A small, 10x10 NICU room has been my 2nd home for nearly the past 3 weeks. This is my view from the vantage point of the rocker recliner, as I rock, feed, love on, and cuddle our foster baby.
Not pictured: lots of wires, a monitor that incessantly beeps, alarms that ding, an uncomfortable vinyl sofa, and a thermostat that doesn’t actually control the temperature in the room. ❄️ There are medications every 3 hours and feeding times that feel like they come so soon after the last one. I’m both bored and I’m busy at the same time.
I sat with one of the Neonatal Nurse Practitioners this morning and talked about what the plan will be for the next few days. I struggle with feeling as though I have no place to ask too many questions, make suggestions, or express my opinion and desires. This is nothing that anyone at the hospital has put on me- this is my own insecurity and fear of judgement. Like, “Who is she and what does she know?” But I know if this were my own child, I would feel differently.
I choked back the tears as we talked this morning.
They tell me he’s a different baby when I’m not there.
I was staying with him during the daytime but yet he was struggling with nights. Then I began staying the night with him, and now he has good nights but struggles during the day.
During the day, the nurses tend to his needs, cuddle him, love on him, and even take him for stroller rides. (They are seriously so amazing.)
But here’s the thing- out of all of the awesome care providers he has and the people in his life, there has been and is only one constant. That’s me.
I’m not his blood. I can’t honestly even say I love him like a mother loves her child (yet), but what I can say and do feel is that I’m committed to him. I love him for the human being that he is. From the moment I said, “Yes” to the phone call, I was committed. It’s how I do things- all in or not at all.
And that’s the thing about attachment. It’s not defined by or limited to biology.
When people say they could never be foster parents because they’d get too attached, I understand what they are trying to say. I do. They’re saying it would be hard. They are saying it would hurt. I believe it. I can see that now. But, that’s the point of fostering.
The most significant relationship in a child’s life is the attachment to their primary caregiver- biologically connected, or not. Attachment and connection are so vital to brain development, emotional regulation, and our ability to form and maintain relationships.
If you foster- or parent- or live- without attachment, you’re missing the whole point. We can have all of the basic necessities, but if we lack love and attachment as children, our ability to feel secure, to be able to express emotion, to adjust, and to form meaningful relationships, will suffer for the rest of our lives.
Even in 3 short weeks, we can look to this little guy and see the power of attachment.
I shared my thoughts this morning- It’s my belief this baby needs to be home. We need to be home. It’s time. Very soon the morphine will be stopped, and once it’s stopped, the clock will start a 72 hour countdown. That 72 hours will be a test to see how he does without the morphine and assure us that he can be at home. It’s not uncommon for a baby to need to be “rescued” by being given a “rescue dose” of morphine, when withdrawal symptoms get to be too much. The downfall is that if a rescue dose is given, the 72 hours starts all over.
The prayers we have been covered with are so appreciated! It’s my prayer that this will not be our view for much longer!
💙
Wednesday, July 11, 2018
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.
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.
<3
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.
<3
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.
Why?
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.
Thursday, October 1, 2015
Perspective
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.
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.
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.”
![]() |
| A little girl at the feeding center |
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!!!!”
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.
Tuesday, September 22, 2015
A Pot to Piss In...and So Much More
Welcome everyone. If it doesn't become obvious momentarily, I (Glen) have been handed the reigns for today's blog. Thankfully, I have had a bit of help with the editing to give it a bit more of a writer's flare. Never fear, I'll make sure Tara picks back up tomorrow!
