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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.

 

Out of Africa or I’ve Been Waiting the Whole Blog to Say That–Jane July 25, 2011

Filed under: Jane,Uganda — EssentialMidwifery @ 11:08 pm

So here we are, coming to the end of the midwifery portion of our trip.  We do go on and have several other adventures, such as waking up beside the Nile and seeing monkeys eating old room service, or staying in the absolutely creepiest hotel in the world and surviving, but those are stories of life and its times, not specifically midwifery, so they will stay untold here, unless I get thousands of private messages, filled with Really Good Bribes.

Our last day in Kasana was just so typically Kasana-ish, that it fills me with a certain masochistic joy.  Anna and her new friend Rachel the sophomore UNC volunteer, were planning on making friendship bracelets and doing relay races with the Teen Girls group.  As it turned out, Anna and I ended up leaving a little before the group was scheduled to start, so we didn’t wind up actually doing that.  But we didn’t know that then.  We girded up our loins and walked up to the main road where all the shops live, to gather needed supplies.  We knew this was going to be an exercise in frustration, but we were up for the challenge.  Africa was not going to win today, my friends.

First, we needed string.  We went to five different “stores,” which are really little shack type things, sometimes with a living area behind them, but always full of things you absolutely do not need.  Certainly, no string.  In each store, we were told that we would probably have to go to Kampala.  Really?  Nobody has ever bought string here before?  Finally we ended up getting embroidery thread from a tailor, and that was only after Rachel shared her street bought popcorn with the proprietor.  Then, of course, we needed beads.  Luckily, there has been a donation full of them fairly recently, if we could find anyone at the center who knew where they had been stored, so we felt pretty confident about that.  It was on to the relay race supplies.

Rachel wanted to do three legged races, so we needed some rope.  Of course rope, the elder sister of string, was also not available, even at hardware “stores,” so we ended up buying a mop and disassembling it, and then tying the pieces of mop together to make a rope.  It was a riot, and I think McGyver would have been proud.  We also needed some eggs for the egg and spoon race, so we headed to Hespa’s little roadside stall, next to our house.

Now, I know where eggs come from.  And I know that the place they come from is pretty close to a chicken’s butt.  However, even with all that poultry knowledge, I am still surprised whenever I buy an egg here, and it has chicken s#$& all over it.  I guess maybe all eggs do, but that our American ones are washed before they are sold?  Or maybe Ugandan chickens are really messy?  Or that maybe I should move on, and not spend quite so much time thinking about chickens, their eggs, and their butts?  Ok.  Moving on.

We headed down to Shanti with our booty, and I was actually quite sad, thinking this was the last time I was going to travel this road.  I had come to know the people along my route, the old women sweeping, the children screaming “Mzungu!”, and the eternally formal old men, who stopped their hoeing to wave, and ask me how I was.  We laughed, thinking of how out-of-place any or all of those things would be in Seattle, the land of the aggressive passivity.  If someone called a greeting to stranger from their porch in Seattle either their mental health or their safety would quickly be called into question.  It is the exact opposite here.

It was hot that afternoon, and soon into the walk we began to sweat, the ever-present red dust sticking to our legs and feet.  I resolved to sweat more at home, to actually get outside and interact with my environment, and not hide in my office or behind a keyboard.  I felt alive, dare I say, at peace, with myself and my place in the world.  And I realized, that this leaving had come at exactly the right time.  I love Uganda.  I will come back.  But for now, I was ready to go home.

We got to Shanti, dropped the supplies off in the prenatal clinic, and said our goodbyes.  We took tons of photographs of the grounds, and of the staff, which I promise I will get up on facebook soon.  (If you are not my friend, and are interested in seeing them, just drop me a friend request.  My internet privacy polices are so low as to be non-existent.)  We shed a few tears, exchanged a few email addresses, and then our ride was there, and our time at Shanti was over.  All that anticipation, all the build-up, all the angst, and it was over.  I felt like the bride after a wedding, sort of empty and confused.  Now what would I think about?  What would I spend my time doing, if I couldn’t chase after string or solve waterbirth logistics?   I’m sure I will think of something.

