Tuesday, April 24, 2018

What 'Postpartum' Should Look Like

Gadgets, Gear, Spanx, and Make-up.

We have a culture that is often focused on which Boppy pillow, DokATot, and latest baby gadget is the best, rather than focusing on what birth is really about- a new life entering the world, and the power of the woman who grew and birthed that life. Our postpartum time is often filled with visitors wanting to hold the sweet baby- not necessarily help in any way- and mothers often go back to everyday expectations of life much too soon after giving birth. So, what can we do to support a new mom in her postpartum days? And what "stuff" really matters?

The “work” of labor and delivery is truly LABOR- hard labor in all aspects- emotional, mental, and physical. It is arguably the equivalent of running a marathon...that you have not trained for...which you have no idea if it is a 5k or a full marathon. To labor and give birth is to use every muscle fiber in your body (which you will likely feel the day afterward!). I have had moms whose shoulders ache, whose thigh muscles throb as if they have been doing repetitive squats, and who have broken blood vessels in their eyes from the physical exertion that it took to birth their baby. For the mommas who have a cesarean section, there is other trauma and healing from having had major abdominal surgery- and even sometimes a birth that wasn't what was planned. This isn't to portray birth as scary...but to speak to the challenge that is birth and the power that is the female body.

After delivery, the body shifts from growing life inside, to continuing to sustain and grow that life outside of the body, with breastfeeding. The task of producing rich breastmilk is another feat! For all these reasons and more, the postpartum time for a new momma is an important one- for her body and mind!

If the female body can grow, birth, and sustain life, what are we doing after such an accomplishment, to nurture that body? In our culture, we don't always hold this time- the postpartum period- in reverence. We fail to see and treat it as a sacred time. Yes, a baby has just been born. But so has a mother!

So, with all of that said, here is a list of a few things every postpartum momma should have, some material comfort items, and some not.

A lovely postpartum stash

1) Depends/Disposable adult underwear
Yes, I know. It's not the coolest, sexiest, most attractive garment, but I promise you, it will be worth it. The first couple of days when bleeding is heavier, it is so nice to not have to worry about pad placement and ruining your underwear. Go to the bathroom ---> take off--->toss in trash--->replace. It's comfy, it's hassle free. Just.do.it.

2) Frozen witch hazel pads. They feel like heaven on your bottom and perineum after you have given birth, particularly if you have stitches for a vaginal/perineal tear. It's cold and soothing, and helps to reduce swelling. Take a heavy absorbency sanitary pad, and moderately fill it with witch hazel. Be careful not to drench it...it will become a solid ice block in the freezer. Curve it slightly upward (as the curve of the body when it's in the underwear) and place it in the freezer. You can stack several. you can also do this with cotton rounds. They are particularly useful to put right on the perineum or up against hemorrhoids. Add in Lavender for a healing perineum or c-section incision and Cypress for hemorrhoid pads and it will make all the difference!

3) Essential Oils. Yes, I love essential oils! There is truly an essential oil for everything- from supporting every body system, to supporting mindset and emotions. From helping with skin healing to promoting circulation, there is an oil to ease those postpartum discomforts and help you through!

4) Rest. I'm not talking about rest in the immediate hours after giving birth. I'm talking days. Weeks. I tell my moms for the first 3 days, stay in the comfort of your own space- your bed. Stay nearly naked (refer back to #1), skin-to-skin with your new baby. Rest. Nurse. Rest some more. Bond. Limit your visitors. You see? These things are interrelated. You're nearly naked, looking like a beautiful mess of a new mother, so why have company over? We also need to keep in mind that company also brings unwelcome company- germs.

What more important task do you have than to establish breastfeeding, provide nutrients and antibodies to your baby, and get to know this precious new person? You can do it all by resting and staying close to one another!

5) Nourishment. In the immediate days after birth and through the postpartum period, the body needs to be nourished and replenished. Hot teas, infusions, broths, and hearty soups are staples for this! We always make homemade bone broth from our leftover bones and freeze it for soups and stews later. It can be made from beef bones, or a turkey or chicken carcass. It's simple to make and nourishing to the body and mind. Best of all, you can do this ahead of time and freeze in large quantities. It's also easy enough that anyone- including Dad- can do it. Recipe at the end!

6) Time. I see it as a midwife and I've lived it as a mother. The postpartum period isn't held in high regard as it should be. We aren't afforded Time. Such a simple thing, but yet not something we typically give and get after having a baby.

I was once leaving a 24 hour postpartum home visit and said to the new mom, "Just in case you were considering it, please do not go to church on Sunday. Stay home. Rest." The momma (who is from Guatemala) looked at me as if  I was crazy! "Ah...no. I stay home," she said. "In my culture, we do not go anywhere for 30 days after having baby." I was in awe. This is not the norm. Perhaps it should be.

Ever heard of the 4th trimester? It refers to the time from birth to the end of a baby's third month. At birth, the brain of the human infant is still immature. Human babies are fragile and vulnerable, depending on the constant care of their mother. At birth, they have innate reflexes and abilities- breathing, sucking, swallowing, pooping. Yep, just the basics! As the end of the 4th trimester nears, they become increasingly more able little beings- regulating their body temperature, interacting more, nursing less often, and being more alert. Shouldn't this vulnerable, dependent time of the newborn tell us something important about the 4th trimester for the mother as well? I think so!