I'm glad our first day started off so
quickly- it gave Camille a taste of what it could be like. But, this
last shift would allow us to sit back and take it all in...and that
might not be all good. We started the day off nice and slow, such a
difference from yesterday, when we literally walked into two
simultaneous deliveries. This shift, we were able to help take care
of some of the tasks of a busy ward. Tara and Camille set off with
our translator to do vitals. Certainly an eclectic mix of
antepartum, postpartum, and post-op moms to be seen. One of the most
interesting was a mom admitted from mobile clinic for suspected early
labor. (Because she lives so far away, she may end up staying there
until she delivers.) On exam, Tara noticed something odd about her
lower belly. It was obvious she was pregnant, but her bladder was so
protruding that it was noticeable with her laying on her back. Tara
expressed concern to me; dare I admit Tara's perplexed concern was
somewhat comical. She wasn't quite sure what the problem was, as I
don't think she had ever seen a bladder so obviously distended. Upon
questioning, the patient stated that she did not feel the need to
urinate. Tara palpated her abdomen and felt her bladder. The patient
didn't flinch, and appeared to not have any discomfort. Clearly
though, she had to pee. But where? In what? There are no restroom
facilities anywhere. Remember the saying your mom always used to
say...'she ain't got a pot to piss in.' I laugh at this...perhaps
that was just MY mom, growing up in rural Kentucky. But, I
remember hearing it and it never was quite as vivid as here. We found
her 'pot,' which was a large bucket that the family had brought with
them. Camille held it under the mom as she stood at the side of her
bed (not 2 feet from a postpartum mom and baby couplet) and peed.
Nearly filled the bucket. You look around and everyone has their pot
to piss in...well, everyone except the birth team. Thankfully Tara
and Camille somehow have the capacity to hold their bladders for 12
hours. But...that's a different story.
Just when you think that we have
everything, or that you can do anything, you're thrown a curveball.
Dr. Celestin had apparently seen this young, first-time mom in his
outside office and sent her to L&D to get a D&C due to a
miscarriage that had not passed. This patient had had consistent
bleeding for 8 days that was not slowing down. D&Cs aren't the
most glamorous procedures to do here as they are typically done
without much in the way of anesthesia and such an invasive procedure
which is normally (back home) done in private, is done here in plain view of everyone. Tonight would be no different, except for one
twist. As I'm preparing myself for the procedure, I go to the stand
beside the patient and look over my instruments. I expect to see all
the usual: speculum, tenaculum, dilators, and a currette. Instead, I
see no currette and a plastic iPas device. I've seen this manual
suction device before, even thought of buying one for use in the
office for miscarriages, but this is not my typical go-to device.
And here it is in front of me.Thankfully, it wasn't very difficult
and all things considered, the D&C went pretty well. Tara stood
by the patient's side, holding her hand and caressing her face to
help her relax through it, while Camille assisted with holding a leg.
One of the Haitian midwives oversaw, and hopefully now could use the
iPas device, should she need to. The best part for me was that at the
end, the patient looked to Tara, took her hand, and said (in clear
English), “Thank You,” for helping get her through it.
| Something is brewing in those clouds |
It's never fails to amaze me that women
come and go in Labor and Delivery here. Somehow, the midwives keep
all of these women straight. One such woman had apparently been
there all day. When I asked what her status was, the midwife says,
'Dr. Celestin is coming in to section her at some point.' “Why,”
I ask? “Transverse lie and her water is broken.”
I decided to examine the mom myself
and confirm that the baby is now vertex! The baby is “Cephalique”
and shouldn't need a cesarean section. A few hours later, Dr.
Celestin comes in and does a vaginal exam and doesn't feel a
presenting part and finds the head is the right lower quadrant.
In our discussion about abnormal lie
(breech, transverse), I ask if anyone there does versions. A
'version' is a procedure where a baby is manually turned to get it to
head down. A fairly common procedure in the states, but not here. I
ask why they don't at least try- certainly an attempted version is
safer than a potential cesarean section- and am told by Dr Jean
Baptiste that they learned in training that versions will cause the
placenta to pull away and harm the baby. This just goes to show that
you just never know what is common sense and commonplace in one
place, may be literally a foreign concept somewhere else.