So now I am home.  Our book needs writing, my clients need midwifing, and my husband needs loving.  My days are indeed full again.  But I left a little piece of myself in Kasana, somewhere on that red dirt road.  And I can’t wait to go back and see what it will have done in my absence.

 

Where are the birth stories?–Jane July 19, 2011

Filed under: Jane,Uganda — EssentialMidwifery @ 10:36 pm
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Ha!  You noticed!  There aren’t any.  Yes, there was not a single baby born during our stay in Uganda.  However, I learned so much anyway.  It really put the focus on prenatal care, and teaching, which is something I really love, so please believe me when I say that the trip was not in any way disappointing.  Good prenatal care is really the foundation of all midwifery work.  It is not only about meeting mothers where they are, but really peeling back the layers of who she is as a person, and showing her how she is absolutely the best mother for her baby.  It is about showing mothers what they already know, and how they are the experts both on their pregnancy and on their particular baby.  And it’s about convincing other people that no matter who this mother is, whether she is a 15 year old singlemama, or a 35 year attorney , they deserve respect and honor.  And in this case, it was doing all of this in a language I do not speak.

Many many women come to these rural centers never intending to deliver there; in many cases they live too far from the center to reliably make it in time.  In others, the pressure to birth in their village is just too strong.  But they come to Shanti anyway, to learn, to share their pregnancy experience, and to be with other women. Remember, these women cannot just look up a symptom on the internet.  They do not have electricity or running water.  And they may not have their mothers or grandmothers around to ask all those questions that a new mother has.  There are 3,000,ooo orphans in Uganda, victims of a brutal civil war in the 80s and 90s, AIDS, or other diseases.  These women are having children now, and are starved for information and love.

Shanti also functions of a de facto medical clinic, dispensing malaria treatments, parasite eradication protocols, and other basic supportive health care needs to pregnant women.  That’s something I would never see in Seattle, and I’m grateful for the chance to deepen my knowledge.  There is also a huge emphasis on post baby family planning.  It is vital that Uganda get its over population problem under control, or the many strides it has made will be for naught.  Safe, reliable birth control has to have a huge place in Uganda’s future, and I was very pleased to see it taken so seriously at Shanti.  The average Ugandan family has 8 children.  The death rate, thank goodness, is dropping, but the birth rate remains the same.  Clearly this is not sustainable, and is a huge obstacle to the empowerment of Ugandan women.  Choosing to have many children, as some of my most delightful clients at home do, is very different from it being forced upon you by circumstance.  Again, choice, choice, choice.

Immersing oneself in another culture is always challenging.  I am asking a lot of the midwives at Shanti, to reevaluate what they have been taught to do, and what they have been doing effectively in their previous jobs. In turn, I am reevaluating my own methods and work, making sure that they still match up with who I am, and what I believe is my purpose in this world.  And really, that is one of the most important things we can do, as midwives, or just as  human beings.  We keep examining, keep searching for clues as to how to find our true place, and if we are really lucky, we meet others who can help us, like I have both here in Uganda and at home.

 

Waterbirth, Waterbirth, Waterbirth–Jane July 19, 2011

Filed under: Uganda — EssentialMidwifery @ 8:21 pm
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At one point, almost 90% of the births I attended took place in the water.  It has dropped off a little, due to some speedy babies that wouldn’t wait for the tub to be filled, but there is just no denying that this is a very popular way to birth.  I was excited to hear Shanti’s take on it, and share what we have learned over the years.

They have a built in tub there, but it is really much too small and much too deep.  Its lovely, of course, as is everything there, but I’m afraid it just wouldn’t really work.  Luckily, Kristin, the coordinator, already knew that, so I wasn’t breaking anybody’s heart with that observation.  They assured me that they could just pull out all the tile and build another one, quite quickly.  (Now, I don’t want to judge, but “quite quickly?”  Well, we will see.)

