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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.

 

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…

 

Winding Down…–Jodilyn July 25, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 12:03 am
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Thursday was humid and sweaty.  I felt like I was  moving through Jello and time was going soooo sloooow.  One of the midwives asked me, “Will today ever end?”  I don’t know what was going on unless they all felt the effects of the humidity as well or this is just one of those common workplace occurrences where everyone has slow-days.

We had several moms in early labor and lots of paper work to catch-up on.  We attacked the paper work, the tidying that never ends, making empty beds, mopping up…on and on.  I did a bunch of newborn exams and spent a lot of time hanging out with the twin’s family.  The dad was there to help get mom and the girls home and we chatted about their older son’s reaction to the babies and seeing mom and dad holding them.  Parenting is a universal challenge—we talked about Touchpoints (thank you Dr. Brazelton) and I shared some stories from when the kids were little.  Dad owns a tour company and they invited me to come and see “their little island” which reminded me of MamaMia : )

Of course everyone decided to have their baby at the same time—we had four mamas going within ten minutes of each other and they threw me into one to work with a student.  I had assessed this mother throughout the day and she would only let me touch her, telling the student and the other senior midwife who came in that she would have none of their fingers in her body.  Ok.  I actually wanted to support this student through it as she needs the hands-on.  At this point, strangely, I am feeling like I have done a lot of births and don’t need to do more.  (time to come home?!)  But I understood her position and respected it.  To make a very long story short she had a super tight fit and pushed for an hour and half, which is like 4 hours of pushing at home—it is unheard of.  She was bleeding ahead of the baby and complaining of acute pain.  We kept tabs on the mother in the bed across from her and they were having parallel experiences.  We prepared for both of them to have some serious bleeds and just asked the doctors to come hang out.  All the other babies were born first—3 girls.  This mother was insisting that she wanted a boy.  I slipped in once, “ok, it might be a girl too” and then held my peace—she would have to make hers or not make hers when the baby was born and I just decided I am wrong to interfere with her hopes and push reality on her when she is clearly a)not ready for that idea and b)in possession of 50% chance of getting what she wants.  The other mother had a high tear that required suturing by a physician and after baby was born so did this mom.  Baby was indeed a boy (!) and she asked me to go out and tell dad.  I went to tell him—he was a young 20 years old.  I asked him to come and see the babe but he wanted to know first what it was.  I told him it was a boy and he told me he actually knew that already so it was no surprise to him—he had had a very strong dream and had no doubts.  He made the transition from playing it cool to being uber excited quite rapidly and jumped up and snapped my finger—a trick the locals do which he later gave me detailed instructions in so I can show Jeffrey.  He wooted and hollered and danced around and clapped me on the back and kept saying, “alright!  alright!”

Friday I filled out and folded dozens of “blue cards” which are health records that parents use keep to track immunizations, well-child visits and any notes a provider would like to make mention of.  I also filled out and folded dozens of birth certificates.  So the next many many babies born in this hospital will have my signature on their birth certificate.  Which is kind of funny, considering I am not even a citizen here.  I am doing a lot of newborn exams as I have to pass my exam in the fall and have to match my scoring to the examiner’s scoring in order to be certified.

The weekend was all atwitter with building booths around the perimeter of the park for a week of celebration.  The booths are made by stripping the bark off of branches and then notching them at the ends so they fit together.  A whole frame is made in this way.  Ceilings and walls are made of woven leaves.  Each booth is about 10×5 or 10×7, depending on the use and they all share a wall with the one next to them.  Everyone was busy preparing, either with the weaving or the framing and then the moving.  That’s right, the moving.  Families move into these booths and use the front to sell goods—mostly food–and the rear to sleep in.  It is like a week-long Seafair from the old days when peons like us could pitch tents and actually enjoy themselves without spending a fortune.  All Sunday afternoon people were hauling pots, pans, sleeping mats and household goods down to the park.  Many of the houses are empty.  Chicken road is well represented with a few booths that are triple-wides in a row.  So now it is easy to visit my friends, I just go to their corner of the park and hang out.

Sunday at 3:00 began the festivities of Children’s Day with a parade led by the Big Chiefs from several islands, the minister of finance of Vanuatu, and several other dignitaries.  Behind them came the band and then the children and then the stragglers.  This parade does not work like our parades where everyone starts at the start and ends at the end.  This one started with the Chiefs and the band and a few children and they parade around the neighborhood and people wait on the street to see them and then join in at the end of the line so that by the end of the parade, when the procession marched onto the field there was a hodge-podge of people of all ages tagging along.  The prize has to go to my father-in-law’s counterpart here who ran around the corner from his house, got a big hat and stuck a Vanuatu flag in it and then waited for his grandkids to come down the street.  They clearly thought they had lost him and laughed and laughed at his prank.  He swooped up one of them and joined in the parade.  I happened to have been on the corner he ran to and he told me his joke while he got his hat situated.  Grandpa’s are da bomb.  I have been listening to so many stories lately and a lot of them are about grandfathers.  I will share one in a later post.

The parade entered the field and the Big Chiefs were called to do an opening ceremony, which is actually a ceremony once reserved for the start of wars between villages, and the singing sounded much  more war-like than happy-Children’s-Day-like.  They went to the middle of the field and exchanged Kava.  There were several chiefs present and they started to dance in a circle.  After a moment a group of grandmothers (I kid you not, some of them are great-grandmothers) ran to the center of the field and started dancing around the chiefs, much to the delight of the onlookers.  The chief from Pentecost saw them and stepped out of the chief’s circle and danced with the grandmothers instead.  This was extremely popular and there were loud cat-calls from the audience, who stood around the perimeter of the field.

Then came the speeches.  I had been warned.  But I’ll just say that I listened to about 6 of them over an hour and a half and then headed back to my room to call home and say happy birthday to Jeffrey and drink water.  I could hear them talking for another 2 hours so it was a good decision.  I had the chance to skype with Jane and I’m not sure what exactly happened but there was an extremely high rate of laughter and accusations leveled at each other regarding something to do with acting like 12-year olds.  Looking back, I’m not sure if 12 isn’t too mature.  Either way, just one more thing making me feel ready to come home.  I talked a long time with the kids and Benjy as well which was so great–also, making me feel ready to come home.  I am really happy to have these feelings.  I was kind of worried when I got here about how I would manage to get on a plane and leave.  Ever.

