essentialmidwifery

Birthy Thoughts by Jane E. Drichta and Jodilyn Owen

“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.

 

Outside the Box–Jodilyn July 4, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 12:09 pm
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I worked from 7-6 today so this shall be short.  Firstly I have heard from the expert in Kangaroo Mother Care who kindly answered my desperate email with a calm, reassuring, and point by point plan for getting these premies onto their mothers and out of the incubators.  This is colossal good news and I am thrilled to have a plan moving forward and to see that the things I had started were at least near the mark if not on the mark.  So hooray!

Today was the day of mothers and babies who decided to do everything outside the box.  I manually rotated an OT baby who was all hung up and malpositioned.  I know it sounds funny but when I try the tricks of the trade I have only read about and expected to rarely to never use, and they work, it is a really really great experience.  There was a case of turtling and sticky shoulders and I went right in and retrieved the stuck child.  And there was a case of a cervix which repeatedly went from fully dilated down to 8cm and back again.  I couldn’t believe my fingers so I went to ask another midwife to come in.  She checked her and pronounced, “fully!” so I told her to wait for a few minutes and check again and then she said “8 cms…oh yes, sometimes the cervix needs to do that, it will be ok” and she trotted off.  Of course mother was ok and baby was ok and it all worked out fine.  At home we rarely to never do internal exams so although I know from seeing so many hospital births with regular internal exams that the cervix will do this and the myth of smooth 0-10 cms is just a myth, it was so bizarre to feel it.  I am trying to layer my innate trust of birth, of mothers, and of babies into all of the actions I am involved in from moment to moment.  Labors here are rarely like they are at home for a variety of reasons and just letting that be and going where these labors take me takes a lot of thinking-through in the moment.

One thing that is not different here is my unofficial 2-minute rule.  After years of observing babies being born and specifically the ones who are allowed to come to breathing on their own I have found that at the 120 second mark babies who don’t breath just after birth (as most do) either begin breathing well on their own or it is time to give them some help to get going.

I know this seems like a long time but babies come with reserves on hand—they are designed to take the time they need and to endure through extremely long, strong contractions and the pressures and squeezes they get at birth.  Everything works for a reason.  Mom’s contractions as or just after the head is born squeeze the torso and lungs and push fluids from the nose and mouth.  The placenta continues to push oxygen and nutrients into the baby for many minutes after birth as the final third of baby’s blood volume is transferred to the baby through the cord.  Cocktails of hormones turn the mother and baby on to each other.  A thousand unseen yet precise and valuable processes are unfolding in the baby, in the mother, and between the two.  We do not interrupt these unless it is absolutely clear that baby or mother need extra help.  So having seen so many babies come to on their own at the 2 minute point I know to be patient and wait, to leave the baby skin to skin with mom and let her talk to and rub her baby as mothers naturally do.

At one of the births today I was suspicious about a baby and I was watching the clock tick slowly away, waiting for the 2 minute mark as I was doing some gentle encouraging.  At exactly the two minutes I started to move in to give a little more help and the other midwife said to me in the quietest of tones, “I think you may need to help that little person out”.  I smiled because she was facing away from the clock but called it right on the mark.  Within the half-second baby let out a big wail and there you have it, two midwives and a baby all agreeing that it was time to get going at the same time!

After work I walked to the market while chatting on the phone with Benjy, bought loads of veggies then stumbled home, wiped out and ready for bed.  Just in case you are wondering what is on the news as I write this…“an australian man was fined today at the airport for not declaring his nuts” (they are showing a picture of two bags of roasted pistachios).

 

Pigs and Bats June 27, 2011

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

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

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

 

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

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

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

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

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

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

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

 

Continuity of Care–Jodilyn June 22, 2011

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

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

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

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

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

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

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

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

 

Context -Jane June 21, 2011

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

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

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

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

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

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

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

 

Walls of Heat, Walls of Rain–Jodilyn June 18, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 8:34 am
Tags: , , , , , , , ,