So forget about fancy gear, breastpumps, and various other gadgets and 'nice-to-haves' for now, and consider this simple, short list. Let us not forget about the 4th trimester for both mom and baby, and all the ways in which we can comfort, nurture, and support them both. <3

Here's that recipe for the nourishing bone broth!

Nourishing Bone Broth

One big pot of water
2 tablespoons vinegar (helps to draw the minerals out of the bones)
. Can be substituted with lemon juice.
3 carrots, peeled and coarsely chopped
3 celery stalks, coarsely chopped

1 large onion, coarsely chopped
1 bunch each of parsley and thyme
2 Bay leaves
About 8 peppercorns
Marrow Bones- we only use organic, hormone-free animal bones such as beef bones, whole turkey, or whole chicken. You can either use a whole chicken with the meat still intact, or use the remaining carcass, after you have already eaten the meat for a previous meal.

• If using a whole chicken, cut off the wings, remove the neck and cut both into pieces. Remove the gizzards from the cavity. Like mentioned above, an already eaten off of chicken or turkey carcass is fine. Throw it in!
• Place marrow bones or chicken and pieces in a pot with water, vinegar, and all vegetables and herbs.
• Bring slowly to a boil, and remove the scum that rises to the top.
• Reduce heat, cover and low simmer for 6 to 8 hours.
• Salt and pepper to taste, or wait until consumption
• Strain the stock into another large pot. Remove the bones and any meat pieces with a slotted spoon. You can save the loose meat to be used for chicken/turkey noodle soup, etc.
• Cool in an ice bath (or, as we do during the wintertime here in Alaska, stick it in the snow outside), and refrigerate until the fat rises to the top and congeals. Skim off the layer of fat. Refrigerate up to 3-4 days or freeze for future use.


Wednesday, March 14, 2018

Birthday Birth

Last night was a first for me in 12 years of being in birth work- I got to assist a family in welcoming their baby on my birthday. ❤️

I sat quietly beside the tub, with our student midwife by my side, knowing that we would soon be meeting a baby. The only light in the room was from the glowing chandelier overhead, the only sound was the breathing of the laboring woman and the quiet garble of her own mother and grandmother whispering in excitement in the background. Dad sat in nervous silence, in witness to it all. 

No blinding overhead lights. No dings, bells, alarms. No repeat questions or pushed agendas. 

“I feel like I have to push!” Slight panic and a hint of doubt in her voice. “What do I do? What should I do??” 

Simple reassurance: “Listen to your body. If your body is pushing, then push.” 

Such a basic concept, but something birth has gotten so far from. 

How did we get here and why? 

She takes that thought and eases more into the water with it. She bears down with guttural pressure, and then starts to creep up in the water, her butt beginning to rise to the surface. 

“Keep your butt in the water.” My voice is soft and gentle, but there’s no if in what I’m saying. 

She doesn’t open her eyes but her body relaxes a little.

“Ease into the water and push into your pain. You’re almost done!”

A few pushes and the baby begins to crown, head slowly emerges. Megan reaches in to get ready to help this mom bring her baby up. 

A snap back from primal incoherence to once again cognizant- she asks, “Will the baby drown?!” 

Her baby’s head is in between her legs, submerged under water. 

Simple reassurance: “Your baby is being born from water, to water.” 

Megan reminds her of the purpose of the umbilical cord- giving oxygen-rich blood to the baby throughout birth. 

I sit overseeing, sitting on my hands to not interfere or disturb unless I’m needed. The baby is born and Megan slowly brings the baby up. He goes straight to his mother’s arms, onto her chest. 

Silence. That’s what we hear. 

The baby doesn’t cry, yet the family rejoices. 


The baby has no clue he’s been born. His heart is excitedly beating. He’s breathing quietly. His lungs are clearing. He starts to open his eyes and looks at his momma. And yet he’s silent. 

A birth so gentle that the baby doesn’t even recognize that he is outside of his momma’s womb. Looking around, in awe of the world. 

Stop. It’s a science and an art. Imagine what would happen if you just stopped. And observed. And thought. 

We don’t wipe him off. 
We don’t routinely stimulate him. There’s no need. 
He’s kept warm by the warm water and his mother’s body. 
We don’t routinely suction him. There’s no need. 

That’s the beauty of midwifery. We are there, but not. There to support, there to safeguard, there to witness, there to intervene when it’s warranted and needed. 

The day before, another patient of ours had to deliver at the local hospital. She was abused, belittled, and threatened by the doctor. An episiotomy was pushed on her and she was told she was going to kill her baby for informly declining certain interventions. The stories aren’t mine to tell, but I will say this- we hear it time and time again, over and over and over. And yet, we are the crazy ones? 

I think to myself of this stark contrast, two different worlds that shouldn’t be so different.

How did we get here and why? 

How do we bring birth back to where it belongs and what it is suppose to be? 