Eventually, we take the patient back
for section. Dr. Celestin jokes in Kreyol that I am the primary and
HE will be assisting me. Apparently, not only am I the primary
surgeon, but the scrub tech as well. I stock the Mayo stand, prep
and drape the patient. Everything, except the sharps, eventually
winds up between the mom's legs...placenta, retractors, scissors,
blood clots...everything. It isn't exactly the prettiest, but it did
get the job done. Camille would join Dr. Celestin and I for the
cesarean and be responsible for the baby. After delivery, Camille
would take the baby to Tara, who was awaiting in Labor &
Delivery. I can't say that the protocol for having an assistant in
charge of baby's care has been implemented, but as Tara reminded me,
we did get to model this. An assigned care
provider for baby to company during the surgery, and someone waiting,
prepared to assist with care on the ward.
| Preparation for the c-section baby |
As our 4 year old Adria would say, this
baby was a 'fat man' (this is her term of endearment for Callen), at
a whopping 8lb 13 oz. Except, apparently it is a curse in Haiti to
call a baby 'fat' because those 'fat' babies will then lose weight
and not thrive or do well. In doing postpartum rounds, Tara proudly
exclaimed, “The baby is so fat!” Our translator had to inform her
that she should not say this, since it is not a good thing for he
family to be told. Lesson learned regarding the importance of cultural appropriateness. No “fat garcon” or “fat
tifi” here!
One of the things about birth that we
take for granted back home is that women, and our culture as a whole,
value and celebrate the 'birth experience' when the baby is born. It
has been my experience that moms and dads often cry when their new
baby is born. Emotions are abundant with birth in our own culture.
However, birth is not typically a time when Haitian women express
emotion. Nor are babies often named at birth. We often get asked
regarding this by friends, why it seems as though Haitians seem
irreverent during birth. While it may appear this way superficially
without understanding Haitian culture, we slowly understand that this
is not the case. At the very basis, we need to consider and remember
that if a baby is born alive, BIRTH is the first of many hurdles that
the baby has to cross to get to adulthood. Enough babies die after
birth that it seems recognized that the newborn's life may be
short-lived.
| A baby girl we assisted with...photo with permission. |
| 2 kilo budle of love |
| #clothdiapering |
I will admit that I was once perplexed
over a total lack of emotion in Haitian people, in birth and in
death. But last night changed that. In the overall quietness of the
night, a spontaneous commotion erupted within the hospital compound.
A woman sprung from the dark, exclaiming, yelping, and wailing,
making us question whether she was having a mental breakdown. The
exterior hallways within the hospital are as pitch black as the night
sky, making visibility in trying to visualize the happenings hardly
possibility. In the wee hours of the morning, with wards overflowing
with admitted patients and no where but the outside for some patients
and their families to sleep, the halls are lined with sleeping
bodies. The shrill hysteric outcries of this woman startled all of
these slumbered bodies, resulting in a scattering of the people that
laid surrounding her. What is going on? What is happening? I am sure
these were the questions in everyone's mind, us and Haitian alike.
The woman's hysterical screams and outcries continue, as random
voices yell to her in the dark. Though we had no idea the specifics
of the situation, it was obvious that this woman was grieving. One
thing is certain, the translation of loss and grief transcends
cultural and language differences. As we would learn from our
translator, someone had just died in the ICU. The yelling sounded
despaired and grieved, and that it was. This was the first overt
display of emotion that I had witnessed in Haiti. Through the pain of
labor, the separation of family, the death of a child, nothing we had
previously seen provided a glimpse into one's personal feelings of
their pain and suffering.
As those of this blog would know,
hypertension in Haiti has been rampant in our previous trips. As we
take vitals in labor I'm amazed that more often than not, the women
have had normal blood pressures. Obviously there has not been a
dramatic change in diet, but perhaps an increase in prenatal and
intrapartum care availability? This of course is anecdotal... I don't
know the answer, but it is very apparent that something is changing.