A note about the weather here:  it has decided to act up.  I got trapped in my room when sheets of, or rather buckets of rain were dumped down upon the island by fast moving clouds plowing their way across the Pacific.  When it finally seemed to let up I headed out to do some errands, carefully placing things that matter to me in ziplocks, just in case.  The roads are slippery here when coated with an inch of rain and silt and the going was slow.  I finished a few of my errands, including one to purchase an umbrella, when the skies opened up again.  I decided to wait it out over a book and a glass of apple juice, which oddly enough hit the spot–likely replenishing some much needed sugars that had been sucked out of my body on the river of sweat which poured forth.  I sat in the back of this ice cream shop which is open to a view of the ocean.  It was so strange watching 60+ year old Australian men drinking milk shakes, which is what was happening in multitudes.  There were only two children in the entire shop.  Actually, let me diverge for a moment and say these Australians really have me baffled.  There are many (and I mean many) women well into their 50s, 60s, and 70s who walk around town wearing corn-rows braided from their foreheads back by the local women who charge a few hundred Vatu for the service.  At first I found myself wondering but now when I see them I just think happy thoughts of women who are no longer 17 years old feeling just good enough in the sun and the surf to try things like this.  So oi oi oi Aussie women, I give it to you for the braids and the male companions 20 years your junior and all the rest of the unmentionables as well!!  And hooray for giant chocolate milkshakes—of all the things a man who wants to venture out and go crazy at the age of 60 might do, a chocolate milkshake seems like a safe foray into pleasure (and it’s decidedly Chlamydia-free)!

By the time I got back to my room I was caked in mud up to my knees…and not Seattle mud.  This was the kind of mud fancy French people use for facials and it requires scrubbing to remove.  I was soaked from head to knee in water from walking in the heat and rain so I took a cold shower and scrubbed my shins, calves, and feet for a very long time.

Ok, back to the weather and the ice cream shop as I seemed to have skipped that part.  I became engrossed in my book when I felt I was being rained on.  I looked up and saw that indeed, the rain was so strong outside it was spraying 8 feet into the non-window windows and I was getting a cool shower.  I could hardly complain as just minutes prior the air had become heavy with heat.  I waited a good 20 minutes for it to let up and then walked back to my room.  The rest of the day was spent in this vicious cycle:  heat builds, pressure builds, it feels like you are sitting in a hot cloud.  Then it sounds like you are about to be run over by a train—this is the only way I can think to describe it:  you are tied to a railroad track with your ear on the rail and you feel and hear the train bearing down on you at the same time.  Then there is water.  Everywhere.  Then it gets louder (an island of tin roofs adds to the noise factor).  And louder still.  Heart rate increases.  Are we *SURE* this complex has not slid down the hill into the ocean before?  Where’s my flashlight?t (oh, in my hand)  Maybe I should listen to some music? (nope, can’t hear it even when the ihome is on full volume!)  What kind of bugs are being unearthed right now?  What kind of snakes are slithering and where will they land?  I hope the dog that charged me earlier today drowns.  Remember Seattle?!!!  It was so calm there…….Then it’s over.  Then there are three blissful minutes of cool breezes and relief from the barometric pressure.  Then you notice it feels funny to draw a full breath again as you are sitting in a hot cloud.

This went on for the better part of the afternoon and all the way into the early morning.  So when it is not stunning here—sunny and wonderful and breezy if a bit humid, it is kind of stunning—a mighty show from Mother Nature I have never seen the likes of before.

 

Name That Road Kill. Oh, it’s me. June 13, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 11:15 am
Tags: , , , , , ,

Apologies in advance for the long post…will keep them short henceforth.

Well first day on the job—check.  6 hours it took to recover using every trick I know to calm myself down—check.

I went in for my first day…and to be fair, I had been told “you just show up, and they put you to work!” But I didn’t fully grasp the meaning of that statement.  Until it was my turn.  I threw the variety of things I thought might come in handy in my backpack.  The Things Midwives Carry…our next book?  I learned today that I have been spoiled rotten in a thousand ways.  Sue for example, always has extra pens.  Tally for example, tends to put things right where we need them.  Jane, for example, has been my partner in this work for as long as I can remember and is always just, well, there.  If not in person, then by text or hurried phone call with hushed tones or on the speaker phone listening to me catch a baby solo.  And she is definitely always there to debrief with.  She takes my side, without fail, and listens to my stories a thousand times until I have made sense of it and we can all agree on the outcome we want next time.  I, for example,  leave work and my colleagues and I come home to Sports Center (which amazingly, I miss!), my children, my husband…the good stuff of the life we have built together.  So today, when I did what I did in this new world, and had to unwind and debrief, and it was midnight in Seattle, it took a little figuring out.

