essentialmidwifery

Birthy Thoughts by Jane E. Drichta and Jodilyn Owen

Drums, Lunch, and Doula Musings-Jane October 20, 2012

Filed under: Jane,Uganda — EssentialMidwifery @ 6:39 pm
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Our visit to the hospital over, it was time for a visit to the drum shop and then lunch.  Sadie wanted to get the large drum used at Shanti bonfires re-covered, and I think we were all interested in perhaps purchasing a percussive souvenir. Drums are such a part of Africa. It is a stereotype to say that the entire country of Uganda has rhythm, but I’m going to risk it.  I’ve seen folks drum on jerry cans when nothing else was available, and it ends up sounding just perfect.

I don’t know what the drum shop lady thought when a herd of mzungus descended on her; its entirely possible that she had never sold so many of her wares at one time, and it is equally possible that she was just sitting down to lunch, and we were a huge interruption.  The drums, however, were beautiful, and we all picked out our favorites.  Several of our gang’s had insects inside, so they set them outside their door back at the guest house, where they remained the rest of the trip. Some people have old room service trays.  We have buggy drums.

Here’s the drum lady.  She looks considerably happier than when we first arrived.

Drums bought, we were off to lunch.  It was a buffet style on the Anglican diocese grounds.  We ate here last year, and it was remarkable in that it was basically our only bites of animal protein the whole trip.  I’m such a carnivore.  I was completely looking forward to it again for that reason.  No mattooke today for this girl!  And, in fact, there it was, sitting in the covered dishes in all its glory”  A piece of stewed chicken.  I think it was a thigh.  I’m not sure.  I didn’t care.  I was just so so happy to be eating it.  i also knocked back a bottle fo the local ginger beer (non-alcoholic).  It was delicious!

The afternoon’s training was four hours on how to educate your clients, and politics and power dynamics in the birth room.  I could talk all day on these subjects.  The education piece is always tricksy for me.  A doula’s job, on the deepest level, is to help draw out what a mama already knows.  We always say we want a mother to trust herself and trust her body.  The easiest way to facilitate this is to help her understand that she already knows the answers to the deepest questions, which in turn builds her confidence that she can participate fully in this experience without fear.  With help, a mother is often able to access that internal knowledge about the larger philosophical questions of birth and life and death, and can be taught how to express them coherently, This is awesome and magnificent, and these moments keep me going as a doula.

However, when it comes to the shallow questions, the nitty gritty details about birthing, like “WIll I poop on the table?”  or “Will Hospital X let me have my baby on my chest right away?”  I am totally fine with just telling them the answers. Many doulas (and this is not a slam.  Really.  It is a stylistic difference.) feel that it is our job to provide resources, rather than provide specific information, so they tell their clients where they can find the information, rather than just sharing the information itself.  People remember things best when they have to work for them a little bit, of course, so there is a great argument for educating that way.

Me?  I think that one of the reasons they hired us is to make their lives just a bit easier on their Birthing Day.  And if I can do that by just saying,”You might poop.  Its a great thing.  It shows you’re pushing in exactly the right place, and chances are you won’t even know you did.”  then I probably will.  It seems like an oral tradition to me, sharing the sacred knowledge (Yeah, I think poop can be sacred.  its an odd life I lead.)  with the uninitiated, helping lead and prepare them for that time when they too will undo go the trials, the rite of passage, if you will, into motherhood.  American women today often don’t have time to completely research every little question they might have, evaluating sources, and wading through a swamp of google hits.  They wanted an expert in birth, and that is why they hired a doula.  And, to bring it back around to Uganda, most of these women don’t have Internet access, so asking question of their mothers, their sisters (read “their doulas”) is how they get information in the first place.

So that means, doulas, know your stuff.  Study up, keep abreast of current information, and don’t be afraid to say that you don’t know, that you will get back to them.  The only thing worse than no information is bad information.  And keep in mind, that at the basest, most primal level, mothers know how they need to give birth.  You’re just there to fill in the blanks

 

A Visit to Kasana Hospital Part 2-Jane October 18, 2012

Filed under: Jane,Uganda,Uncategorized — EssentialMidwifery @ 7:03 pm
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We left the boy with tetanus, and make our way through the regular women’s ward, and then to the maternity section.  We file though in single file, like nuns in a procession, our hands folded, careful not to touch anything.  Our guide, Dr. Agaba, runs this place.  A shortish, roundish man in his early 50′s, Dr. Agaba has the patient resignation of one who has worked in healthcare for a long time, doing his best to do what he can, and knowing with all his being that it will never ever be enough.We actually met him yesterday, when he came out to visit Shanti, and was very interested on our doula training.  He smiles easily, and jokes with Sadie, Shanti’s project manager.  They seem to have a lovely relationship, built on respect and common purpose.

However, he is not smiling now, as we enter the maternity ward.  Softly, he points out the postpartum women sitting on the naked beds, explaining that sometimes they are two and three to a bed, sometimes they are sleeping on the floor.  Agaba explains the culture of rape, the lack of access to safe and legal abortion.  Abortion is illegal in Uganda, although, of course, it still occurs.  Forget the coat hangers and back alleys of North American history; here we are talking about dirty sticks and poisonous herbs, sometimes self administered, sometimes not.  But Agaba does not judge or flinch from reality.  “If a woman comes to me, it is my duty to treat her, not judge her.  I am only here to help.And that does not help.”  Wise words.  What if we only did what helped, forgetting judgement and bias and acting only with love and acceptance?