I was asked to give a workshop on the down and dirty details of waterbirth, and I was delighted to.  It was so off the wall, so unheard of, that I actually think it could work out fine.  See, Shanti is fighting a battle with their midwives.  They have all been trained in the classic 1950′s Western model of birth.  Even getting them to acknowledge that there are better positions than McRoberts has been a bit of a challenge.  They begged me to ask Kristin to get rid of the large queen sized beds with the homemade quilts in the birthing room, and get them some real hospital beds.  They said the beds were too low, and were hurting their back.  (I can completely sympathize with that, of course)  However, when I gently asked if they could just climb up on the beds with their mamas, well, let’s just say my suggestion wasn’t met with overwhelming enthusiasm.  I did, after much roleplaying and coaxing get several of them to promise to at least try it.  So again,we will see.

And don’t even get me started on the episiotomy issue.  I’ve been reading Jodilyn’s struggle with this, and I can only nod vigorously.  They ladies love to cut.  (When they found out I had never ever done one, I think I actually lost some of their respect.  I had to make it up later by bringing chocolate to share.)

I think the main issue here is that out of hospital birth is not seen as a beautiful, candle lit experience, where the mother is surrounded by people of her choosing, and comes gracefully into her power as a woman.  No, here it is a dark and dirty affair, usually with no trained attendant,  the threat of hemorrhage, or other disasters lurking just over there in the corner.  The hospital is a place of (relative) safety, even though that little bit of increased safety comes at a huge moral price.  Shanti is trying to change that.  But its slow going, especially when you have to start with your staff.

But waterbirth?  They had hardly even heard of it, so they had no preconceived ideas.  And that, I have found, is one of the best places to start from a teaching standpoint.  We talked for hours, first dispelling the normal waterbirth questions that everybody from my mother to the guy in the supermarket have asked me.  No, the baby won’t drown.  No, you shouldn’t leave the baby underwater for a long time.  Yes, we tend to see less tears.  Yes, it IS hard to cut an episiotomy in the water.  How great of you to notice!) Etc etc.

Then, one of my favorite midwives asked the question:  “How do you run a resuscitation?”  And just like that, we were off, off in a completely juicy conversation regarding the physiology of delayed cord clamping, the unseen yet oh so powerful bond between a mother and her child, how the midwife’s own attitude and demeanor can influence outcomes, when to actively help and when to encourage from the sidelines…oh, it was wonderful!  We had almost no common ground to start with; they have not been trained in NRP in the same way that I have, so we really had to start from square one, because we really weren’t even talking about the same thing.  But once we defined our terms a bit, we were deeply engaged in one of those meaty philosophical discussions that all midwives love.  (It was a bit more difficult because of the language barrier, but we kept at it.)

By the end, they were excited about waterbirth, and I think, even a little bit eager to try it out.  Annet even wanted to skype me in on their first one, to help guide them.  I wonder how the mother will feel about that!  And I hope its not a long birth, because there is no electricity at the center.  But those are just details.  I’m sure we will work it out.  The point is that we are starting to give these mothers options, options that they have never even heard of before.  And with options comes choice, and with choice comes dignity.  And that is what all mothers deserve.

 

Scat-ology–Jane July 17, 2011

Filed under: Jane — EssentialMidwifery @ 5:04 pm
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Poop gets a lot of attention in this here neck ‘o the wood.  There is an amazingly long and varied list of diseases one can experience, thanks to fecal contamination. To be honest, it’s really hard to avoid dancing with at least one or two during your stay, even if you do absolutely everything you can to avoid them.  And to continue being honest, its hard to do that.  Our  travel doctor, the lovely and talented Dr. Doom, basically advised staying in a gigantic airtight bubble our entire stay, avoiding even breathing African air, or we would surely perish.  We were to avoid fresh fruits and veggies that we did not peel ourselves, (I’m sure this wouldn’t insult our cook at ALL) wash our hands with uncontaminated water every few hours (all tap water in Uganda is suspect, so washing with  contaminated water, probably isn’t that great), never ever some into contact with others people’s poo (has he seen the “bathrooms” here? There is no such thing as toilet paper), never go barefoot (even though culturally one removes one’s shoes when entering a home without a dirt floor), and avoid swimming at all costs  (that one we could handle).  He also advised not even looking at dogs, as they were sure to leap upon us, savagely rip open our throats, and infect us with rabies.

I wonder if he has ever left Seattle.