I came back to my room and wiggled out of the scrubs plastered to my body thanks to gabillions of humidity today (yes, that’s a technical weather term), and I changed.  I put on my flip flops and headed out into the world, over to the other side of the island and the town.  I walked the market.  I purchased a cucumber-like thing for breakfast tomorrow.  I walked along the water and through the dusty busy thoroughfare.  I listened to my ipod—happy music, sad music, angry music, belly dancing music.  I looked up and noticed the sun setting and saw the moon.  It is so bright white here—it looks different than at home.  I haven’t ventured out at night yet so now I was kind of excited to see the stars I have never seen before.  One big star popped out.  I decided to head over to where a crowd of excited locals stood talking and laughing and watching the ocean.   I almost got to them when I noticed some stairs up and a sign promising air conditioning and a bar.  I made my way up and was ahead of the crowd so had the attention of the waiters and waitresses who all came to chat and say hi and see who I am and where I am from.  As we were talking I looked out the full glass wall and saw below hundreds of fish of all sizes.   There was a large light shining on the surface of the ocean and the locals were feeding the fish.  The thing that amazed me is that if there are 7 crumbs in the water but 3 fish try to get one crumb, hundreds of fish fight for that crumb while the other 6 morsels  float nearby untouched.  I ordered a drink and sat by the window watching the fish do their thing.  This ocean doesn’t seem like the one in Hawaii—this one seems much more wild.  I have nothing to base that on other than my observations tonight of thousands of welfare-fed fish but it just seems different.  I thought I saw someone lighting a match in the window—smoking is allowed everywhere here—but then there was another flicker, and another.  Soon the sky was filled with sparkler type flickers.   I asked one of the waiters—“what is that?!” and he explained to me in a long detailed way what they are.  Unfortunately he was speaking in Bislama so I have no idea what he said.  But I replied, “ooooh, like Fireflies?”  to which he heartily nodded and proceeded to consult a few of his co-workers “Fireflies?”  “Yes, yes, blong  Fireflies”.  It was really magical.  I have promised Julia that I will try to capture a picture of this flickering, fish-feeding frenzy when I return there next week.  It was a really nice calming escape from the rest of what I will be doing here and I have promised myself one night a week out with the flickering flies and a drink.   I came back to my room dripping, literally, sopping wet in sweat—despite the fact that I didn’t think I had any more in me—and skyped with Julia for a while.  She was up studying for finals, a convenience for me as it felt really really good to hear about her day and her life.

So…I know…you want to know WHAT could have happened today to send me down a six hour desperate search for a little calm and comfort!  Here Goes:

The oft-spoke of short cut to the hospital from where I am staying has been cemented over and the back gate to the hospital is locked tight.  So even though I left here after a long swim and feeling fresh and clean, by the time I ascended Chicken Road (not the real name, but that’s what I’m calling it due to the copious amounts of chickens who reside there) and walked toe-to-heel along the “sidewalk” at the front of the building and found the hospital I was already drenched again.  There were bunches of people sitting on the grassy knoll underneath the trees with coolers and blankets and fans and all manner of household items.  I have to assume they have family members in the hospital for one reason or another.  The hospital is a series of corridors in a row shooting off to the right and the left of a central outdoor corridor that runs the length.  I found the one marked “maternity” and walked in.  I walked all the way down to one end and all the way back without seeing anybody who looked like they work there.  On one end there was a big open room with 8 or 10 beds and what looked like mostly postpartum moms and babies in them.  There were several smaller rooms all filled with women, a desk with lots of paperwork on it but no workers.  Hmmmm….I went back to the beginning and out of a room came a woman who had the look and feel of a midwife.  She raised her eyebrows at me and I introduced myself.

She nearly hugged me as she went on about how busy they are and the lack of staff and the tendency for the locals to take 2 hour lunch breaks now that she taught them about this concept and insisted that they delegate their work so that they could engage in self care throughout the day…on and on…suddenly she was giving me a tour of the building and the paperwork and the people.  If I ever uttered a word about redundant paperwork I apologize retroactively…I had never met redundant until today.  It is hot everywhere in that building.   There are fans and even an AC in one room which I got turned on but waaaaay too little, too late.

The midwife told me something about how she is keeping stats so we need to carefully make “tics” in certain columns so she will easily see which ones go into which spreadsheet…then there was a meeting with the Dr. Elias Fan Club.  There was a rousing cheer for me since I know him and even more clapping and laughing and oooohing and awwwing when I told them I not only knew him, but he is a dear friend and I was with him just the day before I left Seattle.  AAAAAAHHHH!  I was suddenly the bringer of joy and good tidings and as one of the midwives was checking a mother for dilation she was chattering about Elias and soooo happy.  The mom was nearly complete and it was a little awkward to be having this conversation while she was clearly in transition.  I’m not in Kansas anymore.   I got a tour of the pediatric area where I was introduced to the doc who works with babies under a year and we chatted a bit about what I know and can do there.  We walked down the corridor and I saw the moms layed out on the beds with their children and I definitely had thoughts of Sam and laying on the bed next to him…these women had the same look as I’m sure I did.  They are doing the thing they can do best which is just to be right there for their children.  It is an action that transcends cultures, space, and time.