There is a woman in labor and the hospital midwife takes us into the delivery room to see her. She is sitting on the vinyl table, naked from the waist up.  She is crying and moaning, and we are just staring at her.  This is clearly silly.  We are birth professionals, for goodness sake.  I move to her side, smile, and murmur some words of encouragement.  I don’t expect her to speak English, so I just use the Birth Voice, telling her that she is so strong, that she is doing a great job.  Surprisingly, she answers me.  “I don’t feel like I am doing a good job.  I feel like I’m going to die.”

“It this your first baby?”

“Yes, my first.”  A contraction hits hard and fast.  She slumps over, moaning, her breath hitting me in the face.  The world over, a laboring woman’s breath is slightly sweet, but sharp.  She probably hasn’t eaten today.  I wish that a Cliff Bar would suddenly appear in front of me, or lacking that, at least some drinkable water.

I help her off the bed, and show her how to lean forward onto it, feet wide apart.  We work together for a few more contractions, easing her breath out, rather than holding it, or screaming it out.  She is a strong woman, and has a lot of reserves left.  And she is close.  Her body is beginning to tremble, and she is burping a lot.  The contractions are right on top of each other, pulling apart her resolve.

“First babies are hard.  But you can do this.”  I keep my words simple, but try to infuse them with all my belief, not only in her, but in all women.  I glance behind, and my team has moved on.  Everything in me wants to stay, to support, to help.  I know I probably could.  Shanti volunteers have doula-ed here before, but I don’t want to miss our afternoon training session, so I give her one last smile and a hug, and catch up with my people.

Throughout the day, my thoughts keep returning to that woman.  I feel guilty.  I should have stayed, should have helped. It killed me to walk away from her.  She was scared and in pain, and I left her.  I hope she had a beautiful baby, and that she can forget the pain and the fear, and concentrate on her little one.  I hope she has a man who loves her, and a family that will welcome this baby, and respect her hard work in bring him or her into this world.I hope she does not bleed too much after, or come down with an infection.  I hope her baby lives. It is the most I can hope for in a place like this.  Dr. Agaba said that “if you come to this place, you have come to Hell.”  I hope she finds some bit of Heaven here instead.

 

Sticky Hearts–Jodilyn July 8, 2012

Filed under: Birthy Thoughts,Jane and Jodilyn — EssentialMidwifery @ 10:32 pm
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Midwifery is a profession practiced by daylight for clinic visits.  Timed, scheduled, and pretty predictable, these visits last between thirty and sixty minutes and cover all of the details and measurements of how a mother is feeling, and how her baby is thriving.  We spend a lot of time just talking and hearing about mothers’ lives and day-to-day struggles and joys.

Under ideal circumstances, these visits give us more energy for the work we do.  They leave us feeling inspired and connected with each other and the mothers we serve.  Even as the family ramps up preparations and excitement for their birth, we are also ramping up.  We talk a lot about what we expect from a certain birth, challenges that may come, emotional hurdles we will be there to coach a mother through.  We laugh at the funny things toddlers say and do and bask in the remnants of oxytocin expecting mothers leave behind them like a trail of glitter, everywhere they go.  It does not feel like work-work, it’s a special kind of heart work that happens to require plenty of knowledge and experience.

At a recent birth we sat through the night with a lovely mother, who was intent on moving heaven and earth all on her own to have this baby on her terms.  She had a lousy experience with her first birth and no desire to repeat that.  She didn’t need much from us through the night, just the knowledge of our presence was a comfort to her as she labored.  As the sun rose and we made plans with our own families to make sure our children could get to school or work and all of the minute details it takes to get the day started, this mom turned a corner in her labor.  We stretched and made coffee and settled in for the exhilarating moments ahead.  Mom did birth her baby, in her home, on her terms, surrounded by people who believed in her.  A few days later we did it all again with another family.  It may sound like each birth is some repetition of the one before, but the truth is that each mother is unique, and even after hundreds of births I can still say that every birth is different.  Every family brings me new lessons and insights into birth, the meaning of family, and my understanding of the world. And I’m just one midwife. Every week midwives all over the city, the country, and indeed the world go to homes in the middle of the night, rearrange their family schedules to accommodate their absences, sit with women through the long hours as they labor, encourage them through the hard parts, cheer with them in the joyous moments, and watch over the birth of wonderful babies who bless us with their presence.

When the moms and babies are tucked in with their families and resting and I drive away from these births I rarely view the time I just spent as work.  I feel these families on my heart; like little post-it notes, they stick there and are warm and welcome additions to my person. They expand my capacity for seeing love in the world and feeling that there is goodness to be had.  The work of midwifery is sometimes just work-work, but most often it is heart work.  And I carry it with me on my sticky heart, full of the stories, joys, and triumphs of the families I have been lucky enough to serve during this vital time.

 

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

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

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

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

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

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

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

 

On Grandmothers-Jane April 2, 2012

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

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

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

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

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

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

 

VBAC-less in Seattle February 17, 2012

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

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

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

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

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

 

The Quintessential Togetherness. January 31, 2012

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

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

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

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

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

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

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

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

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

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

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

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

 

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.

 

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

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

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

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

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

 

Waterbirth, Waterbirth, Waterbirth–Jane

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

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

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

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

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

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

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

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

 

 
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