We actually did pretty well, in that we avoided typhoid fever, Hepatitis A and E, cholera, but the regular old bacterial diarrhea?  Well, he graced us with his presence several times.  Actually, once you got used to him (ie, plotted the route to the nearest bathroom,  or large tree, always carrying an emergency supply of paper with you) he wasn’t that bad.  Just a little part of the overall travelling experience.

In fact, what do you get if you put a bunch of travellers in one room together?  Tales of Poo.  This sounds like some twisted internet site combining sexual deviancy and Disney characters, but I assure you, its much more amusing than that.  Everyone has great stories in which their fecal incontinence plays a starring role.  I will not bore you with mine, as it did not win any of the awards, and I have to look most of you in the eye sometime soon.  I’m sure you understand.

Best Poo with a View went to the longsuffering P, at the top of Machu Pichu.

Most embarrassing Public Poo went to J, on a public minibus in Congo, with no restroom.  He had to make the driver stop 13 times, thus making his fellow passengers’ journey two hours longer.

Worst Place to be Without TP has to belong to L, who, in an extreme excrement emergency,  shed his liquid byproduct in an alley in Shanghai, before realizing he was wearing very light-colored shorts.  And was commando.

There’s just no way to compete with these champions, and I hope never in my life to try.

Those of you who followed me in my Philippines adventures will remember my hatred of the squattie potties, although I did have thighs of steel by the end of the trip.  Here in the volunteer house, we do have a regular western toilet.  However, it is extremely short, so you feel like a giant every time you sit down.  It’s also located three inches from the shower, which has no curtain, just an inadequate drain.  So, if anyone has taken a shower in the last day, either the seat is wet, or there are two inches of water (remember…probably contaminated) swirling around your feet.  It is such an exciting way to live.

The “toilets” at the clinic, are a different matter.  A very different matter.  The latrines are beautifully built, with regal stonework, and heavy wooden doors.  However, they are, quite literally, a small, perhaps 5 inches in diameter HOLE IN THE GROUND.  A hole.  A small hole.  In a country rife with diarrhea.  And western midwives who can’t aim whilst squatting.  If I had a dollar for every time I peed on my feet, I could finance my next trip to Africa.  They also have metal roofs, which adds quite a bit of excitement when one must use the facilities in a thunderstorm.  Not only does the peaceful sound of rain bouncing off the roof add to the atmosphere, but the threat of being struck by lightning every time you squat just adds to the inherent dramatic tension.

I will miss most things about Africa, but…

 

Anna–Jane July 17, 2011

Filed under: Jane — EssentialMidwifery @ 3:35 pm

Thanks so much for all the questions I have gotten regarding Anna’s activity, and how she is doing.  She is well, having only been sick once since we got to Africa.  This is some sort of personal record, as during the school year, she spiked a fever at least once a week.  This time, it was just the usual Africa stomach crazy, which it seems is traditional for travelers here.  I also succumbed one day.  I think I opened my mouth while taking a shower, and accidentally injected some water.  Its hard not to, when you are panting and jumping around, trying to distract yourself from the freezing cold water.  (In the Philippines, there was also only cold water, but it was hot there.  Its perfect here, which means cold showers are decidedly not.

Anyway, Anna has been busy doing several projects here at Shanti.  Her biggest one is stencilling birth quotes on the wall of the birthing rooms and the clinic space.  Like everything else in Uganda, it has taken a very very long time.  First she had to find posterboard, from which to cut the stencils.  It doesn’t exist here, so construction paper had to do.  Then she had to draw out the letters, cut them out, measure the wall space, measure the letters, figure out how they would fit, drag the table from the lab, stand on it, stencil, then have someone buy paint, and finally, paint the letters.  it took the better part of four days to accomplish this, but accomplish it she did, with the help of Annet and Rachel.  I will put some photos up on facebook, so you can see the (huge!) finished result.  She has literally left her mark on Shanti.

This trip really has been amazing for her.  While my original hope was for her to see how good she has it in the States, it has become so much more.  She has started asking the hard questions about international aid projects, wondering if we do as much (or more) harm than good.  She is no longer satisfied with easy answers, and has really started thinking critically about development, sustainability, and the hierarchy of countries in the world community.  While she’s not sure she wants to come back to Uganda, she is expressing a desire to travel more, and not just to the Caribbean on holiday.