| Sunrise behind the Midwives for Haiti compound. |
Monday, September 21, 2015
Haiti 2015: Day 1 & 2
We arrived into Port-Au-Prince on Saturday afternoon and made the long, winding journey to Hinche by way of the Midwives for Haiti Land Cruiser. I will admit that I was a bit excited about the travel accomodations, as we have always received transportation in the classic, "Pink Jeep." The enclosed air conditioned vehicle was a welcome repreive from our 20 hours of travel from Alaska, and especially knowing how I get with motion sickness. We would, however, find out that the air conditioner isn't functional. Ha! We packed into the back of the Land Cruiser and within about 20 minutes the first passenger was feeling sick. Thankfully, it wasn't me (yet). I got out the peppermint oil from my purse and Glen got out a rag, which we wet and put on the back of the other volunteer's neck. The rest of us rubbed peppermint on the backs of our necks to help us cool down. The cooling sensation felt amazing in the dense heat we were sitting in. Of course not long after that, I was the next victim of the trecherous journey. The constant swerves, bumps, and horns ablaze from other vehicles flashing by was taxing on my senses and internal stamina. I quickly turned 'green,' earning myself a front seat accomodation, right alongside our driver. I laid back in my seat, splashed water on my face, closed my eyes, and let the wind blow in my face. 2 1/2 hours from that point, we had made it safely to Hinche, and I had made it without vomitting...as did Lea, my partner in sickness
Sunday was our first full day here, and the beginning of a night shift at St. Therese. A group of us rode on motos into town and attended church service.
![]() |
| Volunteers Lea and Shelly |
After church Glen and Camille (our clinic RN back at home, who joined us this trip) took a tour of Hinche. I stayed behind to rest and gear up for night shift. Camille would return, slightly aghast, telling stories of the food she saw in the open market- fruits, meats, fish, all swarming with flies. She held serious concern for Glen, and made sure to report back that he had been eating these items, without concern for what might subsequently happen from ingesting flies and larvae. Glen assured us that it was delicious and he was fine. 20 minutes later I was downstairs eating a late lunch and Camille came flying into the dining area, wide-eyed, as if she had just seen a ghost. She said to me, very much an exclamation rather than a question (because she already knew the answer), "Tara! WHERE IS DR. ELROD!?" (It's funny to me that more times than not, she still refers to him as 'Doctor Elrod,' rather than Glen.)
Amusingly, I had already heard him from downstairs and knew exactly where he was. He is, afterall, the world's loudest puker. I responded with, "Oh, he's upstairs puking." Camille's eyes were as wide as saucers, and just like that, it pretty much validated Camille's hesitance to consume anything out of the ordinary. But don't worry about Glen...it was delicious...and he's fine. ;-)
| Glen trying some dried herring in the marketplace. |
We arrived to the hospital shortly after 7:00pm, and within minutes had assisted with two deliveries. The first baby the Haitian midwife delivered, Camille and I would assist, and Glen would subsequently suture the mom's laceration. Camille helped to stimulate the baby and I tied the cord with string. Camille would do the newborn exam and dress the baby, all while Glen and I pushed with the mom 5 feet in front of the first mom who delivered. As Camille was doing the newborn exam, she noticed that it was oozing and had to re-tie it, tighter than what I had tied. Good catch, Camille.
The postpartum mom would lay there on her own delivery table, legs sprawled and perineum torn, raw from just having given birth, quitely observing the other woman preparing to do the same. I stepped over to her and made sure she understood, "We don't want to start to suture you right now, so that we are prepared for this baby. As soon as this baby is born, we will get you sutured and dressed." She smiled and nodded, appreciating the explanation. Camille took her vitals and tended to the baby while Glen and I assisted the other mom. The Haitian midwife charted, and attended to the other packed room of laboring women.
![]() |
| Camille and a new Haitian life |
![]() |
| A healthy baby girl |
The mom who was pushing had fetal heart tones in the 60s, telling us that baby was not doing well. Glen ruptured the bag of water (and as amnihooks are a luxury, the tool that the Haitian's use to AROM (artificial rupture of membranes) is a needle or the back of the needle cap). The Haitian midwife, Carmelle, joined us in telling the patient to push as hard as she could. "PUSH HARD! KEEP PUSHING, GO ON, PUSH! YES, JUST LIKE THAT...KEEP GOING...GO, GO, GO...PUSH!" These were the sounds now coming from the Maternity Ward. A 2.9 kg baby boy was born, needing stimulation and a couple cuffs of PPV. Mom was expecting a girl and had only brought a girl outfit to put baby in. Not that it would have been the end of the world to dress him up in a pink outfit, but I thought it a better idea to use a baby gift pack. This particular mom had brought a cloth pad but did not have any underwear to put that pad in and keep it in place. I was wishing I had thought to bring a stash of underwear. I think that would be a great addition to our packs next time.
