essentialmidwifery

Birthy Thoughts by Jane E. Drichta and Jodilyn Owen

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

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
Tags: , , , , , , , , , , ,

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!

 

Winding Down…–Jodilyn July 25, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 12:03 am
Tags: , , , , , , , , ,

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.

 

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

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

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
Tags: , , , , , ,

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. 

 

Hooray for Pis Pis!–Jodilyn June 18, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 8:42 am
Tags: , , , , , , ,

Hooray for Pis Pis!

A baby I delivered a couple of days ago was labeled “unable to pis pis” (aka pass urine, pee, piss, etc…)  I immediately went to check the charts to see if the baby had a 2-vessel cord as this can be a marker for genitourinary issues.  But of course, they don’t do newborn exams here in the immediate postpartum and there were no notes.  I sat down and worked out a flow chart for babies who no pis pis and then took it with me to examine the baby.  The cord was too dried to see good remnants of the typical A-A-V (artery, artery, vein) arrangement so I could not rule out a missing artery.  I worked my way down my chart (very officially written on the little 4×5 notebook I keep in my pocket!) and I could not find anything.  Cursing myself for leaving the phone number of a certain ND friend who likes to solve mysteries at my room, I redid my checklist.  Still nothing.  The baby was breastfeeding well and at the very least I would think we would see a distended bladder or feel fluid in the abdomen.  But this perky baby was the picture of perfection.  The pediatrician called in meanwhile and told us to tell the mother to wait a week and if still no pis pis then they will do a scan (ultrasound).  I’d like to see anyone wait a week while we don’t pee—puhlease.  Another midwife and I decided that was no good.  I felt that the wrong people might be being accused of retentiveness and turned my thoughts to the pediatrician who had diagnosed the problem and decided to wait a week to investigate it.  This baby was the aforementioned first boy, youngest sibling of 3 girls, whose father had clapped me on the back many, many times.  I was not going to let him slide down the slippery slope over the course of a week.  Having decided that either one of two things was happening, one being there was something I could neither see nor feel and that something did not bother the baby at all and two being that the diagnosis was wrong, I decided upon a course of action.  I went to visit baby N every 15 minutes and I took a good look and feel in his nappy.  I was posted and on the job, refusing to jump into anything else that would divert my attention.  That is, until the little 2 year old sibling of an almost-born baby climbed into my lap.  We laughed, we plei-pleid (played), we drew pictures in my notebook which she loovvveed.  Her grandmother tried to dissuade her from my person but neither of us would have any of it.  We made fishy noises as she was excited by the fish-mobile hanging in the hallway.  We skipped and marched in little circles.  This little activity made me very popular with the locals who were milling about taking care of their loved ones.  Maybe we play differently or maybe they were just happy to see a white girl who likes children, either way I got claps and smiles aplenty.  And every 15 minutes my new friend would toddle behind me down the corridor to watch me stick my hand in a baby’s nappy.

At the 2hr check, wonder of wonders, miracles of miracles, Pis Pis!!!  I admit I had grown anxious and was wondering who I was going to have to corner to get this baby cared for but all such thoughts fled my mind as I did  a happy pis pis dance with the toddler and baby N’s grandmother!  I then strutted down the hall like the proud mamahen I was and announced to the midwives and nurses  “We have Pis Pis!!”  They stared at me and then I remembered to put that in the correct vernacular to be a little more clear that it wasn’t “us” that had pis pis, but the baby who belongs to M who has pis pis.  “OOOOH,” they said and started laughing at me.   I decided to hunt down the pediatrician so returned my little friend to her family, giving her the piece of paper she had scribbled on.

I learned today that to get to pediatrics if one takes the wrong corridor, one has to walk the length of geriatrics.  As I walked through some of the old people reached out and I stopped and held their hands and talked with them.  These are such a lovely, heart-led people.  The first thing they share with me isn’t who they are or what they do, it’s just a warm smile and a bit of silence.  I made my way slowly through geriatrics and then across to peds.  I found the doctor and shared the good pis pis news then went to see if there were any kids who might want to plei plei.  One of the mothers of the ortho babies who are stuck in one place because their legs are casted and suspended from a rope contraption had fallen into a deep sleep while nursing her baby.  The Baby was wiggly and fussy so I quietly went and sat next to the bed and played with him…mom didn’t even stir one bit.  We played peek-a-boo, pet Jodilyn’s bracelet, and we said the letter “o” in quite a few different ways until he got tired and closed his eyes for a nap with mama.  I taught an older kid in a wheelchair the hand-slapping game, even though things were weighted on his side as he had an IV in one hand and I was unable to slap that one with any real intention.  My hands plenty red from my big loss, I headed back up to maternity.

