If only Seattle was so green! I’m afraid Shanti Uganda has outdone us.

 

　

 

4AM Interlude-Jane

Filed under: Jane,Uganda,Uncategorized — EssentialMidwifery @ 7:15 am
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She rolls over, half awake, but wishing she wasn’t. Her body curls around mine, damp with sweat, and I gently wipe a few strands of hair from her mouth. We still fit. I wasn’t sure we still did, but we do.

 

Snorkel, Snorkel, Snorkel…–Jodilyn June 29, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 9:32 am
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Well, firstly, hooray!  Jane has made it to Uganda in one piece : )  And just a reminder–we will put our names after the title of the post so you know if you are in the south pacific or uganda before you start to read…

Very little makes me as happy as when I am Under Water…chlorinated, fresh, ocean, doesn’t really matter. I am covering for a midwife shortage coming up when two of the midwives head to a conference so am taking a couple of days before hand to relax and get ahead on work. Today I headed to Hideaway Island…just a mini-bus and skiff ride away. This tiny island boasts a resort that is open for day-use for the cost of about $10 which is then credited back to you for purchasing a drink at the snack bar. It’s something out of a dream really, with white lounge chairs in a single row across the ocean front and picnic table under the shade behind them. The island seems to be made of millions of pieces of washed up coral. Hideaway is the proud home of the only underwater post office and I bit it and paid $4.00 to send one home. It’s kind of a dive down and there were several folks who purchased them and wrote their notes but couldn’t make the dive down so I played post-lady (or so the aussie’s call it) and dove repeatedly under to get the cards posted. It is kind of funny as at 2pm every day a man dressed in scuba gear waddles into the ocean, empties the box and then puts the postcards in the skiff where they are delivered to the main post office in Vila, where they may or may not make it out to their destinations. But it is just so cool, I couldn’t resist. The coral here is full of color and life, with purples of all hues, deep reds, bright yellows, endless endless color everywhere I looked under the ocean. I saw giant purple clams and swam in a school fish that was hundreds and hundreds of fish big. I tried to herd them and got a big circle going but realized I was in the middle of it and suddenly surrounded by yellow-striped fish all staring at me with one eye was a bit creepy and I swam over the top of the pack. Little black and white fish are curious fellows and if you stay still for two long they will converge on you to investigate. And luminescent rainbow fish like to be warm and will hover near your body if you stand on the ocean floor. Giant fish disguised as coral show themselves if you keep very still and wait for them to move. The water is in a protected bay and quite a lot calmer than the snorkeling Benjy I did all over Kauai. I met a woman from New Zealand who was also playing hookie and we lounged and read and chatted the afternoon away. The sun felt great after the week-plus of rain and cold. I took the skiff back to the main island (a 4 minute nauseating ride), then took a walk down a long spit which turns into black sand at the end. It was incredibly beautiful and quiet. I would love to go back there at night for a bon fire. On the way back I saw the pack of med students and they invited me to come out with them tonight but I am beat from the day in the sun and surf and hope to get a good sleep tonight without the noise of the squalls waking me up every 15 minutes or the noise of the Aussie rugby team that was here last night hooting and hollering in a drunken roar at 2am (urrrrgggghhh). I have made my most important connection so far when I struck up conversation with a loud happy local woman at the NumbaWan Café. I was wondering what approach to take when it comes to independence day here and heard her speaking English so I asked. Should I diverge and tell you the contents of the conversation I overheard? Probably, at least a snippet of it. She and her girlfriend were looking at pictures of some of the dancers that are performing on independence night here. They pulled up a photo and her girlfriend said “there is a G-d!” to which she replied, without missing a beat, “or a devil, but either way, I’m in!!” This was followed by huge infectious laughs. But back to the story…there are clearly parties being planned all over every neighborhood. It turns out that she is in charge of the events in my ‘hood. She actually seems like she might be in charge of the neighborhood in general. She has a week-long program and was detailing all of the night’s activities. There are competitions for everything—kid’s competitions, men’s, women’s, beauty, dancing, kustom dancers, foreign dancers, food, on and on and on…It kind of sounds like 7 nights of the Camp Talent Show. But the important part of this story is that now I get to go and hang out with Ciska—Queen of Seaside Neighborhood. Hooray! A word about Aussie TV: It’s Horrible. (ok , that was two words but now I’m done) A word about morals on Vanuatu: As long as one is honest about their immorality, it is moral. Steal? Cheat? Play around on your spouse? Just own up to it without skipping a beat when asked and it’s all good. A word about bugs in Vanuatu: If they have left their home and entered yours, and Dirty Harry is not doing his little lizard job and eating them, close your eyes and smack with a shoe. Gross, but better than bug bites.