One woman, one baby, and one birth at a time, just like this Birthday Birth. 

Tuesday, September 20, 2016

Moments of a Midwife

Water broke and hour 20 with no action. Tick tock, tick tock...if the damn clock was working, that's what it'd say. That's what is on everyone's mind, anyhow. They know what the birth center regulations say, and that hour 24 seems so near. Sent them to the mall for a walk, but they return with nothing to report. Smiles, yet underlying doubt and discouragement. My best midwife reassurance that there is still "plenty of time," and not to worry. Even if that midwife herself had doubts. An hour later and that 4th time momma labors hard, her first unmedicated birth. Sirens blazing outside in downtown Anchorage and roads surrounding us blocked off. A suspected bomb right down the road. Sirens, fireworks, people in the streets. I reminisce to myself, "This sounds like Haiti." Downtown Anchorage on a Saturday night. We ain't in Palmer anymore, Toto. 

Low quiet noises and that momma repeatedly apologizes for how loud she is being. This is a real-life lesson on our individual Reality and Perception...such a funny thing. Wanting a waterbirth and realizing it ain't for you. That's ok. Pushing past that pain, and a baby boy is born. 
Those parents thanking you for what you've given them, but you being thankful that there are families out there who give you the opportunity.

The very next day, in that very same room, within those 100 year old walls...

First time momma contracting every 2-3 and she means serious business. Partner like a deer in the headlights, looking at anyone, everyone, whoever for reassurance. Little does he know he is probably one of the best support I've ever seen. He asks the midwives, "Are you scared?" He's stone faced serious, but we laugh. I would hope the midwives aren't scared! A room full of strong women, supporting this first time momma. She doesn't bat an eye at the laughter and clatter in the room...she is what we call In The Zone. Mary is primarying- midwife speak for the person primarily responsible and catching the baby- she's front and center. I'm directly behind her on her left, but even more so her proverbial "Right Hand Man." The head comes out and Mary looks at me, and states matter-of-factly, so, so serious, "The.head.is.out." I'm not by any means normally witty- it's a characteristic I seem to have been born without- but it comes out without skipping a beat, "Thanks, I see that." We laugh at that she felt the need to state the obvious. We can pretty much read each others minds, so this makes it even more comical. A baby girl is born, welcomed into the world by the hands of a midwife that I trained, and the hands of her mother and father. The sun shines in through the window. It's 8:58 am and a beautiful Fall day in Alaska. 

I've been up for two days straight...but all I can think is...
This. Right. Here. 

Wednesday, July 13, 2016

50 Questions For Your Dr./Midwife When Planning a Birth Center Delivery

 At Integrated Women's Wellness & Center for Birth, we offer a monthly Birth Center Orientation class, to give new and potential clients the opportunity to learn about our free-standing birth center, the services we offer, and what to expect when you have a baby with us!

Here is a list of questions that might be helpful in interviewing or getting to know your doctor or midwife! 


1. What is your philosophy regarding pregnancy and birth? What is your role during the pregnancy and birth of your clients? 

2. How long have you been a midwife/doctor and how many births have you attended? 

3.  Have you ever had a mom or baby die under your care? (What is the maternal and infant mortality rate?) What was the situation? 

4. Who is on your birth team? How many midwives or obstetricians? Do you have students? Nurses? Medical Assistants? Who will attend my birth? Do I have a say in my birth team? Will I be certain to have you attend my birth? 

5. How many births do you attend per month? Do you have a cut-off for the amount of clients you accept? 

6. How many women are under the care of one midwife or doctor at a time? How much will you be with me throughout my labor? Will anyone else be providing care to me or supporting me during labor?

7. What happens if I go into labor at the same time as another mom? 

8. What does a typical prenatal appointment consist of? How often will I be seen? How long is each appointment? Who can be present for my appointments? 

9. How do I get in touch with you after hours? Can I call or email you with any questions? 

10. What are your thoughts on weight gain, nutrition, and supplements during pregnancy? Are you familiar with alternative and complementary therapies such as essential oils, homeopathy, acupuncture, massage therapy, chiropractic care, etc.? How, if at all, are these a part of your practice? 

11. What are some reasons, as well as the most common reasons, why a client "risks out" of your care? What can you do to help me avoid "risking out?"

12.  Do you offer childbirth classes? Any other educational offerings? What is the cost? 

13. What prenatal testing do you recommend and why? 

14. Do you recommend or offer GBS testing? If so, do you offer any treatment for GBS positive moms? What? 

15. Do you recommend ultrasounds? When, why? Who performs them? 

16. Do you typically do vaginal/cervical/pelvic exams prenatally? If so, when and why? 


17. What happens if I deliver early? How early can I be and still deliver with you? What happens if I go late? How late can I be and still deliver with you? 

18. What would happen if I had pre-term labor? What would happen if I went past my due date? What testing is available and when would it begin? 