Medicine here is strictly clinical—very much like the 1950s in America.  But it has been shown how much joy and human touch and concern improves clinical outcomes and I am unsure why this hasn’t reached this little island of joyful connected people yet.  I’d like to go over to Papua New Guinea where these docs are trained and get into their minds a bit about “bed side manner”.    Somebody comment and tell me the name of that Robin Williams movie where he cheers up patients? We should show it at the next staff training.

Meanwhile, I am headed back later tonight as we have 3 premature labors (mothers who are all between 26 and 28 weeks along) in the works…

 

Walls of Heat, Walls of Rain–Jodilyn

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.

 

The Truth About Tabu Dogs–Jodilyn

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 8:28 am
Tags: , , , , , ,

Since Jane and I are both posting here, we’ll put our names at the end of the title so you know if you’re in Africa or the South Pacific : )

 

The shift in weather woke up the sleeping dogs.  I have a picture in the facebook album “Vanuatu I” which shows the normal state I have met these dogs in:  sound asleep and deeply involved in dreams of chasing what I thought was bugs and rabbits but now I see is American women.  Or as Jane put it, nobody mentions the last midwife who was here from South Africa—cause the dogs got her.  So as I was walking along the road I always walk on I was met quite suddenly by a pack of dogs growling and barking.  I “knew” each dog as I have passed them all a dozen times or more by now.  I have opinions about dogs.  I watch Cesar  the Dog Whisperer “tssss” the fiercest ones into calm submission.  But that many dogs and all I did was hold my hands across my face thinking if I want to keep working here I will need both my hands and my eyes.  A fleeting thought crossed my mind…”seriously?! after everything, it comes down to THIS?!”  Gads.  Before I could think further along those lines I had dozens of rescuers by my side…little boys about 5 or 6 locked and loaded their tiny hands with pebbles and began pelting the dogs and yelling at them.  These are not big strong boys, they are small boys with bad aim.  But within seconds the dogs ran whimpering away and the boys were yelling at me, “It’s OK Sistah!  It’s OK Sistah!”  I congratulated my heroes and gave them big “Tankyiou Tumas!!” (Thank you so much!) to them.  Then I started laughing.  Really really hard big laughing.  Julia Roberts would have been embarrassed.  I tried to control it but it kept coming up.  Laughing.  Where am I?  What am I doing have these adventures in hot clouds with packs of big-talkin’ dogs and an endless supply of Chlamydia?  I laughed the block or so til I got home and the thing is that here, laughter is contagious so the bus drivers slowed down to see what I was up to and laughed with me, the mothers preparing snacks for their kids under tin shelters laughed with me, and I laughed with myself.   Tabu Dogs really Are Tabu!  Pshaaa.

 

AwfulWonderfulBusyDay June 16, 2011

Filed under: Jodilyn,Vanuatu — EssentialMidwifery @ 10:01 am
Tags: , , , , , ,

Today was stunning in its chaos, challenges, and joys.    I will try to give a quick run-down.  Thankfully I started with my therapy—a good long swim—so that when I needed it most, I had already had it!

I went in to the ward today (yes, that’s me using the word “ward” but there just isn’t another word for it here!) and walked in on a delivery of a healthy boy to a young  mother.  I helped settle her and the baby—babies and mothers are left alone with the baby sin-to-skin for an hour before they are moved to the postpartum area and given meds.