 

“For I Have Slipped the Surly Bounds of Earth”–Jane

Filed under: Jane,Uganda — EssentialMidwifery @ 7:07 am

I’m so used to planes leaving first thing in the morning, that I overestimated how long it would take to get out if town for a 6:15pm flight. I think I’m one of those people who work best under pressure. (But doesn’t everything think that? Well, everyone but my mother, who is fully packed three weeks before she goes anywhere. ) By 11 am, I had yet to put a single thing in my new, huge, bright blue I-could-climb-Mt.Everest-but-I-won’t because-I-don’t want-to-make-you-feel inferior backpack. By 12:30, Anna and Mitchell had just walked in the door from breakfast, and by 1:30, half an hour before my appointed time to leave for the airport, I had decided to completely switch carryons, almost leaving the anti-maleria prophylactics on the bed.

Wonders of wonders, come 2:30, merely half an hour past our original estimate, we had hugged the dog, found my sunglasses, and were on the road. The airport was basically empty when we arrived, which is my favorite kind of airport. Saying goodbye to Pat was hard, as always. Ursula K. LeQuin said, “If you can’t marry money, at least don’t marry envy.” Well, I did good on both counts. He has never been anything but incredibly supportive of the bizarre things I decide to do , and this was no exception. I love him unconditionally, and I just can’t imagine doing what I do (or anything really!) without him.
I was told conflicting stories regarding visas for Uganda. Everyone up to and including our contact in Uganda and the US state department, told us we could get them on the ground. For $50. Everyone, that is, except British Airways, who couldn’t actually make up its mind. So, rather than be sorry, I was safe, and bought them beforehand. For considerably more than $50. It seemed to work, as the counter lady just smiled at us, and complemented our backpacks. I’m still not convinced. (About the visas. Our backpacks are uncountably rad.)
We got through security with no hassles; we didn’t even have to go through the full body scanners. Dinner at the airport Anthony’s, a tram ride to the S terminal, a photo in front of the huge 747, and off we went!

Our first stop was London, were we spent our 9 hour layover encased in a small pod, sleeping, and attempting not to shower on each other. Look up Yotel. The only available word for them is cute, overused though it may be. Smaller than my bedroom at home, these mini hotel suites remind me of a beautifully painted submarine berth. With a toothbrush holder. These are clearly a Japanese invention, and rank up there under Ichiro, but above Hello Kitty as my favorite import.
When we got on the next plane, I was thrilled to see both “Indiana Jones and the Crystal Skull,” AND “Return of the King” were playing on our personal entertainment systems. It was so nice to be going on this journey with friends!! I mean, Indy has probably already been to Uganda at least ten times, and Aragorn is so hot, it just doesn’t even matter. Naturally, exactly seven minutes after starting a movie, I fell asleep. Thank you, Ambien! I love you. I want to marry you.
Entebbe airport is very clean, and actually, at least today, AK-47 free. Also rooster free ,thank God, unlike last year’s Davao adventure. We were met by Ben, a Celine Dion loving, NASCAR worshipping love of a man who manages to talk intelligently about Ugandan building techniques while simultaneously not getting killed by turning left into traffic. I appreciated this so much, although I was still so tired that I may not even have noticed. After picking up Kristin, the center director, we drove for about two and a half hours, Anna falling asleep almost immediately.

As the pollution and traffic snarls faded away, I was struck by how absolutely beautiful this country is. It reminds me a bit of the Big Island, with hills that roll, clouds that race, and people who wave. And it is so clean! The red dirt roads look almost like a movie set; I wouldn’t be surprised to all of sudden bust through a huge picture of the road, a la “The Muppe t Movie.” The internet says it is the dry season, but it still rains frequently enough to keep the dust down. There are chickens everywhere, of course, and cows with horns that would make the University of Texas weep for the beauty.
Our digs in Kasana are a thick, mud paste house, painted white, inside a tall fence. Unlike my home in the PI, there is no concertina wire. I took this as a good sign. Anna and I are sharing a large bedroom, with a large bed, and a mosquito knew with large holes. I’m putting my faith in Malerone and deet to save us from that particular malady. Shanti rents two of the houses in the compound, one for the director, Kristin, and one for the volunteer. The other houses the landlord and her family, including the a very vocal, very opinionated three year old boy named Boy. They tell me that “Boy” is the Lugandan equivalent of calling somebody Junior, and belive them.. Its just hard for me to shake the American racial overtones, so he and I have compromised on “KIddo.”