After these two deliveries, we realized that there were no more syringes for Pitocin or Lidocaine, as well as no more Vitamin K. We searched everywhere, and ended up having to resort to putting Pitocin in the 1mL syringes that are typically used for Vitamin K.
7 hours into our shift and it was a bit quiet, with 4 babies delivered and no one imminitently delivering. We all retreated to the storage room, which also doubles as a break room for the midwives and volunteers. We intermittently talked, rested, and checked on the women who remained in Labor & Delivery. Over the course of the night we participated in 4 deliveries, with the Haitian midwife doing another delivery as we rested.
As an outsider coming to Haiti, it is so easy to feel sadness, despair, frustration, and helplessness. Nights like tonight are a welcomed blessing, showing us the good, the life, the hope...A competent and compassionate skilled birth attendant that is the product of Midwives for Haiti. Healthy, term babies. Perhaps it was a smooth initiation to preserve Camille. Either way, it was good to see the good.
In my time here and life since my first trip to Haiti, it seems that the feelings of sadness, despair, frustration, and helplessness are necessary: they are catalysts for change, afterall. Can you imagine a world in which we turn a blind eye and guarded heart to the pain and suffering that exists? Just because it is not happening where we are, does not mean it is not happening. I type that from my laptop and you read that from your computer screen or iphone. Human pain and suffering can be mentally comprehended, but to really GET IT, and act on it...that's a different challenge. More on that later.
Until next time...
Tara
Saturday, August 1, 2015
Haiti 2015: How Can You Help?
Glen and I will be leaving for Haiti in 7 short weeks, and are in need of your support! Our trip to Haiti is one we look forward to but seems to financially add up so quickly for us...the snacks, medical supplies, airfare, the cost of checking our baggage and the cost of volunteer accommodations with Midwives for Haiti. It is something we are able to do, but not without challenge.
So we ask...
Are you able to help? In the next few weeks we will have various ways we will ask for your help and support.
One of my favorite gifts to take to Haiti has become what I call "Newborn Gift Packs." The packs are ziplock freezer bags which typically consist of a newborn onesie, pair of socks, hat, light blanket, cloth diaper, and cloth pad for Mom. (Note: The cloth diaper and cloth pad do not need to be anything expensive, but even just a thick, absorbent fabric such as cotton or flannel.)
These gift packs have been handed out at mobile clinics throughout Haiti as a way to encourage moms to keep returning for prenatal care. Glen and I have also kept some on hand when we work shifts at the hospital. Inevitably, there are moms who have no clean sheet to deliver on, nor anything for their new babies.
These gift packs have been handed out at mobile clinics throughout Haiti as a way to encourage moms to keep returning for prenatal care. Glen and I have also kept some on hand when we work shifts at the hospital. Inevitably, there are moms who have no clean sheet to deliver on, nor anything for their new babies.
If you are interested in making some "Newborn Gift Packs," please message me. We will be collecting them, as well as additional supplies, up until September 16th.
Items do not need to be brand new, but simply in clean, like-new condition.
If you are interested in purchasing clothing items to be put into gift packs, all L'oved Baby clothing items which are purchased for this cause will be 50% off at Betula Baby (the baby boutique located inside Integrated Women's Wellness & Center for Birth). Simply let us know that your purchase will be donated to our Haiti 2015 trip, and all clothing items purchased for the trip will be 50% off. This would be a great and EASY way to help. If you do not have supplies or the time to put together gift packs, you can purchase items from Betula Baby that we will then put into gift packs and take with us to Haiti.
Thank you, for whatever support you can give!
[Be sure to follow along our journey by checking the blog, our facebook pages, and @tara_elrod and @thecenterforbirth on Instagram.]
[Be sure to follow along our journey by checking the blog, our facebook pages, and @tara_elrod and @thecenterforbirth on Instagram.]
Subscribe to:
Posts (Atom)