Our relationship has also grown, and I think, changed for the better.  We are closer again, but in a more mature way.  I think I needed her to show me that she is capable.  I think I had forgotten that.

 

 

Gestational Age Workshop-Jane July 13, 2011

Filed under: Jane — EssentialMidwifery @ 11:39 pm
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So, let’s say you are living in an imaginary developing nation called, just for the sake of arugument, Huganda.  And in the great country of Huganda, there is little access to, well, anything. And that’s usually fairly ok, as you are a midwife, and make a pretty good salarly working for this NGO called, just for the sake of argument, Manti Huganda. 

Now, Manti Huganda has been trying so hard to do everything by the book in the great country of Huganda, as it is new and wants badly to be a recognizable force of positive change.  So Manti has some rules, like they do not accept anyone over 20 weeks, and they transfer mamas out of care when they hit 41.5 weeks, or if they deliver before 37 weeks. 

(Now we who live in the great country of (just for the sake of argument) Lamerica, or maybe Janada, especially those of us who may have some more liberal ideas about mothers and babies, and all of their inherent perfect timing in regards to birthing, may not understand these rules, and why Manti is interested in playing by them.  Its ok.  Just accept it.  In Huganda, rules can get you into a place, and then, you can work to change them.    It will be ok.)

But on a practical level, how can you abide by the rules you have set, if the mamas don’t?  What if they have no idea when the first day of their last period was, and they cannot afford a dating ultrasound?  What if they are measuring small because of bad nutrition?  Or, conversely, measuring big because of bad nutrition?  What if you, as the midwife, only had one tape measure anyway, and now its lost, and who knows if they even sell tape measures in Kasana? 

 (This is not as weird as it sounds.  We could not even buy string.  We were told four times that we would have to go to Kampala.  Finally, we bought stove wicks and pulled them apart.  And let’s not even get on the subject of zip locks.  I may, at one point have offered to trade both Anna and Rachel for a box of gallon sized.  )

Oh, and let’s also assume that Manti doesn’t have a gestational wheel, and has to rely on manual calculations.  I think someone should donate a few to them.  Let me know if you’d like to get in on that.  I know an organization called, for the sake of argument, deesentialschmidwifery, that will probably throw a few over the ocean. 

So if dates are not known, and ultrasounds are too expensive, and you’ve lost your tape measure, how do you determine gestational age?  This was the question the lovely Annet posed.  We were going to have to get creative.  Old School.

The first thing I asked our next ambiguously pregnant woman was whether or not they had felt the baby move.  Back in the day, this ws really the only reliable way you even knew you were pregnant for sure.  Until delivery, that is)  Most first time moms feel those first fluttery kicks around 16 weeks.  But some feel them as early as 13, and some as late as 25.  Second and subsequent pregnancies are usually felt earlier, but this is not a hard and fast rule.  So now, we can narrow our mama’s pregnancy to between 12 and 25 weeks.  Not extremely helpful.

Here’s where palpation comes in, and as its one of the things I like doing best in the world, I was eager to show these techniques to Annet and this lovely mother, who was wondering when the heck she was actually going to birth her first baby.  If she were only 12 weeks along, we would barely be able to feel her uterus just beginning to poke over her pubic bone. At 16 weeks, the top of the uterus would be about halfway between her pubic bone and her belly button, and by 20 weeks, it should be at just about the umbilicus.  And when the baby is done cooking, it should be about level with xyphoid process at the bottom of the sternum.

See?  That just clears it right up, doesn’t it?

Of course, there is always the copyrighted Shrugging technique, where the attendant smiles ruefully (this is an important part of the protocol), and slowly raises her shoulders towards the ears, holding the pose for a second or two, before lowering them, saying, “Well, we can always Ballard or Dubowitz them when they come out.”  These are assessment scales used to measure certain infant behaviors and physical properties to make an educated guess on the age of the baby.)