A word about communications, or lack thereof. Jodilyn says she is living in 1999, where she has to buy internet time by the minute. I’m living in 1990, where the internet is kept in large rooms, outside of one’s own home. In this case, the nearest hook-up is at Read Uganda, an NGO (non-governmental organization) about a quarter of a mile away. They seem happy to let me buy some of their internets, but schedules being what they are, I’m just not sure how often I will be able to update. Also, there is almost no power here. I’ll do my best, because I miss you all.

Off to sleep, the jet lag is winning, and my mosquito net is calling. And Jodilyn, we also have a lizard on our wall. His name is Bob. Anna is playing flashlight tag with him. I don’t quite know where this will end.

 

Pigs and Bats June 27, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 12:27 am
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Just a quick note to tell you that Sunday morning started out with me getting chased by a pig on the way to the pool (enter the usual rescue heroes an old lady with no teeth and an umbrella to beat him back and masses of small boys under six with pebbles and pig-wrestling skills).  For the record it was a Giant Pig and not the cute pink kind with the curly tail.  We looked eye-to-eye and after he added some snorting and grunting to the posturing I decided he could win and bolted.

The midwife here from New Zealand and her husband took us American girls on a round-the-island tour where we sampled coffee from Tanna, saw black sand beaches, and stood in the roaring wind with our feet in the warm turquoise waters of the south pacific.  The weather was stormy but we had a great day.  I shouldn’t forget to mention the one beach we stopped at where some locals had trapped some bats (which I think they call flying foxes) and were prepping them for a good ole fashion BBQ.  The other American midwife and I were making gagging gestures—I believe at one point she said she would rather eat a locust than one of those bats—while they explained how they grill ‘em up.  Apparantly the armpit is quite succulent we were told, while he spread the wings out to show us.  These creatures look like squirrels with bad-ass teeth and leather wings.  They should be the mascot for a biker gang.   I really can’t go on about it, it is making me a bit queasy.  We ended the day with an outdoor movie down at the NumbaWan Café where they string up a screen just in front of the ocean and use a projector with DVD to show the movie.  It was quite fun and I discovered that they do have ice cream here but it doesn’t taste at all like ours.  There is finally sun again after a week of squalls and rain, though it is entirely blustery, which I am just trying to enjoy as the humidity has been blown away for now.

And for the record, when I went this morning to swim the pig had been thoroughly detained in the back of the property again so I called him a name and walked slowly by.

 

Twins, Breech, A Baby who is Here to Stay–Jodilyn June 25, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 1:46 pm
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After six days of 8-12 hour shifts I happily collapsed Friday night, falling asleep to a light but steady rain.  Squalls woke me up and kept me up most of the night and I finally gave up and decided to walk up to the hospital to say goodbye to several mothers and babies who were checking out today.

The family who named their baby after me told me they will be having a party in a couple of weeks and will send someone to collect me for it : )

The next bed down was a first time mother who had no one with her for her labor or delivery except for me as her aunty and her husband were at work and she hadn’t thought to call them until she was already pushing.  I gave her lots and lots of good back rubs and managed to hold her hand right until the baby was born and then she held my arm while I caught her baby, who I somersaulted gently out of the cord that was around her neck and straight up to her mother’s chest.  Next in the row was a first time mother who was so tiny I had asked for a second pair of hands from the midwives who were eating lunch and watching French soap operas.  She had the body of a 10 year old and I just didn’t have a lot of confidence about the whole thing…of course she proved me wrong and delivered a 2700 kg baby over an intact perineum.  She was 20 years old and was clearly madly in love with her little baby when I saw her this morning.  Her young girlfriend had been with her and was cowering in a corner when mom started to push so I encouraged her to come and hold her friends hand and sit by her.  She had never been to a birth before, something I figured out when she nearly fainted as the baby was born.  She caught herself and rested her head on the pillow next to the new mother’s.  As soon as baby was settled on mom’s chest and I was sure the mother wasn’t going to do any excessive bleeding I went around the bed and kicked a chair under the friend.  She looked up at me and said “OH WOW” and then laughed and laughed.  The Tutu (grandmother) came in and started clapping and kissing her granddaughter who had just delivered and then kissing and hugging me in a great show of affection.  It is hard to argue with an octogenarian who wants to shower you with love, even while waiting for a placenta to deliver!