19. Do you do vaginal exams during labor? If so, when and why? 

20. What type of monitoring do you do during labor? How often? For how long? What are you looking for and why?
21. Will I get an IV in labor? When would I need one? How often do you place IVs? 
22. What are my options for pain relief? 
23. Is waterbirth available? What percentage of the births you attend are waterbirths? 
24. Am I and the baby still able be monitored while I'm in the water? 
25. Are you comfortable working alongside others such as a doula or birth photographer? 
26. What kind of circumstances would you recommend induction for? Are you able to offer natural methods of induction? If I had to have a hospital induction, would you be with me? 
27. If my water breaks first, without me being in labor, how long do I have to get into active labor naturally? 
28. How long can my water be broken when I'm in labor? How long can I be in labor? 
29. Who attends births? (Other providers, apprentices, students, nurses, medical assistants?)
30. Do you ever artificially break water? Under what circumstances? How is this done? 
31. What is the percentage of moms who need to transport in labor to the hospital? What is the most common reason? What does that scenario look like? 

32. What is your episiotomy rate? 

33. What is your cesarean section rate? 

34. What is your postpartum infection rate? 

35. Can I eat and drink in labor? Do you provide food? 
36. What positions are an option during labor and birth? Would there be any restrictions on what I am able to do? 
37. What are the reasons why a transport to the hospital would be necessary? Which hospital do you use? Why? 

Postpartum & Newborn Care

38. Do you practice active management or expectant management of the 3rd stage, and why?
39. How long do you allow for the delivery of the placenta? Do you offer delayed cord clamping? If so, what is your definition of delayed cord clamping? Do you offer cord burning? Do you offer placental encapsulation, or can you refer me to someone who does? 
40. What if I tear and require stitches? Are you able to repair a laceration? What if I have an extensive tear such as a 3rd or 4th degree laceration? 
41. How long is the typical stay after birth? What is the soonest I can go home? What is the longest I can stay? What post-partum care do you provide? When? How many appointments?
42. What does newborn care consist of? When and where does this occur? Under what circumstances would my newborn need to be taken away from me?
43. Are you trained in and do you hold a current certification in Neonatal Resuscitation? Is everyone on your birth team trained and certified in neonatal resuscitation? 
44. Are you trained in and do you hold a current CPR or BLS certification? Is everyone on your birth team trained and certified in CPR/BLS? 
45. How often do you perform resuscitation efforts on a newborn? 
46. What resuscitation equipment do you have? 
47. What newborn testing and/or procedures do you recommend? What is available at the center? 
48. Are you comfortable with me declining any recommended testing or procedures? 
49. Do you offer breastfeeding support?
50. Do you offer continued care or support, beyond the first few weeks postpartum? 

Can you think of any thing else to add to this list when interviewing or getting to know your doctor or midwife? 

Thursday, October 1, 2015


Perhaps it can be said that the last birth Glen and I attended in Haiti was the perfect birth. Perhaps I shouldn't use the word "perfect." After all, I know as a midwife and as a woman that has given birth, the word 'perfect' in reference to birth is highly subjective...and sensitive.  It wasn't a glorious birth by our standards at home, by any means. If you've read even one other blog post regarding maternity care and birth in Haiti, you will understand this. A typical birth back home takes place in a pristine and beautiful birth room that is private, surrounded in candlelight, endless hot water, a walk-in glass shower, a deep soaker tub, clean instruments and supplies, and...just simply...Calm. Birth in Haiti is quite a different experience. When basic care and a trained birth attendant is the exception and not the norm, it puts all of the other "luxuries" into perspective.

There had been four women all nearing delivery. The mom who had induced an abortion had just delivered. I had just held her one pound baby girl in my hands, holding her as she took her first breath and holding her as she took her last breath. My heart was sad as I processed this. I retreated to the back storage room for a clean place to rest, where I sat and thought in the still quietness. Camille was not feeling well and needed to lay down and rest. As she laid the camping mat down on the storage room floor, she questioned the rat situation. I assured her that there were no rats on the inside of the Labor & Delivery unit. I had only ever seen them on the exterior corridor. I told her I would keep an eye out and let her know if I saw any though.

Awhile later, Glen had gone to make rounds on Labor & Delivery and listen to heart tones. After a bit, he hadn't returned, so I ventured out to see what he was up to. I won't ever forget what I saw and what he said. With hands on the belly of a laboring mom and a big grin on his face, he exclaimed, "Look Love, I'm a doula!" I think of it now, and I smile. The laboring woman wouldn't let him leave her. He had tried to walk away, and she had insisted that he stayed.

The needs of humans are actually quite simple, when you take away the materialistic possessions and perhaps more importantly, the ego. This woman simply needed a human presence; the comfort and touch of someone who cared. The fact that he was a male obstetrician, nearly from another world, made no difference. She was in need. She didn't want to be alone.

I walked over and relieved him of his new-found, slightly awkward doula duties. I placed my hands on her belly, and ever so gently, just touched her. Without hesitance, she grabbed my hands and put them exactly where she needed them to be, getting a reprieve from the pain, with my hands gently rubbing her belly as she had a contraction. As she progressed over the next hour, she would grab my hands and move them to her hips, then the small of her back, telling me with not a single spoken word, that she was having back labor. Occasionally she would look into my eyes and nod her head, as if saying to me, "Yes! That helps so much!"  Isn't it fascinating, certain situations in life where spoken words are irrelevant, when the most insightful, effective form of communication is simply through the eyes and subtle, unintentional body language? Two people, two strangers, connected only by the human experience...one in pain and afraid, the other simply having understanding and compassion, and their connection not extending beyond that simple awareness.