The partying went into the wee hours of the morning and this morning was the only morning since I have been here that the neighborhood was not awake with the sun.  I walked to the pool and it was still pretty quiet with the exception of a few toddlers who rose at the usual hour and teenagers who hadn’t gone to bed yet.  This will continue on for a week—even now there is a huge game of soccer going on the field and a live band playing music.  And it’s only 10:00am.

I am winding down my work hours as I want to see some more sights here before returning home and am frankly wanting fresh air.  All of the weeks in the hospital and the fumes from the cleaning agent still make my eyes water and set my gagger off.  I have caught a lot of babies.  I have delivered quite a few.  I feel confident about suturing, dystocias, breeches, twins, internal exams, and mothers with friable tissue.  But not so confident that I will ever approach birth without knowing that regardless of what I know, the mother knows more and the baby knows more and as a team they know best about how to birth and be born.

And not so confident that I would ever assume I could midwife better, just because I midwife differently than my colleagues, mentors, or peers.  This place has knocked the judgment out of me.  I hope that I can go on to support those in my profession with an open heart and genuine curiosity about who they are and how they arrive at decision points.

And certainly not so confident that I will ever stop learning or wanting to know more about why things unfold in the way that they do.  I am so lucky that the people I work with are information seekers and that they not only put up with my endless energy for getting to the bottom of things but they one-up me or encourage me or sit patiently with me as we talk these things out again and again so that we can all be better for the families we serve.

 

Triage and a Day Off! –Jodilyn July 20, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 7:54 am

A twins update:  both girls were born vaginally and are doing quite well.  I checked on them every 30 minutes through my shift.  Mom is tired but thrilled.

I know I often write that there was a big blur and then I break it down and talk it all through here but last night really was a big blur—I delivered 3 babies and we had 6 women walk in within 5 minutes with their entourages.  The corridor swelled with people as one of the moms had at least 7 people with her, mostly very large men who wanted something done.  Right away.  Haha…I can hop-to with the best of them but I can’t make babies be born, they tend to do that little trick on their own time.  So they all had to wait and wait and wait while this mom labored.  We had one of the premature babies pass away during the middle of this so one midwife went to work with that family, one was someplace unaccounted for (and by unaccounted for I mean I couldn’t find her in the chaos but she was probably busy working somewhere), and then there was me.  I triaged 6 moms in a matter of minutes—two of them with the same name.  Taking histories, feeling the baby for position, doing internal exams to figure out who needs immediate and who needs almost immediate attention.  One girls was 16 and in with her Aunty–this would be like my sister-in-law bringing Julia in for a birth!  I slowed everything down and did some education with her, drawing pictures of the cervix and the baby for her on her chart.  I gave her encouragement and assured her that even though it is hard to do at her age, her body and her baby would be amazing for her. She went home to labor there for a bit longer and I organized everyone’s charts and stapled the papers in place and put people places so they would not all be on top of each other.

At the end of that hour I suddenly, for the first time, felt utterly, totally, completely ready to go home.  I couldn’t keep their names and faces and progress straight.  I took copious notes but I just did not like how it felt.  I am really happy to be a homebirth midwife and know the mamas I am working with.

One suture job was a joke as every stitch I put in slid through her tissue—so friable and awful.  I finally called for backup and the other midwife came and sutured her from far outside of the wound and said it should just heal by being held together.  Once again, I can only say that they have seen this so many times and I have not.  I am not judging.

I finally abandoned ship at 1am—2 hours past when I was supposed to come home.  I walked down Chicken Road and was greeted every few feet by men sitting on their chairs on the side of the road listening to their Kava.

Today I decided to get out of the hospital and see the rest of the island.  It was a hot sunny perfect day.  I swam in the South Pacific, I snorkeled through lagoons where fresh and salt water meet and mix in warm and deep turquoise water.  It was crazy to look at my hand under water and see it surrounded by the colors I have only known from Crayola in the old 180 crayon box with the sharpener on it.  So many deep blues!  I waded in creeks and gave loud woots of joy with some locals who had knocked off work early to play in the hills.  I jumped into a pool below a waterfall (it was full of fish—how did they get there when it is in the middle of the jungle?) and read Pablo Neruda on a white sandy beach.  I had a stare-down with some beef cattle and a local boy climbed a coconut tree with his father’s machete and got me a fresh drink.  I marveled at one grandmother hiking up a muddy jungle-bush covered short-cut in the hills barefoot on an incline that many 20 year olds would tremble at.  I had a philosophical discussion with a 24 year old driver who, through mirrored sunglasses and sporting a mohawk with beads down the back of his head explained to me why, even though Vanuatu is a small country and not big and strong like United State, it is better to live here because they know how to relax after they knock off work.  I couldn’t agree more.  I have learned a lot about not working in the hours I am not at work.

I took lots of pictures but no promises about when they will get up, I have to go sit at the café where the internet is free to upload them.  It was a perfect day off and I am so happy that I took it!

 

Knowledge vs Fear: a 12 round bout. –Jodilyn July 19, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 3:35 am
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Working nights has its distinct advantages and disadvantages…it is quite rough as the senior midwives on at night deliver babies using a method called “chinning” which is quite rough on both mother and baby.  This is the method taught in 1940’s and 50’s Obstetrics.  It is brutal to watch and I have taken to actually looking away just to preserve my sanity.

I did have one of them ask me why we leave the placenta instead of clamping and cutting it right away and she was really amazed to learn about the transfer of blood from placenta to baby that takes place.  I saw the light turn on as I explained the physiology of it to her.  She has now taken to waiting until the cord stops pulsing before cutting.  I am always impressed when someone in the middle or end of their career wants to learn and grow in their knowledge and skills and she surprised me with her eager discussion.