There are a lot of issues here with congenital heart disease due to improper nutrition–someone had the bright idea to give newborns powdered milk several years ago, which fills them up and gives them no nutrition whatsoever.  This has led to a group of children with respiratory and heart failure.  Breastfeeding is now so important here it has its own two forms for the midwives to document the teaching and initiating of breastfeeding.

We went for a tour of the Nursery which is their NICU, a small room with old rusty incubators and four babies who looked to be premature.  There were issues with the pump which they pulled me in to resolve and then promises to have me back to help them with these fragile babies, which I am really pleased about as I might be a neonatologist in a midwife’s body and this will give me the opportunity  to work in that area.

Then someone asked me to go work with a laboring woman who was in a delivery room (two beds per room, two rooms actually connected to each other btw).  There were parting words along the lines of, “if the contractions aren’t close enough, just increase the syntocin”.  As if I’ve ever done that before!  Inductions are the property of the big hospital on the hill where I come from, not homebirth midwives!  But I decided to be here, so here I am and I will be doing things I have never done before.  Clearly.  Long story short, this mother starts screaming at me in Bislama “You Kutum Me!  You Kutom Me!”  Aha!  This labor stuff is the same in any language—she wants me to cut the baby out so she doesn’t have to do this anymore…”No.”  I say.  “Strong Mama.  Strong Baby.  Relax…Relax.”  Her eyes popped wide open and she had me in The Stare.  The one where they trust you to help them and make it alright.  The one that says, “Ok—I’ll do this!  But You’re Going Down With Me.”

I worked with her for a half hour and had her dancing and stomping which she loved and the local midwife was very shocked by but did not contradict me.  The nurses aide came in and told her to get on the bed so I could check her.  Huh?  Ok.  I acted like that was all normal. I didn’t feel the need to check her, I could tell from her body and her words what was happening.  But I had the voices of my senior midwives in my head “when they tell you to do exams, do them…you’ll really get to understand this in a new way”….yes, there was Star-Trek music playing in the background of my mind.  I checked her and she was a soft 8 with an anterior lip of a cervix.  I wanted her on her hands and knees to help her dilate that bit that was left.  That was more than the locals could take so I settled for asking her to lay on her left side.  But everytime she jumped up and asked for a “walkabout” I encouraged her to do it while the nurse looked at me like I must be a specialist in coloring books or joke telling.  But she progressed quickly and I saw from the beady sweat on her upper lip that she was ready to push.  Sure enough with the next contraction she pushed at the peak.  She was still standing up and I helped her to stomp until the urge was great and she would push at the peak again.  The nurse finally got her on the bed but then she left and I was there and the baby was born with the perfection they are because birth really does work and I placed the baby immediately skin-to-skin and whispered to the mother “strong mama”.  She looked up at me and gave me a big beautiful toothy grin.

I waited for the cord to stop pulsing before cutting it, and waited for the baby to initiate the breast crawl—which it did, of course.  The rest of the day was all about postpartum care for that mama and shots and vaccines for babies.  They had me bathe the baby and give her shots and as I wrapped her up I noticed a particularly foul green goo coming out of her eyes.  Well that is bizarre.  I spent the better part of two years rewriting the code in Washington State regarding the eye medication that is used to prevent infections that occur from STD’s from the mother.  I know a lot about it.  But have never seen it in person.  I thought I was seeing it but took the baby to the midwife to confirm or look like an over-eager fool.  She went to the prenatal forms and confirmed the mother has had Chlamydia…and we got the medication for the baby and installed it in the eyes and hopefully that will be the end of it.  They told me they haven’t seen such an infection in over 18 months.  It felt good catching something that really does need to be treated and is a solvable problem.

The original midwife who had given me the dizzying tour had me fill out all of the paperwork and then kicked me out.  She told me to sleep in tomorrow and see how I feel then come in when I want to tomorrow or the next day and we’ll set a schedule.

It is hot hard stinky work in that hospital.  My sensory overload was beyond measurement.  I walked back down Chicken Road, the heat of the evening making the air thick to walk through.  The boys were celebrating and had made a banner, “NumbaWan Soccer Team 2010-2011”.  I found my room and that is precisely where this all started…and where it will end as I am about to drop onto my pillow for a little reprieve…

 

 

 
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