As we pushed with this woman- supporting and encouraging her in birthing her babe, I saw something out of the corner of my eye, running on the floor. "GAAAAHHH!" I nearly jumped 3 feet in the air, hardly an exaggeration. "GLEN! Do you see that?!" I pointed to the mouse that was now contently resting in the center of the L&D floor.

I thought of Camille, sleeping on the floor just a few feet away. "Should we wake Camille and tell her?"

We decided that it was just a mouse, not a rat, and well, I had told Camille that I would wake her if I saw a RAT. All about perspective, right? No need in waking her up unnecessarily. I got a little chuckle at that, but vowed that I would be keeping a good eye on the little guy, to ensure he didn't make his way to the storage room.

The birth would be what we might call "uneventful"...except for the obvious, of course- a child, as well as a mother, was born. As Camille and Sheily (our translator) rested, Glen and I would attend this birth together. We had a language barrier that made verbal communication nearly impossible between us and our patient (without our translator), but even without a language barrier, Glen and I needed just as few words between us. Perhaps that is a benefit of a husband-midwife team. We are confident in the each other's ability; we can read each other's minds simply with subtle looks or gestures.

I don't remember if the baby was a boy or a girl. I don't even remember which one of us "caught" the baby. I remember the calm. I remember the Haitian midwives quietly watching, the intact perineum, cleaning her up, placing the makeshift pad of folded cotton fabric between her legs, and helping her to slowly get dressed. There was no bed for her that night. Imagine that: a woman who just gave birth and yet there is no bed in the entire hospital for her to sleep with her new baby. In the wee hours of the morning- some time after midnight but yet still hours before dawn, freshly dressed and brand-new bundled up life in her arms, she shuffled herself to the entrance of the Labor & Delivery unit, laid down a sheet, and spent the first night with her baby on the cool concrete floor.

And yet, she was beaming with happiness and pride.

Friday, September 25, 2015

Blood, Sweat, & Tears...and Love

Often times in life, we are our biggest critic and our own greatest set-back, allowing idealistic perceptions define what is “good enough,” and inevitably, setting our very own limitations. One of my favorite quotes speaks to this thought- “If you limit your choice only to what seems possible or reasonable, you disconnect yourself from what you truly want, and all that is left is a compromise.” (Robert Fritz)

It is not just the rare occasion in which I feel inadequate myself...Am I good enough? Am I competent enough? Am I worthy enough? Does any of what I'm doing matter? I'm tired...I'm scared...I'm unsure. These are a fraction of my own internal limitations. It is a continual effort to remove my own limitations and push myself past these internal barriers. Yes I am good enough. Yes I am competent enough. Yes I am worthy enough. Yes, this matters.

Last night we arrived on the Labor & Delivery unit to a young woman writhing and moaning loudly in pain. She hardly looked pregnant. When I questioned the Haitian midwife on why the patient was there, I was told that the patient was “4 months” pregnant, and had fallen. As I spoke with the patient and took her vitals, I suspected that the patient may be lying about falling. She had no tenderness, no bruises or abrasions. Induced abortions with Cytotec here are rampant- Cytotec is inexpensive and easily obtainable. Whatever the cause- a fall or an intended abortion- the patient's cervix was dilating and she would no doubt be miscarrying. There was nothing we could do. Soon after our arrival, things became more intense, with it apparent that delivery was imminent. I looked to Glen and said, “I can't do this delivery. Will you please do it?” He asked me why and I answered honestly. “I'm scared. I've never seen or touched such an early baby.” I didn't know what to expect. I didn't know what this baby was going to look like. Would this baby come out intact? Damaged? Bloody, gory? I was afraid I did not know how to serve her well. I had no clue, and the unknown is frightening.

As we were expecting an imminent delivery, we would find out from the patient's family who accompanied her to the hospital that she had indeed taken Cytotec. The loss of this baby was intentional.

Around us, all Hell breaks loose. Four patients, all near delivery, are contained in a small room the size of my master bathroom at home. The walls contain the yelling, screaming, moaning, and shouts to Jesus. “Jesus, I am dying!” is exclaimed into the air.

The patient begins pushing and in two pushes, the baby's butt becomes visible, revealing to us that this baby is breech. Glen delivers the butt, legs, and abdomen, and as this limp baby girl hangs out of her mother, she suddenly wiggles and kicks fiercely. Glen and I both startle. Glen looks at me and states the obvious, “THIS BABY IS ALIVE.”

He delivers the baby's head, and places her in my blanketed hands. I gently place the baby on her mother's abdomen, gently wipe her dry, cradle her body in the blanket, and place my stethoscope over her. Her heart rate is strong and steady at 160 beats per minute, and she is making an effort to breathe.