A senior midwife has just returned from 3 months at the hospital on another island so I met her for the first time last night.  We were sitting with a mom who had been induced using Cytotec.  This off-label use of the drug causes terrible labors.  I have seen many back in the day at home (it is not used as often in the US anymore due to piles of research and controversy about its safety) and recall with perfect clarity the vomiting, the intense pain, the constant contraction as the uterus clamps down and will not release for extended periods of time.  This mother was having a classic cytotec birth.  I explained this to the students who were kind of baffled by her behavior.  She was literally out of her mind and laying on the bed groaning and rolling from side to side.  I stood next to her and placed a hand on her chest, below her neck.  She stilled and reached up and looped her arm through mine.  I rubbed her forehead with my thumb and she rolled towards the other midwife who was on the other side of the bed and puked.  The look of surprise on the other midwife’s face was something else.  Women don’t typically throw up here.  This is only the second one I’ve seen who has.  Somehow the shower of vomit narrowly missed the midwife and she barked at a student to go get a bowl and the mop and clean it up.  Sometimes it just sucks to be the lowest one on the totem pole.  I mean, you have no responsibility which is awesome, but you also get the grunt work.  After all was tidy the midwife I normally work with at night came in.   These two proceeded to tell me their life story—they have been friends since they were small and slip into stories and laughter at each other and themselves.  All of the sudden one of them starts singing, “Darling I’ll miss you…Remember I’ll always be true…And then while I’m away I’ll write home everyday…” they trail off, forgetting the words to this classic Beatles tune.  I pick up where they left off and it prompts them to continue with their concert, which becomes a medley.  I have my hand on the mother and feel her still.  I look at her and her mouth is agape in clear wonderment at this turn of events.  There is a popular Fijian musician who apparently came and sang at the conference in the Solomon Islands last week.  The midwife who was there proceeds to reenact both his singing and the response of the Fijian midwives, nurses, and doctors.  This included fanning and screaming “Oh Sossi, you’re so sexy!  You’re so sexy!”  I have to say that I was so completely entertained by this woman—I could not peel my eyes away.  I was having fantasies of bringing in a Kareoke machine and setting her loose.  The mother also seemed to be taken with the show but felt too lousy to enjoy it.

Mother was stuck with an anterior lip—something I am convinced most mothers have but we don’t worry about because we don’t know about them because we are keeping our hands out of their most intimate private places and leaving the baby to do the work of birth as much as possible.  With the help of the nursing student who has become accustomed to my ways, the mother got on her hands and knees for four contractions, on her left side for two, and then rolled onto her back and pushed her baby out.

The next birth was also a primip but everything was slow going.  I have come to expect the friable tissue when things go that slowly here…a lack of coordination of the uterus was clear as her contractions were quite short despite the fact that baby was so low.  The baby’s heart rate was very low due to the never-ending head compression and it felt like time to birth.  We gave her what we call a “whiff” of synto—a super small dose just to inspire the uterus a bit and it clicked her contractions right into the strength she needed to push the baby out.  I put my stethoscope on the baby’s back and listened to its heart and lungs as they kicked into gear.  I caught a glimpse of the cord and noticed it looked strange, with big bubbles of Wharton’s jelly staggered up the length of the cord.  I was helping the student with the placenta which looked odd when it came out and sure enough the membranes dissolved before they were totally out.  Thus I went on my first true fishing expedition.  I have had to coax them out before when they trail or break but there is still a visible bit there.  This was about looking for bits and pieces.  I gave myself a pep talk—I knew that it would hurt her but the other choice was to let her bleed endlessly.  I proceeded to fish bits and pieces from near and far until I could find no more.  I watched her bleeding and wondered if there were some left.  I tried again but got none.  I asked the other midwife to check as well—they do this all the time so have experienced hands.  She found no more but I paid attention to how she held her hand and her methodology.  Learning, learning, always learning…

After getting both mothers and babies settled in they asked me to do a CTG on a mother with twins.  I went to fetch her—she has asymptomatic pre-eclampsia and was sleeping in the private room of the hospital.  I brought her to the room and she sat down and cried.  She looked like a Samoan princess—tall and with a regal face and posture and gigantic belly full of babies.  I sat down next to her and put my arm around her and she started talking in English (!)  She was afraid.  She did not understand this hospital and just wanted  her babies to be healthy and did not want a cesarean birth.  She did not want to take medicine to make her numb so they could operate on her.  She did not want to feel so out of control.  Oh mama.  Oh mama.  How hard it is to come into a strange place and feel that people will do things to you without your permission.  How frightening not to understand why or have things explained to you.  Of course you are stressed out.  You have been housing and loving these babies for 36 weeks.  You are not a woman anymore.  You are a fierce lion-mama and you feel protective.  You have the power to take down anyone who comes near you and you feel that power in surges over and over and over again throughout the day as a parade of doctors and midwives and students come in to “feel the babies”, ignoring the person that you are.  She nods in vigorous agreement.  “Yes, like a lion!  I want to claw them!”  I nod and listen to her tell me her story.

She was married in 2009 to a man she met at a church conference in Samoa.  They had exchanged letters and one day he appeared at her house with his family and spoke with her parents and the two families happily became one as they married.  They moved to his home here in Vanuatu where he runs day tours to a small island and is quite successful.  They hoped for babies but none came.  A woman she knows in Samoa had her 8th child and could not provide for him.  She asked this young couple to adopt him.  They have loved him hard.  He is the child of their heart and he cries when his daddy goes to work each day.  About 30 weeks ago she started feeling ill and vomiting.  She came to the hospital where they told her she was pregnant.  She could not believe it.  They rejoiced and he comes home every day for lunch—not to eat but to take care of the baby so that she can rest for a half hour.  She has a good man.  She went home to visit her family in Samoa for Christmas and visited the hospital there where she was told she has twins.  She called home and told her husband and he was so stunned he just kept repeating, “it can’t be, it can’t be.”  But it is, and they are so excited.  And now she has learned that both babies are head down but she doesn’t know anything about birth because her girlfriends at home started to tell her how much it hurt and she felt that was bad preparation so stopped listening to them.