Next in row in the postpartum area was a second time mother who was up and looking like a beauty queen—as if she hadn’t ever given birth.  Aha!  So they have those mothers here as well!  Across from her were our most recently delivered twins.  The mother came in having had no prenatal care and in active labor.  The head midwife wanted the doctor I’ve been working a lot with to be primary on this delivery.  The other American midwife and I talked over what to expect with her extensively as the mother labored.  Since we had no idea about these babies and how they were situated inside—one sac or two, one placenta or two, we planned on taking preventive measures and doing the best we could.  It was clear that twin b was sitting breech so as we waited on the birth we reviewed the mechanics of breech birth with this doc who had never seen a breech birth before.  It was a great collaborative spirit and the other American midwife and I were happy that the doc was asking for instruction.  As the first baby came she asked if she should cut an episiotomy to which we both cried “no!”…so she waited.  She kept asking if we were sure about that but before she could finish the sentence twice the whole head was born.  Then she went to reach in and pull the baby out and we both cried “no!”  I told her, “the baby will come to you.  Just keep your hands there and let it come to you”  the other midwife was speaking in the calm soothing tones to the doctor I had seen her use with mothers so many times now and I smiled at what we were doing there…retraining her, talking about the baby’s ability to restitute on its own.  Sure enough the baby turned to one side and one shoulder slipped free, then the next, and the body quickly followed.  We clamped and cut the cord pretty quickly since we did not know if the twins had any of their vessels crossed so we wanted to keep the blood supply even between them.  The doc looked up at us, “boy you ladies are patient!!”  We provided some guidance for twin B and felt from the outside as it settled into a nice breech deep in the pelvis and after several minutes the mother felt like pushing again.  10 toes appeared first and they were so darn cute as they wiggled their way into the world.  We lifted mom way to the edge of the bed so that the baby would just hang on its own with no disturbance from any of us or a table which might block its way out.  I had repeated several times to the doctor the mantra “hands off the breech” and as the feet were fully born she went in to support them and we both said “no!  hands off the breech”.  I said “Dr. X, I know this is the hardest thing to do but you cannot touch that baby!”  The other midwife showed her the sweeping motion she could do once the head was born to bring the baby to mom.  Dr. X did a little dance to keep from touching the baby which I have subsequently showcased for her over and over again : )  Breech baby twin B arrived without drama after a proper hang and maneuvers,  all self-directed.  Dr X was quite thrilled with the whole event and I let her in on the little secret that most of what midwives do is wait and paperwork.

So I said goodbye to those moms as they were on their way out today and it was nice to be in there just in my “civies” which is what they call clothing that is not scrubs and to sit and relax with the moms.

One other case this week that I don’t think I wrote about was a couple who were in having their second child.  Their first had died on day two due to some very tragic circumstances and they were extremely traumatized.  They were terrified their baby that was just born this week was not doing well and he would die too.  I spent about an hour with them doing a whole newborn exam and assessment.  The father was so upset because the mother was refusing to sleep and the baby was already 20 hours old so she was into day two + of not sleeping.  He spoke great English which was wonderful as I could really talk him through everything.  I reassured him it was normal for mothers not to sleep and to be primally obsessed with their newborns under these circumstances and that it would take baby proving his intent to stay on day 3, 4, 5, and so on for her to start to buy-in to releasing the fear she has now.   The baby looked like a normal 1 day old but was very smooth in some ways that I didn’t love, although nothing tangible enough to really complain about.  I told her since she was awake she should provide kangaroo care for the baby since that will give him the best shot at regulating his heart and respiratory rates and give her the feeling that she is getting to know him and get a sense of who he is.  She loved this idea and immediately put the baby skin-to-skin under her lava-lava (sarong).  I modeled for them talking to the baby and I asked them to express their fears and then I retold them to the baby and asked him to understand how loved and wanted he is and to know that the fear they have is not because they believe he will not stay but because this is all they have known.  There is something really amazing about telling their stories to babies, as they tend to perk up and listen.  He did this and I encouraged her to talk and sing to him that night plenty.  I told them I would be back first thing in the morning to check on them all.  I spoke that night with the other American midwife about this baby and she agreed there was something not quite great about him. Even though we know that babies on day one will sleep the bulk of the hours of the day, it was hard not share the fear with the parents, and I’m not sure if that wasn’t what was causing us to see him in this way.   I skipped swimming in the morning to get there early and went straight to them.  He was nursing vigorously and showing off great muscle tone.  I asked her if I could bring the medical students by and share her story with them and talk to them about the assessment I was going to do again.  She agreed.  As I did the exam he was clearly totally present and accounted for and although he started out fussy (which frankly I was happy to see!), he slowly got interested in what we were doing and he landed in that wonderful state where he was primed to learn and play.  He showed off by tracking further than the average baby does and regulating his states beautifully.  The mother finally smiled as she watched the incredible language of her newborn and when I was done I passed him to her but he had seen her from the middle of the bed and was all-eyes for her, and she was taken in by him entirely.  It was incredible to see him win her confidence over and although she was exhausted she looked fresh and eager to be with him as we left them alone to discover each other.