Her heart pounding strongly.
My heart racing wildly.
I am dripping sweat and nauseous, my stomach contorted, feeling as if it is in my throat.
The stagnant air is relieved by a breeze coming through the window from the storm that is brewing outside.
“Camille, can you close the window? I don't want her to be cold.”
Camille closes the window.
Dripping sweat, my back is aching, I'm leaning over listening to the baby girl's heart beat.

I begin to cry and don't even try to refrain myself. Tears are streaming down my face; big fat tears fall to the already saturated, filthy floor beneath us, joining the mom's blood, sweat, urine, and every other patient's blood, sweat, urine, and vomit. This floor knows my sweat well, and now, my tears join it all. This, THIS, is the definition of Blood, Sweat, & Tears.

I am sweating and crying for this baby, and my heart aches so bad for this baby girl that it could bleed for her as well.

She wasn't just “4 months,” she was probably about 22-23 weeks...but she didn't even have a chance. Not here. I cried as I heard her heart beating because I knew I was the first to hear her heart, and I would also be the last. I cried because she was living. I cried because she was dying. I cried because there was nothing I could do. I cried because this didn't have to happen.

I looked to Glen, me having never done this before and not knowing what to expect. “How long will she live?” He says to me that it could be just a few minutes...or a couple hours.

I look into the mother's eyes and tell her that her baby has a heart beat, but will soon die. I ask her if I can hold the baby up on her chest, and wait. She nods yes. This is a big deal. I tell her that I will continue to listen to the baby's heart and will let her know when it stops beating. I ask her to look at her baby. I ask her to touch her baby. I tell her that I'm so, so, so very sorry. There is so much I could say, but right here, right now, it's not appropriate and it doesn't matter anyhow. I want to pray but my mind is not able to assemble any coherent thoughts. I simply say quietly, over and over, “Lord Jesus, please be with this baby; please be with this mother.” I know The Lord doesn't need my words. He knows my thoughts, and knows what is in my heart.

Slowly, the baby's heart would gradually slow...160...130...120...100...and finally, just simply stopped. Over the course of that baby's hour here on earth, she was against her mother, and in my hands, wrapped in not only a blanket from Alaska, but also wrapped in prayer. I said to the patient, “Your baby's heart has stopped.” She cried. I cried.

Eventually, after I had carried the baby away, I placed the baby on the scale, looked her over, and weighed her. I wrapped her gingerly in her blanket, and then placed her in the box that was given to me.

In the beginning, I doubted myself and my ability to do a good job and serve this mother and her baby well. I was fearful. I felt I lacked the “right” words. But in the end, my own expectations and self-imposed limitations didn't matter. In the end, I gave my blood, sweat, & tears...and love. That mattered.

I took my gloves off, washed my hands, and walked away.

Thursday, September 24, 2015

Reverence for Life

Before I write the story of the last shift, I want to first say this: There are many people who have read this blog and who have subsequently saturated us with thanks and praise, pouring us over with statements of what great things we are doing, how selfless this work is, and how we are doing such phenomenal things. While this praise does indeed lift us up and make us feel good, I want to acknowledge that we are doing nothing special, nothing requiring anything but a love and respect for life, and the heart to care. The word 'altruism' comes to mind, and there are times I wonder if true altruism exists. Don't we all do things for a purpose of our own heart and conscience? I cannot say that volunteering my time does not make me feel “good,” simply. That in itself is a selfish reason.

I've recently finished a book that was very insightful. It gives an understanding of early Haiti, how Haiti came to be the Haiti that it is. Mainly, it is the story of an ordinary man and woman, not much unlike you or me, detailing how these two individuals did extraordinary things in Haiti. This book I speak of is called Song of Haiti, which details the lives of Dr. Larimer and Gwen Mellon. The recurrent theme (and purpose of Larry Mellon and his philosophical mentor, Albert Schweitzer) speaks to what draws me to Haiti: “Reverence for Life.”

What is Reverence for Life? It is recognizing the value of all life, with the fundamental principle of morality being that good consists in maintaining, promoting, and enhancing life. I value my life. I value the life of my children. There is nothing more valuable to me than this. I see my own life and the life of my own children here. We are not so different. I value life and the right to live without pain and suffering- no matter in my own country, or half a world away. I it's because of this that I cannot have a skill that I can share and not share it, which I know will save lives and help to ease suffering.

A little girl at the feeding center

“The fundamental fact of human awareness is this: 'I am life that wills to live in the midst of life that wills to live.' A thinking man feels compelled to approach all life with the same reverence he has for his own.” -Albert Schweitzer