We had a little childbirth education class.  I talked with her about the physiology of the sensations.  She asked questions, and we talked and talked.  After an hour and a half she was ready for the CTG.  The machine here does not handle twins very well but I tricked it into giving a reading on one baby, and a reading on the contractions.  I used a handheld Doppler intermittently throughout the 20 minutes to listen to the second baby and wrote its heart rate on the strip of paper issuing forth from the little machine.  Babies sound wonderful.  She held my hand and we walked back to her room and she asked if she could eat some dinner.  I encouraged her to prepare as if she was going to run a marathon, plenty to eat and drink.  Because the worst that will happen is she will go into labor tonight and feel like she has to throw-up and so-what if she does!  She should take care of herself.  She was smiling and happy and beautiful.  It was nearing the end of my shift and I went to review the CTG results with the head midwife.  She asked me to go and get a full set of vitals from her before I left.  I went back in and her mother, who had been sitting in the corner on a chair looking at me suspiciously before stood up and hugged me and smiled and said thank you.  I checked her blood pressure, her temperature, her pulse and told her to get a good dinner and sleep, and left them alone for the night.  All I want to do is go in and see how she is doing today but my shift doesn’t start for another hour.

I am back where I started six weeks ago—that humanity always matters.  Kindness and communication transcend culture, skin color, and the “way things have always been done”.  Fear will always rule where knowledge is lacking—in one woman or in a society of people.  And while midwives can’t solve all of the problems of a society, we can always ease the fear of the woman in front of us by sharing the truths in the most complete ways we can find to do so (even when they are unhappy truths).  Did I miss a birth?  Actually, I missed two.  And I feel I was the beneficiary of this woman’s sharing of her-self and the story of her family.  Today I don’t want to go see and what that busy ward will bring me in terms of experience and skill development.  I just want to see her and sit with her and hopefully welcome those babies and tell them what a great mama they have.

 

The Story Unfolds–Jodilyn July 17, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 9:59 pm
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Yesterday was Sunday.  It has been raining and although I got myself all caked in mud on Friday in the name of going to market and getting out a bit, I stayed inside Saturday and had cabin fever by 5:30am Sunday morning.  The computer seemed like a trap I had no desire to lose my toes in so I decided to go to work.  I brought my umbrella to walk there.  It doesn’t rain for 10 or 15 feet and then the showers come on and frankly, they come on so fast and so hard that by the time my umbrella is up I am already drenched.  So I was mostly wet by the time I arrived but I passed one of my favorite midwives on her way home as I walked down the hill to the hospital.  She told me it was super busy and they will be happy to have my hands.

After that there is a giant blur but I will try to break it apart.  I walked in and put my backpack down in the lounge.  As I made my way to the board to see what was happening someone handed me a baby with directions to bathe and give it shots.  Oh Happy Work!!  I love love love floating these babies in warm water, watching as they unfold and look around and kick and relax.  Not to mention the baby cuddles which come in spades as I hold them in a towel to dry them off instead of rubbing their skin which I think must feel so sensitive in the first days after birth.  I brought baby to her mother and got them skin to skin, laying down in bed and then walked back to check the board which I had not managed to do.

“Jordilyrn!”  (every midwife here has their own version of my name, this I recognized as one of the senior midwives who walks with a limp but manages to lift mothers out of bed and scrub blood and muck out of sheets and do all of the hard labor involved in working here.)  I followed her voice to the delivery room and she told me she thought this mama was going fast.  She was opening the delivery kit and I looked at the mom, walked over to the counter and put on some gloves and turned around and caught the baby.  “Oh, you are going to do this delivery?”  She asked.  “Ummmm….you are welcome to but here is baby.”  A delighted laugh issued forth as she turned around again and saw baby already skin-to-skin with mom.  I offered to clean up and suture which she gratefully accepted.   I tidied up, sutured, and then got to scrubbing while the mother enjoyed her baby and her extended family came in to admire the new arrival.  I got mom to her bed, baby bathed and in bed with mom and then went to try again to look at the board and the charts.

The hallway was swarming with pregnant women.  They rub their own backs through contractions, reaching around and pushing up and down on their tailbones.  Sometimes their mothers or aunties or sister-in-laws will be there doing it for them and sometimes they will be sitting nearby chatting with the other mothers and aunties and sister-in laws.  Who is who?  I wonder about them.  I like to have my hands on a woman’s body before she births so I have an idea of her.  I want to know her name and what number child this is and if she tested positively or negatively for STDs.  I want to feel her belly and say hello to the baby.  I want to have a sense of her hygiene and some idea if her hemoglobin is beyond the low we think of as low.  I read through as many charts as I could but another page through the hallway, “Jordilyrn!”

I follow the call back to the delivery room where a young mother (and by young, I mean she is the exact age of my own daughter) is pacing back and forth, moaning.  I assume she is a first time mother because she is so young.  The midwife tells, me, “you stay with her.”  So I do.  I pick up her chart off the counter and see this is her second child.  The first was by cesarean section birth because the baby had been lying sideways in the belly.  OK, hooray!  A VBAC! I am really good at these.  I am smiling to myself and happy to be there.  I read the whole chart.  The doctor wants regular updates as to her progress and he wants her waters broken when the baby gets low enough.  OK, out of the range of things we would do to a VBAC but I am here on their turf.  I pause and watch her and start to think this through.  My rebellious VBAC self is screaming just to let her go and to have her baby before we call.  I rub her back and she wraps her lanky arm around my neck and strokes my shoulder.  She nuzzles her face into my neck and moans.  She is a child.  I feel her body, rubbing her hips and shoulders.  I look at her mother who is watching us and her daughter cries out to her, “Auwe Mommy!” I miss my girl.  Her mom is crying, watching her daughter like this.  She wipes her tears and shakes her head and comes to her daughter who launches herself from me to her mother.  She leans on her mother as I rub her back and talk in soothing soft words.  Telling her not to be afraid of what she is feeling.  Telling her she is safe and this is ok.