 

Continuity of Care–Jodilyn June 22, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 11:34 am
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Being cared for by a provider who a woman gets to know and develop a trusting relationship with matters.  Having that same provider care for that woman throughout her labor and birth matters.  I had started to wonder if these truths, which seemed so fundamentally true in my little world, were true at all in the great big world I have come to.  I have seen over the past two weeks women laboring alone in the hallway as providers buzz past them without a kind word, or any word at all for that matter.  I have seen only two husbands present for the laboring and birthing.  I have seen soon-to-be-grandmothers doing the hard work of massaging, nourishing, encouraging a mama—their daughters–in labor.  I have seen everyone a mother knows scramble out of the room just after the birth as they have been taught that this is what they should do.  I have seen babies parked in corners in bassinets.  I have seen women wanting to stay upright or on their sides while providers bark at them to lay down flat and open their legs.  I have seen mothers whose bodies were instructing them to perfection in the slow art of pushing out a baby told to push for sustained periods of time and I have watched them lose their breath trying to do so.  I have seen providers trained without the understanding that after a baby’s head is born, the body will restitute to one side for the birth of the shoulders and body, reach inside and pull babies from their not-quite finished process.  I have seen mothers whose eyes go flat as the providers are giving a series of cold harsh commands that deny the truth of what the woman and baby in front of them are doing in that moment.  I have wondered:  why do these loving connected people turn into the essence of 1950’s medical model when it comes to birth?  How do these women accept what is done?  Do they gather and tell their stories to each other or is this just parked away as one of the many things women here experience as part of their lives?  Am I projecting all of this onto the women and it does not bother them at all?

Today I went in early and stayed late.  I learned so much today about so many aspects of birth and this culture and the women here.  Last week I did a day of prenatal clinic as you’ll recall if you’ve been reading.  It was very insightful and helped me understand the charting and what kind of care is received before we see them during labor down on the maternity ward.  That day I was shown how one visit typically goes and then thrown into a room by myself.  One of the women came in and stopped me in my struggle with Bislama by telling me she speaks English.  We had quite a long visit with her as she had some things going on and it took a while for me to find out what kind of tests (if any) I could order for her as well as for me to interpret the previous results from another test she had done (we measure differently to start with but I could not read the doctor’s writing at all—another thing that seems to be the same in any language!  And for the LD fans out there, I thought right away to go to a pharmacist to have it interpreted but the pharmacy is three buildings away!)  She is a very tall woman by American standards, but here, where I am tall, she is several heads above most of the people here.  She is a calm, centered, and strong woman.  Long and short of it, I just really enjoyed her and hoped very much I would be on duty for her birth.  When I came in this morning she was there, in very early labor with her fourth child.  She was unhappy with what she felt was prodromal labor (a long early labor that didn’t seem to be picking up in intensity).  She asked me what I thought about her going outside for some exercise and I agreed that sounded like a good idea.  I showed her the stomping I had been taught by some Kenyan woman many years ago and she headed out the door to “go find a hill to stomp down”.  She came in a bit later looking more active and indeed when she was checked she had made quite a lot of progress.  I understand her frustration as all around her women here have their babies after only a few short but intense hours of labor (we had one deliver in the car on the way to the hospital today btw) and woman after woman came through delivering while she walked the corridor with her mom.  I checked in on her often and between other deliveries gave her mom a break and rubbed her back.  I did manage something fun today with a dad who had missed the birth of his first baby and was adamant that he would not miss this one.  He was so involved and loving with his wife.  I had him discover the sex of the baby by picking up the legs and making eyes at him to look—he sang out as he announced “one smol boy!!” and then I had him cut the cord.  Something very few men here have done.  He loved it.  It was a very celebratory moment and he kept checking on me the rest of the day and smiling proudly.