And that, my friends, is how we determine gestational age.  And also, just maybe, how we can get around a few of those pesky rules, and renew our trust that babies come when they are meant to, even if that time is “early” or “late.”  Even a baby that arrives unexpectedly, and needs some help, might be telling us that she was better out than in, that something in the interuterine environment was not as healthy as it could have been.  We can still believe in that baby and that mama’s innate wisdom, while providing the best support for both of them that we can.  And that, I believe, is more important than anything else.

 

Mean Girl-Jane July 13, 2011

Filed under: Jane,Uganda — EssentialMidwifery @ 9:41 pm
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For the first time today, I felt threatened. It was not from the men who regularly ask me if I want an African lover. I mean, they are shouting from trucks, so even if I decided that, yes, I absolutely did want an African lover,right now, they would be long gone. They may need to work on their technique.

And it was not from the slightly sketchy guys at the Indian supermarket, who glare at me whenever I ask for something they do not carry, as if it is my fault. And it’s not even from the market men who happily cheat me, and charge me twice as much as a Ugandan, cause they smile when they do it, and we both sort of consider it a game.

No, my nemesis is a teenage girl. She approached Rachel, Anna, and I last evening, as we were walking back from the market, munching on some roasted corn. She stepped in front of Rachel quite aggressively, throwing her shoulders back and narrowing her eyes. She demanded to know where we were from, and when told spat out, “Give me your corn. I want it.”

Now, there was no way Rachel was going to give her the corn. It was good, and it was Rachel’s. The girl glared, told us she had no money (although she was carrying school papers, thus was getting an education, and was obviously not starving) and got a little up in Rachel’s face. It was classic bullying behavior, and it was not going to work. Eventually she gave up, said what I can only assume to be a few rude words, tossed her fake hair, and flounced off down the road with her friends.

Now, if that were the end of it, I would have forgotten it already. But this morning, she was outside her house, with her friends, on the road to Shanti. As I passed her, she looked me in the eye. I greeted her and kept walking. I heard her say, “That’s my friend,” loudly, in a way that was definitely not friendly. The hairs on the back of my neck did a little dance, and I was acutely aware that I was alone, carrying a bag with comparatively, quite a bit of money in .

Strange that of all the people I have encountered and all the places I have been, that I would feel intimidated by a run of the mill, common Mean Girl. I will watch out for her.

 

War Stories-Jane July 12, 2011

Filed under: Jane,Uganda — EssentialMidwifery @ 7:08 pm
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It is just inevitable that when a group of like minded individuals get together, the war stories come out. (I know of what I speak, for I am the former wife of a F-15 pilot, and the now-wife of an SCA fighter.) This is especially true if there is a stoop involved, and some heavy warm air, maybe not quite enough work to fill the time, and some food to be shared. And so it was today at Shanti.

 

Annet began. “Jane, have you ever had the woman with the pre-eclampsia? She who had a fit? It happened to me, when I was alone here with Martha. It was night time, and the woman had not come to the clinic for two months. She only came when it was time for delivery. And she had great big pitting edema, and her blood pressure was so high. And I was so scared, and I told the mother of the mother that this was very dangerous, and that we had to go to hospital right away.”

 

“So I called Ben (the driver) but I could not get him on the phone, and she was starting to get worse. As I was thinking about what to do, her eyes rolled into her head, and she had a fit. She was shaking and not breathing well, and we were all alone at Shanti in the middle of the night. So I ran down the hill to the end of the road where there lives a boda man (Boda-bodas are motorcycle taxis and the drivers are known for insane traffic moves), and I banged on his door over and over again. Finally, he came to the door and I was screaming, ‘ I am a midwife, and this mother is going to die!’

 

So he came to Shanti and Martha and I were trying to balance this woman who was so out of it and without strength on the back of the boda. There is not really room for three people on the back of the boda, so Martha was standing up to make more room, and I was hanging on to the woman, and all I could think of was what if she had another fit on the way to hospital. And then it started to rain.

 

It rained all the way to hospital, when we finally got there. And she was already pushing on the boda, but she was actually only 6cm, so she had to wait. After a time, she did push out her baby, and she was ok. But I was so scared, and I did not know if I wanted to be a midwife anymore. I had to think about it a lot, but I decided that nobody else could have done better than me in that situation, so I might as well stay.”