The board seemed quiet so I went to have a look at the Nursery babies.  Twin B born two days ago had passed away during the night.  Three of the respiratory distress babies seemed to be doing well and one had a note on its incubator that breastfeeding had been successful overnight.  Our 1100 gram baby (just under 2lbs) was looking very unwell.  The mother was sitting next to the incubator crying.  Expressions of affection are different here so while in America I would have put my hand on her shoulder, here I stood close to her but did not touch her.  The baby was declining fast and she got up and started to walk out and nodded to me to come with her.   I followed her into the outside corridor, knowing that none of the technology we have within relatively easy reach at home would be wheeled in to save this baby.  It is kind of maddening and mind-blowing to understand this and it pushes the loss beyond sad and into bitter.  But for this mother, I just wanted to meet her where she was at and be with her in whatever way she needed.  Her husband had left crying and I assumed he was nearby but I could not see him.  The mother and I locked eyes and hers welled with tears, fear, and sadness.  So much sadness.  I nodded my head slightly at her and she collapsed in tears in my arms and wept very hard for about two minutes.  She then took a deep breath and walked back in the corridor, past the 12 beds of new mothers with healthy babies and into the nursery, where her husband sat waiting for her.  The baby died shortly thereafter—I was upset that they were not allowed to hold their baby as he died, it was awful seeing them separated by scratched and discolored plexiglass.

Within moments their families arrived and they were given one of the private birthing rooms to hold their baby and be with their family.  There was a tremendous wailing and mourning not 10 feet from the postpartum area and the grandmothers and some of the mothers in there stood up and walked close without going in.

I stood quietly in the hall when suddenly a woman came running out of the bathroom calling me “sistah, sistah, she go feint!”  A woman had fainted while trying to use the bathroom.  I scooped her up, a puddle of blood beneath her and opened her IV so it would drip fast.  She came to nicely and just like American women when they pass out, she woke up confused and oddly cheerful.  Another midwife brought a wheelchair and we put her in it, brought her back to the delivery room and dealt with her boggy uterus.  She looked much stronger after 20 minutes and we cleaned her up and started her back to her bed.  I went to check on M, the mom who had delivered just after I walked in.  There was a circle of blood on her top sheet which was odd.  I lifted it to have a look and sure enough, there was a very large pool of blood under her.  Must be the day for it.  I had her lie flat and massaged her uterus into submission which gently calling for assistance.  Her IV was out and finally a midwife came and switched it out for a new one and added some Syntocin (synthetic pitocin) and somewhere between my rubbing and the meds her uterus behaved.  It was decided she should rest with her baby an additional half hour.

A fourth-time mother I had been watching labor for a few hours decided that would be the right time to push her baby out.  Hers was the first husband I have seen involved in the labor—he had been with her rubbing her back and giving her water for hours.  He told me he was done “OK” and patted me on the back on his way out of the ward.  He was jittery and nervous.  Mom delivered quite quickly.  There is no fanfare or ritual like we have…waiting for the mother to discover the sex of her baby by looking herself?  No way.  Husband or loved one cutting the cord?  Nope.  I went to find the dad and told him mom was good and baby is healthy and strong, congratulations.  He asked me “smol boy o smol girl?”  I told him, “com see.  you com look.”  This quite disturbed him and he repeated his initial question.  “Ok,” I said, “Smol Boy!”  Well that was one proud father—he had three girls at home.  He clapped me on the back hard several times while grinning from ear to ear and repeating “smol boy! smol boy!”.  We walked right past the now 30 or so people gathered and mourning the loss of their baby and he came in and joyously greeted his boy.  Later he came and found me and told me the boys name.  I have to find out if it means something special…it is a name I have not seen here.

I went to check on a recently discharged-from-the-Nursery baby who is staying with mom at the hospital until she reaches 2 Kilos. She is so darn teeny and cute.  Her mom dresses her in all hot pink and she seems to be doing very well, indeed.

I had a talk with the head midwife here about Kangaroo Care—which is the technical term for “holding a baby” that has been proven since the 90’s to severely reduce mortality rates.  Babies are held skin-to-skin in an upright position on mom’s or dad’s chest for as long as possible.  Ideally the parents provide this care, and it has been shown to improve the mental health of parents, but substitutes work just as well.  It helps regulate baby’s heart and respiratory systems as well as their temperatures.   Kangaroo care is the first best option even in developed countries, but here it would seem of paramount importance to provide this care for premies.  She said this is on her list…which is decidedly long…and asked if I would put together some research to present to the baby docs so I will work on that this weekend .

I was getting used to the fact that it is hot and sticky all the time until I skyped home tonight and saw my clean, climate controlled house with couches one can just relax on without worrying about bugs…

 

 
Follow

Get every new post delivered to your Inbox.

Join 754 other followers