As her labor progresses I ask her if she wants me to check her.  She says she does.  I go and get my favorite nurse who acts as my translator.  She speaks softly to the moms and treats them gently.  I ask her to tell the mom that if the baby is low enough we can break her water, which will make her labor more intense.  I want to know if she wants me to do this or if she prefers not.  She wants me to if I can so I prepare ahead of the exam and confirm the plan with the head midwife.  I feel the baby, so low into the pelvis, and a bulging bag of waters ahead of it.  I snag the bag gently and it opens.  But the give of the bag was too easy and I felt it pull apart and rip down.  I listen to the baby as I think about what I felt.  Baby is doing great.  When I think about things not being as robust as I would expect them to feel or be here, I wonder right away about nutrition.  I ask the mom if she eats fish, chicken, beef, or ham.  No.  She eats island cabbage and white rice for dinner.  I park that in the back of my mind.  I tell the head midwife that she is nearly complete but since it is the first time she is pushing a baby out it could be a while. I don’t want the doctor cranky with me for calling too soon.

I walk back into the room and she is pushing.  I trot back out and say, “Nevermind.  She is pushing.  Calling Dr. B.”  The midwife comes into the room as the first of the head is showing with strict directions from the doctor to call if she has not delivered within an hour.  I ask her to stay.  I don’t feel good about friable tissue.  I see the telltale sign of bleeding from behind the baby.  I know what this is now, after having seen it so many times and know that she will be shredded on the inside and I want a witness to see that I did not do it to her by not cutting an episiotomy and that I have followed the doctor’s orders.  The midwife even remarked that she must be tearing on the inside.  Baby is born with three pushes, it is a beautiful wonderful birth.  And then the bleeding starts.  It is not pulsing, just gushing.  I feel for the uterus and can’t find it.  I make a map of her belly and start my search in quadrants.  I finally locate it but it is too low down.  Something is really really not right.  I rub and rub and it finally hardens beneath my hands.

I ask the midwife to start an IV and give her fluids and synto.  She gets it up fast.  We can’t run IVs as fast as mom is bleeding.  I take gauze and go in hard, looking for the source of the bleeding, thinking that if I can compress the tear it will stop.  It hurts mom.  I tell her I’m sorry and to take deep breaths.  I see one big tear, and what looks like the uterus, or the front of the uterus, or some other organ.  There is blood everywhere and it is hard to see but I know my landmarks and that is not one.  I start packing gauze into every tear I can find.  I am screaming in my head, “Protein!”  I know this is not the time to be thinking about nutrition and that I should be screaming other things in my head.  But I am frustrated with these women falling apart.  The doctor comes in and he is friendly and kind.  Blood is pouring over the gauze I have packed in her.  I am trying to convince her uterus to stay firm and I say outloud, “I would really like this uterus to stay firm.  Mama:  talk to your uterus, tell it to get hard.  Talk to your body.  Tell it to stop bleeding.”  It sounds bananas but this really does help when we do it at home.

I am dumping a bowl-full of blood out and putting the bowl back again.  And again.  I give the doctor the summary.  What has happened.  What I’ve felt.  What I’ve seen.  He takes my position and asks for a speculum.  I do not waste time removing my gloves and my bloody hands open the door and get out the kit he needs.  He confirms that the lower segment of the uterus has come down, he can see the rectum.  Everything is in the wrong place.  The one thing I know about this is that we can get it back up where it goes.  Sure enough he pushes the uterus back up and I can see it rolling up her belly.  I lock my hand in place on her belly to hold it there from the outside.  I massage it with my other hand.  It won’t stay hard despite the massive quantities of syntocin going into her through IV.  We place a second IV and draw blood to cross and match it, then hook her up to more fluids.  The doctor meanwhile is busy trying to find an apex to one of the tears so he can start suturing.  He eventually does it by feel.

He worked for 45 minutes with myself and another doctor assisting him.  She was bleeding the whole time.

He cleans up the best he can—the room is a flood of blood and looks like a hurricane has hit it as we tore open supplies and cracked bottles of medicine and fluids.  I am eager to clean up, I know it will feel soothing.  I ask for instructions from him—how often to do vitals (I did them twice as often), how much fluid to give, when to call him back.  I made a chart to record everything and put in consults to him once every 45 minutes for the first three hours.  He leaves and she has the shakes.  I chase him down and ask him how he feels about that.  He tells me to put some blankets on her and watch her vitals.  I do.  Her blood pressure tanks.   I get the senior midwife back again and she tells me to load on a plasma replacement gel and she will call the doctor and tell him that he wants us to do that.  I love that woman.  He tells us to load her with two doses of gel and keep running fluids until her pressure normalizes.  She has no urine output despite the now 4000 units of fluid we have put in.

I spent four hours with her, scrubbing the room to a shine while taking her pulse and temperature and blood pressure.  The grand-mother had taken the baby out to be with family.  I realized she needed a family member with her so I went to find her mom.  I saw her boyfriend there and I changed tactics.  I asked if he would come see her.  He too is just a teenager and he was scared witless.  I told him just to come talk with her.  She was in a sleep when we got to the room so I woke her and told her to say hello…I would later tell the doctor that this young man was the best medicine we gave her all day long.  I watched him step over his fear to be with her and encourage her.  She was shaking and pale and he spoke gently to her.  He looked up at me and said, “I think she is hungry.”  Teenagers are magnificent, capable, wonderful creatures.  I know they are busy finding out who they are but the sensitivity and depth of empathy they display when the chips are down are palpable.

I sent him to go get her some food and he returned with the source of her friable tissue….orange soda and white bread.  Frankly, I thought the sugar would do her good so did not object but made my way to the mom to ask her to go and get some milk.  She slowly ate and the combination of his company, the fluids, the food, and time seemed to be bringing her some strength.  At the end of the fourth hour her blood pressure looked pretty darn good and there was urine output again.

For my birthy people, don’t think I haven’t wondered if I had ignored orders and not broken her water if she would have shredded.  All I can offer up is past experiences here which tell me it did not make a difference whether the water was neatly emptied on a midwife’s schedule or came flying out all over me—this is so far beyond what we know of in America.  Poor nutrition here is not fast food and snickers bars.  It is a lifetime of orange soda, white bread, fried leafy greens and white rice.  No protein.   An entire lifetime of it.

It was already two hours past the end of the shift but the senior midwife had stayed with me to see this mom through.  I learned from this mother.  At home I always tell laboring moms who are having a long labor that they and the baby each have a story to tell and a journey to make, and we will understand it very clearly when it is all over, but cannot know it before then.  So too for the midwife.  The labor will tell its own story.  If I assume that each moment is the story I will be mired in parts instead of learning from the whole.  She was dying.  Then she was not.  And she did not.  And I worked hard and sweated and used everything I had available to me, including a consult to a very good physician to make it so.   We moved her to a postpartum room close to the midwives’ desk and got her settled with her baby, who forgave her the hours she had been away and eagerly looked at her and nursed well.