There are a handful of Australian medical students here and they are full of questions and eager to learn so I spent a lot of the day talking to them about what we do and why, and what they will see here and why not to do it.  One student attached himself to me and he was blown away by simple things like comfort measures and acupressure points.  He took his learning quite seriously and it was something else to see this 6’3 Australian doctor rubbing a mother’s back and asking if he was getting it right.   There is the most amazing midwife here from New Zealand—she is here on a two year contract and is a wonderful teacher and mentor for the staff here, and for myself and the other volunteer midwives.  I have learned from her to stake my claim to a birthing woman and I have learned that I would rather be alone, knowing I can call out for help at any time if I need it, and manage the birth the way I want to then to have some of the local midwives come in and start barking at the mothers.  We can be having a gentle lovely birthing with an actively engaged mother and it can all get shut down in a second when the local midwives come in and tell the women to lay flat and stop talking and push until they are purple in the face.  I have learned to speak up for what I want here in all new ways as I talk over them, coaxing the mother back to what is hers:  her birthing.

Late in the afternoon around 2:30 this mother got into active busy labor.  I stayed with her, as did the Australian doc.  We massaged her and gave her water and told her how wonderful she was.  She labored silently, smiling or grimacing when a contraction hit and then resting in between them.  She sat upright on the bed for a while, then asked if it was ok if she took a walk-about (which means, as it suggests, that she wanted to be able to walk around).  I encouraged her to do so, to follow her body and was so happy as the local providers all got busy elsewhere and left us alone.  Her mother stayed with her and she had a lot of attention from the three of us.  She became very hot and I used one of the gauze cuttings as a washcloth, wetting it with cold water and wiping her down.  She made such happy moans and told me it felt sooo good.  Around 3:30 she told us her other birth stories.  We listened to her.  We asked her questions.  She said this number 4 baby was acting like her number 2 baby—taking a long long time to come.  Around 3:50 she told me her husband is a sea-man, out on a ship due back tonight at 8pm.  I said, “oh, now I see what is happening here—do you miss him?”  She looked at me and smiled.  Her contractions picked up and became very long.  The Aussie doc had to leave and the other American midwife came on duty and offered to assist which I was so happy for.  At 4:02 mom leaned back and arched her back and her waters burst forth like those from a damn, suddenly shattered.  I felt the wetness seep into my scrubs and saw how far it reached across the room.  I love that power—it shows us how strong those membranes are and how strong the contractions are!  A local midwife wandered in and sure enough started barking at her.  I spoke right over her and said the mother’s name.  She looked up at me and I told her, “gently, gently, you keep doing what you are doing, you are perfect.  Do not be afraid and do not rush, we are right here and your baby is fine.”  The other American midwife spoke in such soothing low tones to her, talking slowly and never relenting until the other midwife stopped talking and just stood back and listened and watched.  Slowly, slowly the baby crowned showing us a bit more of herself each minute.  At 4:08 the baby was born with hardly a cry and I put her right on mom’s chest, skin to skin.  The mother said, “she is happy here on my belly, she is not crying.”  Smart mama.  After we had her all cleaned up and resting and nursing her baby she told me she felt  so fortunate to have come when I was there, to have had this birth where no one was commanding her to do this or that, to feel she could come up onto her elbows to birth the baby instead of laying flat.  I finally got to ask my questions to a woman who could answer them fully and we talked about the treatment here and the perception of the treatment in great detail.

I told her that we believe babies are conceived in love and should come into this world surrounded by love to which she and her mother fully agreed.  The midwife from New Zealand told her she needs to go and tell her women friends that this is what it should be like and this is what they should demand…to be respected and encouraged and trusted, that change comes best from the consumers.  We talked about our families and she told me she had been a basketball player.  I told her about Julia and that she loves basketball so much that in all of her school pictures she has her basketball with her.  She replied a simple, “of course they do.  A girl who loves basketball is all about basketball.”  Fabulous.  And in a delightful surprise I now have a very tall 4200 kilogram (9.3 lbs) baby named after me : )  .  Tomorrow I am bringing in my camera as I must have a picture with this family!