Our evening started off rather eventful, and not in the usual way. We rode to the hospital in the usual fashion, riding on the back of a moto. This is something that I fear dearly. The black and white logical thinker that I am, has mulled over many times the various ways that we could come into harm while in Haiti, and I've concluded that the moto is likely the #1 culprit for injury. Further add that we are most often on motos during dark hours- going to the hospital in the evenings after the sun has set, and returning in the morning, before the sun has fully risen. The darkness adds the factor of limited visibility, in addition to the dirt roads entrenched with large stones, rolling and bumping land, that further creates an unstable journey on two wheels. As we were riding to the hospital, I thought to myself, “I wonder if we are going faster each time, or if I am becoming more paranoid?” It was as if Glen read my mind because as soon as I finished my thought, he says out loud, “It seems like the moto drivers are going even faster than before!” Oh Lord, it wasn't just me. Not 1 minute after that, I look forward and see the single headlight of another moto coming straight at us, both us and him going full moto-speed, directly toward each other. I think, “Oh shit, we are going to die,” and instinctively yell out, “SHIT!” My hands fly up to grab the first thing they could grasp onto to brace myself- that being the drivers neck. As I yelled, “SHIT!” I felt my nails sink into the driver's skin. Thankfully both motos slammed on their brakes, bringing us to a halt right before collision. I am also thankful that SHIT wasn't my last word before I died. I apologized profusely to the moto driver, and even though he spoke no English, I am certain he got the gist of what I was trying to convey, as I tapped his neck and said repeatedly, “So sorry!!!!”

Our view from the back of a moto

Planting my feet firmly on the ground, I was relieved to get off the moto and walk the few hundred feet from the outside gates of the hospital compound, to the entrance of the Maternity Ward. As we walked through the hospital grounds, the sky above was thundering and rain started to fall down on us. I stopped just before the metal gate entrance to the ward, and stood there under the falling water. Even in the dark night with a deep blanket of clouds above, the air here remains thick. The cool rain felt good.

We began our night by making rounds on the antepartum, postpartum, and post-op units. These are each one room units, lined with beds on both sides of the room, each bed numbered on the wall above. The first patients we see is a mom and baby. The baby is about a week old and is being watched for a low-grade fever. The first observation is that the baby is swaddled up tightly with a thick winter blanket. It is hot as hell in here, and no one should be using a blanket, baby included. I have no doubt this is likely contributing to her low-grade fever. We take her vitals and do a full assessment. I see that the baby's diaper is full, and note that it is soft, yellow stool. Just as it should be. I help Grandma change the baby's diaper and discover that this baby girl dressed in all pink, actually has a penis. I laugh at my own assumption, because really, using whatever clothing you have is simply practical.

As we are doing our rounds, one of our favorite Haitian midwives Carmell says to us, “I will let you know if we have anyone in labor come in. I know you like to do deliveries!” I smile at that. I know she likes the help, and she is right- I do like birth.

At 9:50pm I catch a baby- a normal vaginal delivery, a healthy mom and healthy baby. As I am finishing up and helping the new mom get cleaned up, Glen listens to heart tones on another patient who is being induced with misoprostol due to severe hypertension. This mom looks terrible and seems to be very sick. Her whole body is extremely swollen, tight from the fluid that is collected in her body. Her face is so swollen that even her eyelids are puffy. I am certain she is nearly unrecognizable from what she normally looks like. Just looking at the woman is a reminder that hypertension in pregnancy is no joke. It may cost this woman her life, or her baby's life. Glen puts the doppler on and we hear clunk.........clunk..........clunk......................clunk. The baby's heart rate is in the 80s and stays there. They reposition her and continue to monitor baby. There's no oxygen available. The baby continues there, sometimes skipping beats. With this mother's hypertension and severe symptoms, along with misoprostol induction, there is no doubt that this baby has little reserve. Glen checks her to see if we are close to delivery and can somehow expedite it. She's only 3 cm. We know that this baby is not going to tolerate labor much longer. He calls a c-section. It's 9:55pm. The Haitian midwives call the Haitian OB. He's busy and can't come. He says that Glen needs to do the c-section. The midwives hang up and jump into action. Within mere minutes, a foley catheter has been placed and the patient is prepped for surgery. Honestly, I'm dumbfounded. I have never seen anything happen so fast in Haiti. There is true urgency in the room, and I have never before witnessed this in Haitian culture. Maybe I'm naïve, but this is my honest observation. Glen tries to listen to the baby again and can't find heart tones again. Is it because of a positional issue or have we lost the baby? We are all wondering the same thing. He continues to try, and nothing is heard. The clock is ticking...ticking...ticking...we wait and the minutes pass by. The Haitian OB who they previously called cannot get a hold of the anesthesiologist, and neither can they. She isn't answering her phone. Glen can't do a c-section without anesthesia. Tick...tick...tick...the minutes are ticking by, and this baby is dying with each tick. Finally, an ambulance arrives to the hospital, and in the ambulance emerges not a patient, but the anesthesiologist and a scrub tech. How interesting that the ambulance brought them to us. As we would find out, this crew is Cuban and only speaks Spanish.

So there they went, an Anesthesiologist and scrub tech who only speak Spanish, an OB and RN who only speak English, and a Haitian O.R. assistant who only speaks Creole. As Glen leaves he shakes his head and tells us that it is inevitably too late. There is no way this baby is still alive. My chest is heavy as I think that we listened to that baby's heart slow down as it gradually stopped beating altogether. I walk to the storage closet, to where Shelly was, and I ask her (as if she were more insightful than I was on the matter), “Do you think the baby is still alive???” I feel as if I am grasping at straws, wanting some reassurance that this little life is still in existence, that we even have a chance. Not just the he or she has a chance, but that yes, WE, have a chance. This life is valued. This life matters. I don't know the swollen face of the mother from any other random face of the day, and I might never know her baby, but in these fleeting minutes, tick, tick, ticking away, there is Reverence for Life.