As I was dragging myself toward my backpack and home, I heard it again.  “Jordilyrn!”

I took a breath.  Really?  “Can you just check one mom before you go?”  Of course I can.  I brought mom into the admissions room.  A fourth time mom.  A posterior cervix.  No bleeding, no broken waters.  Hardly a contraction to speak of.  I saw Dr. B in the hall and asked him to come translate as she had no English.  “Can you ask her if she has any concerns?  I am wondering why she is here so early in labor if it is her 4th—she must feel something is happening.”  He skips my version and asks her all of the questions I already know how to ask and he tells me she should just go home.  She lives nearby and can come back later in more active labor.  Now a fourth time mother usually has a reason for calling a provider or showing up to a maternity ward.  I put her on the CTG to get a read on baby and contractions, just making sure everyone looked good before sending her home.  They looked stellar.  After 10 minutes I unpluged the machine from her and told her she could go home, or walk-about around here, or go into town with her sister for a girls night out…the choice was hers.  I helped her sit up.  She stood and there was a puddle of water.  I looked at her.  Her face had changed.  She was sweating and looking at me like I might  have the missing piece to a puzzle she has been working on for years.  “OK”  I say, “let’s go—right there”  I was pointing to the delivery room.  She is nodding slightly and making small deep questioning Scooby-doo-like noises.  “huhhhhh?”

I would like to pause to thank the two women I have been with as a doula who had posterior cervixes hardly dilated, followed by two contractions, followed by a baby.  Thank you.  I recognized in her what I was privileged enough to see in you.  I remember the nurses yammering on and on about how you couldn’t possibly be in labor, about how it will be several hours…I resolved not to be that person.

Mom took two steps up the stool to the bed and lay down.  I put on some gloves and turned around. I placed my hand gently on moms belly.  “Ok baby, today is your day.  Now is your moment.  Come to us gently and kiss your mama who has taken such good care of you.”  Mom smiled and pushed her baby out slowly.  A lovely pink healthy girl.  She did not cry.  She just lifted her head from mom’s chest and looked around.  “Welcome, welcome” I hum.  Mom was smiling dreamily from the baby to me and back again.  Auntywas laughing and crying.  I was waiting for the hemorrhage but it did not come.  I know how to do this birth.  I relax and smile and am thankful.  So thankful.  I feel the cord pulsing.  It pulsed for 19 minutes.  Aunty cut the cord.  Placenta came easily.  Hardly any bleeding.  “Surprise!” I say, laughing.  “Happy, Happy Birthday Baby…I’m so happy you are here ” I talk to the baby as I check to see if the cord has three vessels, if she is really as healthy and strong as I think she is.   Mom names her Jodilyn on the spot.  I can’t refuse.  I’m too happy.

 

Patching up Sores July 15, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 5:23 am

On my way home from the hospital I  saw one of my little friends on Chicken Road.  She is 4 years old and had a gaping fresh wound on her arm that was covered in flies.  Oh the glories of humidity—the flies were all out feasting.  I asked her aunty if it was ok if I came back with some medicine and plaster (plaster=band-aid) for her.  She said yes.  I trotted home, my scrubs sticking to me and the stench of the hospital rising in steam from my whole person.  All I wanted was a shower.  But I threw my backpack down and retrieved my first-aid kit and what looked like the right size band-aid.  Then I had a flash-back.  Julia gets scraped and needs a band-aid.  Sam wants a band-aid too.  So does Jeffrey now.  Tiny crumbs of lunch on the arm or little scratches are suddenly wounds in need of band-aids.  And if Jeffrey has a band-aid Aiden wants to talk about it but Eli wants one also and down the chain it goes…I wondered:  Are children here subject to the same Rule of Band-aids?  I grabbed a handful and stuffed them in my scrubs pocket.  I pulled some gloves out of the stash I brought with me and shoved them in there too.  And I headed back up the road in that sticky heat.

I figured she would be crying by the time I returned.  I never met a 4 year old with an actual injury that wants it to be cleaned up.  She was there, a puddle of tears and snot.  OK…strategy time.  I needed to have her see me put one on someone else.  I sat down on a wooden pallet which is on the ground.  It felt good to sit after the long day, even with my scrubs sticking to me, even in the heat.  I opened the first aid kit and put the bandaids on top of it.  And there he is, the answer to my prayers.  A 6-year old who is showing me his sore and asking, “plaster?!”  A-ha.  Ok.  I look at the target of my visit and say, “none for you, one for him.”

This is a strategy I learned from watching Dr. T Berry Brazelton do a well-visit on video.  He sat on the floor and hid from the child’s line of sight behind the mother.  As he was hiding he was talking to the mother about why she was there and collecting a general history.  As the child looked around the mother’s shoulder he would duck the other way.  And then he looked at the camera and he said, “if you want to see a child in a medical setting the easiest way to go about it is to make them want to see you.”

I put some bacitracin on his sore, and say “goodbye germs!!” which he fondly echoed with his own dramatic flair, “oh, ta-ta germies, goodbye bye!”  I feel little parts draping on my back.  I feel the comfortable press of kid against my sides.  I look around and am I surrounded by children, packed in as for a Scram in rugby.  (haha that is right I can now use Rugby analogies because I am figuring that game out!!)  They are holding out their arms and legs and showing me their sores and all talking at once.  “OK,”  I say, “Who wants to be one doctor when they grow up?”.  A hand shoots into the air and I hear “Me! Me!” and a boy of about 10 presses himself so he is seated next to me.  “Good, you are my assistant now.”  I hand him the scissors and we proceed to patch up dozens of open festering wounds and half-healed wounds, and old scars that obviously are  just begging for plasters.  I ask each child to tell me the story of their sore.  These kids play hard.  That is about all I can say.  I listened as I was cleaning out debris and brushing away flies and congratulating them on their hard-earned sores.  I am lost in a chorus of child jabber and enthusiasm.  We cut gauze and tape and I give appropriate gasps at the sights they are so eager to share.  I have two small children leaning on me from behind to get front row seats.  And there is the 4 year old, with her big eyes still streaming tears.  But she steps forward and I gently clean the wound—it is so nasty but I just do it—and then put the bacitracin on and a big plaster and I give her a warm hug and have my assistant do the same, because “as a doctor you must always be kind and gentle”.  He takes this seriously and proceeds to hug every child we patch up.  Some of the wounds are healed over but I can see there is something in them.  They have developed tough round scars and I leave them alone…the body has taken care of the wound on its own and isolated the offending material so that it has no access to the blood stream.