Today I learned that it is not just about one birth or one mother and me doing the best I can for that woman and that baby.  It is all about one birth and one mother and me doing the best I can for that woman and that baby.  We don’t know when we are interacting with someone where that interaction will take them.  And we certainly don’t know where it will take us.  Her birth has taken me places.  It was transformative for my understanding of who I can be, here and at home.

I have seen many wonderful things from the midwives here.  I have seen them stop a postpartum hemorrhage with finesse.  I have seen them mop and scrub and set up a bed for a mother with great concern for the details of cleanliness and infection prevention.  I have seen them wrestling with what care plan to lay out for a complicated case.  I have seen lights turn on in their minds when a new plan was introduced to try to understand why the babies who die here are dying.  I have seen them attend to families as if they were their own.  They have so much they do so well and I know they have the capacity for the rest.  They were trained in this very specific way and I think with the work that this New Zealand midwife is doing they will continue to improve and grow as providers.

On a side note, the Aussie med students came in today with loads of boxes full of brand new and used hospital equipment, including a new pump for the Nursery/NICU, resuscitation equipment and so much more.  It was very thrilling.  For anyone planning on coming here, if you take Air Pacific you can bring as many bags as you’d like if they are under 50lbs.  Please let me know if you are coming and I will email you a list of much needed supplies.  It is worth the lug to get them here!

 

Context -Jane June 21, 2011

Filed under: Jane,Uganda,Uncategorized — EssentialMidwifery @ 10:14 pm
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Do you remember being 16?  The intensity and power that comes with knowing exactly what you DON’T want, while being completely confused as to what you do?  Everything matters so hard at 16.  You have the most delicious sense of invulnerability, with a healthy smattering of self-righteousness and passion thrown in for good measure.  Its wonderful and delicious and frightening, and I miss it.

Anna, on the other hand, will not miss it.  Those of you who know me well know just how hard a year this has been for my daughter.  She has had a series of absolutely bizarre health problems, which has caused no small measure of stress in her academic and personal lives.  It has been so difficult watching her struggle; seeing our children in serious pain or seriously lost is the dark dark side of parenting.  Its Darth Vader, and not the whiney prequel version.  This is the Admiral Motti-choking, chopping off Luke’s hand, bad-ass terrifying version, the dark side that demands respect.

I hate those parents who always gloom and doom the next developmental stage (“You think infancy is hard?  Wait until they start walking!  That’s when it gets really bad!”  Or “Toilet training is nothing!  Wait until 12, when they slam the door off its hinges!”)  I do not want to be that parent.  To those of you who have young teenagers, don’t take anything I say seriously.  I’m sure your child’s sophomore year will be just fine.  I wish you a year of giggles, of staying out too late, of pushing the boundaries just enough to stretch, but not enough to snap.  I wish you student council elections, good grades and some, but not too much, heartbreak.

But for us, well, this was a year we would both rather put behind us.  I have never known the depths of frustration, the depths of anger I could feel toward my sweet blue-eyes baby until now, that baby I have loved so hard and strong for so many years. I never knew I could be driven to tears, over and over, as the exact wrong thing came out of my mouth at the exactly the wrong time.  I never knew how many times I would drive her to tears.  As the year went on, and things became more and more complicated, the phone calls and email between the guidance counselor and home became more and more frequent, it seemed our relationship would break.  We circled each other warily, unable to speak even the smallest of words without a miscommunication, and its attendant, drama encrusted argument. 

 It was awful. I hope nobody out there, no matter how much I dislike you, has to go through what we did.  I hope my worst enemy is spared the year of blackness that began with terror in the emergency room at Seattle Children’s Hospital, moved through uncaring and inflexible teachers, and ended with Anna not even purchasing a yearbook, as she just wanted this year to disappear.  There are scars on our hearts from this year; I can only hope they are not permenant.

But as school is finally getting out for the summer, and we prepare for this trip, we enter a new phase.  The last few days,  as we pack our brand new, bright blue backpacks, fill our carry-ons with passports and loaded Kindles, have been wonderful.  She sees a new start, an end to the crazy.  She is a rising junior, a young adult looking forward to this huge undertaking.  When she returns, she will have seen and done things that most Americans will never experience, and she is ready to make it her own.

Midwifing babies?  Piece of cake. Midwifing myself? Not so simple. 

 

 
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