 

So here’s a secret, and it is what I told Annet: Every midwife in the world has felt that fear. Everyone from the senior-est PhD Certified Nurse Midwife at Yale down to the youngest traditional birth attendant in a mud hut in Sudan. If they haven’t they are either lying, or a bad midwife. The fear is good. It keeps you and your clients grounded in the moment, and its in single moments when lives are lost or saved.

 

Midwifery is a lifestyle full of contradictions. You must do the schooling and learn the facts, but also be open to your intuition. You speak of honoring families, while neglecting your own.

 

But most importantly, like Annete, you have to humble yourself to the mother’s inner knowledge and respect her experience , yet be arrogant enough to act fast and hard when you have to. Its knowing that when a person’s life depends on you, nobody else can do it better. So you might as well stay.

 

Buying Day-Jane July 12, 2011

Filed under: Jane,Uganda — EssentialMidwifery @ 4:39 pm

 

Shanti sponsors two microfinance projects for HIV positive women. In the first women make beautiful beads out of recycled paper, and in the second, they make yoga bags, purses and tote bags. These products are then sent back to Canada to be sold at various festivals and private parties. The profit is turned around and put directly back in Shanti, so technically, this is a non-profit, although the rules are a little different in Africa.

 

They are envisioning the Women’s Group lasting three years, and during that time, the women are expected to diversify their profits into individual money making activities. Then another Women’s Group will start. One woman has had just terrible luck. She took her bead money, and bought a pig. But the pig died. So she bought a bicycle. But the bicycle was stolen. So she bought another bicycle, but that one was stolen too. (Goodness, it sounds like that Monty Python bit from “The Search for the Holy Grail!” “And I built another castle! And it sunk into the swamp! So I built another castle! And it sunk into the swamp!”) So now she’s back to square one. Luckily, she makes very pretty beads, so I think she will be back in the black soon. She thinks so too.

 

That is another thing about the Ugandan people, at least the ones I have met. They have such a happy fatalism. They know bad things happen, and its ok. Well, not ok, per se, but inevitable, and not to be avoided, and that eventually life will be right again. And lawsuits? Not here. Nobody even knows a lawyer, let alone knows how to engage one.

 

Buying Day happens twice a month. The Women’s Group brings their wares, and Kristin decides what to purchase to fill the Vancouver orders. We helped out by providing quality inspections, channelling our inner Seattle Crunchy Mama in deciding what would sell and what wouldn’t. Kristin is adamant that there be no “African” AFrican prints. Meaning, in her words, “No #$%^ giraffes!” Luckily there was only one bag with giraffes on it, and Rachel felt sorry for it, so she bought it.

 

　

 

Buying Day is actually very intense. Kristin only buys a fraction of the beads each woman brings, and is very selective. For instance, NO Yellow. Yellow doesn’t sell. And each bag must be perfect and not have tacky buttons on it. After a while, you kind of forget what is cute and what is not, and it all blurs together. And you find yourself going to bat for a ridiculous pink button with silver sparkles. Perhaps I was thinking of Elisabeth’s daughter Louise when I lobbied for that one.

HIV is a way of life here. I guess it makes sense for the place that practically invented it. If could go online I would deluge you with statistics and facts, but as I’m typing by flashlight at 5am from the Volunteer House, because we have no power, I guess you are just stuck with my impressions. Medicine is available here, but it is difficult to take consistently. Heck, its hard for US patients to take all their drugs at the prescribed time, with no problems or interactions. It’s just impossible here. And many people have to make a choice between food for their families and medicines. There are programs, led by US drug companies to distribute medications for free, but I’m sure that doesn’t work very well. Remember that it takes four hours to cook dinner here. Unless someone actually went door to door, and gave them out, with specific instructions and some concrete incentive, well, I’m not even sure that would work.

HIV status is mentioned in personal ads, and is taught about in schools. There are posters about it hanging on the walls in public buildings. There are songs about how it is transmitted and how to prevent it. And I’m sure this is good. But there is still so much misinformation and tragedy. It hurts to look around the sewing pavilion and know that if I come back, there is a good chance some of these people will not be here.

 

 
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