The whole time there were two self appointed triage nurses who assessed the wounds on each child and then lifted shorts or skirts or shirt sleeves or feet to show me where the damage was.  At the end they said “Halle has one big one”.  I look for Halle.  She is a sweet shy girl, about 12, who is smiling at me and holding her hands behind her back saying “no, no, I’m ok.”  I tell her the choice is hers or I can give her a plaster to put on herself.  She smiles and sways.  The kids are urging her, “come Halle, get one plaster!  ok Halle!”  I start quietly chanting, “Halle!  Halle!  Halle!” which is picked up in a wild ruckus of hopping and cheering.  Hearing the name she shares with one of Julia’s friends I thought of home and Julia and her friends and I missed them so much.  Halle came forward and gave me her leg.  There was a deep sore on it that was clearly so so wrong.  I cleaned it slowly and carefully until it looked like wounded flesh and not a festering mass of something I can’t even describe.  I had my assistant cut the gauze and tape and we patched her up really good.  I told them all their plasters would probably fall off soon but that was ok, it was good to have them on for a little bit and let the medicine kill the germs.  I told them I tell my kids something when they get hurt playing which is that when you get hurt playing, it must have been a great game!  They loved that.  I said I had one more game for them.  “One Game!  One Game…”  they chanted.  I pulled out my extra gloves and began blowing them up and tying them.  First I tucked it under my chin and made like a rooster which was so impressive to them.  Fits of giggles are always a good motivation : )

I popped one blown-up glove over the clothes line and said “beach volleyball”—a game that is well known here as Vanuatu has a women’s beach volleyball team going to the Olympics and it is a big deal.  We played volley-glove for a bit and then I finally could not stand it anymore and opted out for a shower with promises of returning with more gloves and games.

 

Teaching a Birth–Jodilyn July 15, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 4:33 am
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Firstly, my world feels right again now that I see Jane online : )  I am taking this afternoon to read her blog entries and cannot wait to devour them.

This week felt like it was acutely about teaching, with some wonderful and challenging births and delicious babies as the centerpieces for the lessons.  We got a whole new crew of students in.  They are medical, midwifery and nursing students from Australia.  We also got a fresh crew of local nursing students coming through and I have been really working with them as much as possible.  Many of the nurses here start nursing school in grade 11 so they tend to be about 17 years old, although there are some older ones as well.  They have no allowance while in school beyond what their families can afford so it can be quite challenging and I have heard the most inspiring personal stories from them.  One single mom who worked at the supermarket and scrimped and saved and now owns a small plot of land of her own and is in school full time, another who is a father of three that live 45 miles away from the hospital and he could not afford the bus fair (about $5 a day) to and from school and home so he stayed with some family of his that live locally for the first year of school.  The problem was that they had so many extended family members living with them there was no room to sleep on the floor so he slept every night upright in a chair so that he could stay here and keep going to school.  AussieAide provided the nursing school with scholarship funds—half to be given out on merit and half on need and he was the recipient of one of the scholarships so now will finish school with a place to sleep.  The stories go on and on of these young people getting themselves educated and contributing to their communities.  Most of them will go to school for 3 years and then work supervised for 2 years and then become the primary care providers in rural settings, so they need to know how to do everything and do it well.  I have tried to attach two of them to me, constantly teaching them and putting their hands on moms and babies—the New Zealand midwife here keeps them busy with meaningful projects and they are responsible for helping to clean and make the beds and assist in other duties in the nursery.  I don’t know how they do it.  I suppose it helps that they are young and excited about their work!

Yesterday we had a first time mom who kind of acted like an American mother—I was so surprised.  She threw up in labor and hollered and even whined.  I said, “oh, it feels like home…” mind you I said it with a big smile on my face.  It is a new skill I have developed out of necessity to read the cultural cues here and it can be hard understanding where someone is at from watching them when they act like they are taking a stroll through the mall and don’t really make much of a fuss until it is time to push.  At home I can almost always tell just by watching and listening how far along a mother is.

So one mama who was all out there with her labor was kind of fun.  Normally I wait to see a head to write down that someone is fully dilated instead of checking and checking them.  But she flew through her labor and had been checked a couple of times by other midwives.  She felt like pushing and got up on the bed.  I had been told to do an exam and then have the student do one so she could feel what a fully dilated cervix feels like.  I did and felt a tight anterior lip (just some cervix along one side).  I had the crew of aussie students standing at the back of the room watching and this nursing student there with me by the mother.  So I talked about what I was feeling and had the student feel.  Then I talked about using position changes such as hands and knees and asked the student to tell mom that if she would get on her hands and knees it makes more room for baby to do its work and might take away the urge to push she was feeling.  The baby was super low.  Much to my surprise she flipped right over.  I can’t count the times I have asked moms to do this and they refuse—and look at me like I am idiot.  They think it is acting like a dog and won’t have any part of it.  I covered her with a blanket so she would not feel exposed and asked the NZ midwife to come in and do some acupressure.  We did four contractions like that and then the mom, with a roar, flopped down on her side.

