essentialmidwifery

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

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

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

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

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

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

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

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