Shelly looked at me and answered my question. “I don't know...probably not. But I hope so.”

I would walk away to another mom laying on an exam table who was pushing. I would do this delivery by myself, as Glen and Camille were likely just beginning the c-section. I couldn't help but to think that as one life blazed into the world screaming, one life was ending, coming into the world silent. That is a profound feeling. As Glen and Camille would later tell me, Glen would lift the blue, lifeless baby boy from his mom, hand him to Camille. He was certain this was a lifeless baby he was handing over, and contemplated this as he sutured this mom's very sick body back together.

I had just finished with this mom when Camille entered the room with the tiny bundle in her arms, pressed against her body. I heard her say my name, “Tara.” She called it out firmly, not exclaiming but still, making a statement.

I knew when I heard her that the baby was alive. I asked her, “Is the baby breathing?” The baby was trying to breathe, though not very effectively. The conversation between Camille and I is a blur. I took Camille's stethoscope and placed it over the baby's heart and was surprised to hear a heart galloping away; 140 beats per minute. A couple breathes of PPV and some stimulation and this baby was breathing on his own. My fingers remember what that limp body felt like under my fingers. This baby was not even two pounds. So delicate, so frail. We wrapped up this tiny, flopping body who was now making an effort to breathe, and carried him down the hall to the NICU. A pulse ox was placed and showed that his heart rate was 160 bpm and oxygen saturation was 87%. Astounding. We would leave the baby there, under the care of the NICU team. We walked away having done what we could, leaving him in the care of others who will hopefully do what the can.

Meanwhile, we do an intake assessment on a young and very tiny mom whose water has broken. She is a first time mom, looks to be about 100 pounds, and is about 28 weeks pregnant. There is amniotic fluid everywhere- the exam table is drenched, and as Camille and I speak to her, our shoes are in a sea of in her amniotic fluid. She lays on the exam table, without underwear, her legs spread. Her vulva and legs are dripping with fluid, smeared with mucous and blood. I place my hands on her belly, and see that her abdomen hardly looks pregnant. The untrained eye would likely not suspect this naked abdomen to be a pregnant belly. My sweaty, gloved hands could hardly palpate a baby. Her muscles were taut and solid, her skin and muscles from not having held a baby before. Her vitals were normal and her baby sounded fine. She was not contracting. The Haitian midwife had already completed a vaginal exam and said she was 1cm dilated. I went over to the Haitian midwife and asked if we were staring steroids, to help mature the baby's lungs. She shook her head no. I asked why. She said because the patient was already dilated and it was too late, steroids would not be useful. I felt the need to clarify how dilated this mom was, and asked again. She said 1cm. I had so much to say but recalled a good piece of advice that I had just read in the Midwives for Haiti volunteer manual...the best place for questioning something and to correct or teach, isn't in real time, in the clinical setting. This is, after all, their territory, we are just here to help, and teach by example, or when otherwise appropriate. I walked to the back room where Glen was and explained the situation. He agreed that the mom should get steroids and antibiotics. I asked Shelly how I might say this, to let the midwife know, “This is what we would do at home...” Shelly ended up doing a great job with translating this, and in the end, the midwife was very receptive to it, asked Glen the appropriate medicine and dose, and then said she would do it. [The next day we would find out that this mom would subsequently deliver her 28 week breech baby into the hands of another midwife volunteer with Midwives for Haiti. No one knew if the baby was dead or alive, and when the baby's legs were delivered. Jamie was surprised when they started to move. As I write this, the baby is alive and well in the NICU. I hope those steroids got to where they needed to go.]

We would have another delivery later in the night, and this one wouldn't be easy on use either. I wouldn't have expected anything less. The Haitian midwives were taking care of a mom in labor. I had previously told them to just let us know what we could do to help, that we were available if need be. While pushing with the mom, the midwife heard that the baby's heart rate was having decelerations. It would go from 140 to 80...70...and then slowly recover back to baseline. That's not something that we don't sometimes see. Except then she noticed that the baby began to have repetitive decels that were taking longer and longer to recover, now staying a good bit of time in the 70s and then not recovering. She asked for “Dr. Glen” to come help. At this point we were seeing baby's head at the peak of the push, but not crowning. The Haitian midwife asks if Glen can do an episiotomy, but he explains that this will be useless because the baby isn't to the perineum yet. The midwife nods in undertsanding. I see her contemplating something, and as I open my mouth to offer a suggestion, she says the same thing, but in Creole. “What about a vacuum,” we both ask? Glen looks surprised and says, “Oh, do we even HAVE a vacuum?” Why yes, yes we do. I had seen them in the storage closet. He says ok, and a vacuum is retrieved. He puts it on, mom pushes, and he assists her pushing with the traction of the vacuum. A baby girl is born, screaming.

All in all, a busy two days...reminding us and revealing to us in new ways, how delicately precious life is.