The NZ midwife did an exam and lifted the baby back out of the pelvis to try to get the pressure of mom’s bottom so she wouldn’t need to push as there was still some cervix left.  I asked for one more round on her hands and knees which she did.  She was screaming and moaning like the best of them—rocking her hips and grabbing onto her mother for dear life.  I was quietly talking to the medical students—telling them this was all good and healthy and we are just watching her come into her power and birth is hard, hard work.   The NZ midwife asked me to check again and I did, and I will share that she felt very very tight internally.  And I said outloud, “that feels tight”.  And then I looked up at all of the students watching me and the NZ midwife watching me and I just kept talking out loud, getting my thoughts out there.  “Here’s the problem with internal exams.  We get judgmental.  I don’t know what this baby is going to do to find his way here.  I am feeling her and thinking, ‘this is too tight’.   But it won’t be, because it rarely ever is.  Babies are born.  Mamas birth.  I just know too much about her body now because we have checked her too much.  If I never checked her, all I would be doing is using position changes to shift the diameter of pelvis to help that head get applied correctly.”  To which the NZ midwife replied, “Right-O”.

The mom was switching positions on her own now, sometimes on her side with her foot in my ribs.  Sometimes on her back arching and lifting her bottom.  Sometimes on her hands and knees and once she got into yoga’s Child Pose.  And then there was grunting and pushing.  And the tip of baby’s head.  “Hello, Baby!” I said.  Mama locked eyes with me, I smiled and gave her a big “Good on you!  You are doing it!”.  I placed her hand on that small strip of baby’s head.   She jammed her foot onto my shoulder and brought the head out.  Baby restituted.  “Thank you baby” (I said to baby).  “See how this baby is finding his way out, turning to birth its own shoulder with the next contraction” (I said to students) “ooooooooooh” (said the peanut gallery).  “There’s a cord around the neck!” (alarm from a med student)  I felt it.  Plenty of slack but not enough to slip over the head.  “First I am feeling if it will easily slip over the head…I am not worried, the neck is the safest place to park the cord for birth so I just think to myself, ‘here is one smart baby parking its cord in this nice protected cove of a neck’.  And it has good slack but I can’t slip it over so we will somersault it out”  The next contraction, “Just one small push now mama”.  And she does.  And I say quietly “somersault, somersault, and….somersault” as I support the baby through the loop of its cord and out of it again, the natural movements it would make with or without me there to help.

And swish….up to mama’s chest, ear on the heart.  A baby in its new habitat, the one place that is designed to nurture, calm, and regulate it best:  skin-to-skin, belly to belly, ear to heart with mama.  Baby gives a cry and looks around.  Students are clapping.  Grandma is crying.  Mama is over the moon, gazing up and away with her hands on her baby and a smile that would put the best Orbit Gum commercial to shame.  There is no time for me to exhale as a spurt and gush of blood pour forth from mother and I am on again.  “ok now I just look up at the clock and see the second hand—it is on the 35”  I am feeling the uterus, rubbing it to make sure it is hard…it is.  I take the student’s hand and place it on the organ, which feels like a grapefruit.  “If this stops shortly than it is the placenta working its way apart from the uterus”  If it is still going when we get to the 5 I will deal with that then.  15 seconds go by and the flood stops just. like. that.  “Oh, this is just lovely…it is the placenta”.  I tell one of the onlookers to grab some gloves and he can help me with the placenta when it is time.  We feel the cord pulsing and talk about letting the baby reach homeostasis by waiting until it quits.   We feel it quit slowly, from the bottom, working its way up to the baby’s umbilicus.

There are stars in the eyes of some of the students…I wonder I this is transformative for them and if so, which part?  Is it the birth or is it this mother or is it seeing all of the intricate details from a provider’s perspective that is speaking to them?  Or something I can’t guess at perhaps.

The cord is done pulsing.  I ask the mother if it is ok if we separate baby from its placenta now.  She nods yes.  I clamp and milk the cord about two inches down and clamp again.  I give the scissors to grandma.  She looks at me in shock and amazement but takes them.  I tell her to go in strong, and she does.  And it still takes two tries to cut that miraculous tether which feeds life from one to the other.  She is crying again and kissing her daughter all over her face…a thousand mama-kisses for her child and this incredible gift she has brought into their family.

I wrap the cord around the clamp and motion the med student over.  He looks like any one of Julia’s friends…lanky and still a boy but trying out the world in new ways.  I tell him to put his hand over mine, talk about guarding the uterus, the path the placenta has to travel to get to us.  We ask the mother for one last small push and the placenta comes nicely out.  I inspect it, I talk about what I am seeing and looking for and how to find it.  I show the mom and grandma.  They are stunned and excited to see the house where baby lived.  I go and put it in the sink and encourage the students to put on gloves and feel it, and run their fingers along the membranes so they will see how strong that sack is and to keep their questions in their minds, we will talk after we are done and in another room.

I check the mother for tears, and she has one well placed tear.  I confirm the apex with another midwife and then suture her.  It worked really well.  I am pleased as punch that I did that.  But I am also so new to suturing that I never believe it works when I do it.  More on that in a bit.

I see the door popping open in bits and look.  It is the new mother’s father, anxious to see that his daughter is ok, surprised by the sight of his new grandson in her arms.  I coax him in so that he can see them.  His response is an echo of his wife’s as he holds his heart and plants a big kiss on his daughter’s forehead and then a small one on the new boy.  Whispers rush fort from his mouth to the baby’s ear.  A loving welcome to this world indeed, a new life celebrated with gratitude and affection.  I feel lucky, lucky, lucky.  I am witnessing love.

I kept a close eye on mom for the whole day, sure that she would bleed to death because I did not suture her correctly.  Knowing intellectually that I did does not help.  She is 18.  She has rebounded 2 hours after the birth and is up walking around.  I am behind her at every turn.  Waiting for her to pass out in a good southern faint with her hand to her forehead and a big Scarlett O’hara sigh.  She wants to shower.  I can’t believe my eyes.  She is just up and walking about.  My doctor friend asks me, “why are you following her like that?”.  I tell her the truth.  “Because I sutured her and I must have done it wrong so she is going to bleed to death”.  She looks me in the eye and sing-song says to me, “Jodilyn, come now.  She is fine.  You did alright.  You are alright”.  Oh.   OK.  I’m alright.  She is fine.  I believe my friend and wait for what I know is coming next… “however, if you noticed with this primip that she tore and did not tear so straight and if you had just cut an epis[iotomy] you would not even wonder about these things”.  Nope. Nope. Nope.  I shake my head at her and smile and go to meet the next mother.

 

 
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