The Birth of Callen Grey

Birth for me is very vulnerable...though, vulnerable not in the sense of being broken down and susceptible, exposed and weak (because in labor and birth I know and feel I am anything but these things). Birth for me is feeling vulnerable to the world...vulnerable in cognizance and coherence of how fragile life is, how powerful yet also how delicate the body is, and, perhaps the most physically, emotionally, and mentally possessive- the awareness of how very little control we truly have.

I knew going into this birth that my support people mattered very much to me. I knew I likely wouldn't need much from them, only their presence and perhaps reassuring words, but that these two things mattered greatly to me. We planned to have our midwife, Peggy, our doula, Mary (who is also our student midwife that works alongside us), and my cousin, Melissa, as support.

Melissa flew in from California and planned to stay two weeks. When she arrived I was 39+2 weeks. Having had Aubrey at 38 weeks, Ethan at 39, and Adria at 40+4, the running joke was that I would likely continue this trend and go slightly longer with this pregnancy. Of course, labor and birth are unpredictable, so we surely didn't know for certain. Just over 39 weeks seemed like a safe time for her to arrive- unlikely that I would deliver before then, and unlikely that two weeks later- at 41+2 weeks- I would still be pregnant.

No surprise to any though, my due date came and went...and the days ticked by, with Melissa and Glen getting more anxious. I felt so good and so not as if my body were ready (literally no signs of anything), I began wondering if my dates were correct. Ha! Perhaps a bit of "nearing-41-week-denial!"

On the Sunday before 41 weeks (40+6) we awoke to a beautiful day. The air was cool with just a slight Autumn crisp to it, the sky was a perfect blue and sparred of the presence of even the slightest speckle of cloud. This beautiful day could not go unused- and so we set off for a day trip to Talkeetna.

We ate at the local brewery, perused the small, eclectic gift shops, and made our way to the river bank, where Denali was clearly exposed, in all her glory. There remained not a cloud in the sky, and both Glen and I repeatedly marveled and remarked at how we had never before seen Denali so clear and unobscured. Even with our repetitious awe, I am not quite sure Melissa understood what a rare presence we had. The world around us was glorious.

As the next day I would officially be 41 weeks, on the way home from Talkeetna we stopped at the office and did an NST and an AFI. All was well. With Melissa set to leave on Wednesday, both her and Glen were getting anxious. But, it was what it was- I felt great, and baby was active and still doing well.

The next day, we met with our midwife, Peggy, for a prenatal appointment. I am not one for vaginal exams (and am quite a baby when it comes to them, apparently), but I felt it wouldn't be unreasonable to have Peggy check me, and if possible, "strip my membranes" to see if it  would help to get things going. She checked me at the end of our appointment and I was 3cm, 50% effaced, and -2 station. She was able to strip my membranes and then left, knowing that she might be hearing from me later that night. Or...it could do nothing.

The kids went to bed, and then Melissa went to bed...both not without being adamant that I was to wake them up should anything start happening.

10:30pm and my contractions were regular but not very close together. As I would advise any of my own patients to do- I ignored them as best as I could and didn't time them. If I had to guess, I would say they were about 10 minutes apart. Glen and I laid there for nearly 2 hours- just together in the quiet, dark room, side-lying together with him holding me from behind. I remember whispering to him how much I liked laboring with him, quietly, just the two of us. No fuss, no noise, just us.

A little after midnight, I needed a change of position. The contractions still were spaced out but when they were happening, they were much stronger. I got in the shower for a bit. Not long after that, at about 12:30am, I told Glen that though it might be on the early side, he should text Mary (our doula) and tell her to head over. She too had been adamant about me not waiting until the last minute to call her (for fear that she would miss the birth), and so I was taking this into consideration. It dawned on me that we hadn't even mentioned to Peggy that I was in labor. I all of a sudden had my midwife hat on, thinking of how much I would not like it if a patient of mine was in communication with her birth team but not keeping me in the loop as well. I verbalized this to Glen and told him he should text Peggy and tell her that maybe she should head over too. I then changed my mind and said nevermind- I didn't want her to come over and just be sitting at the house for hours. "Maybe you should check me first." He had already sent her a text by this point but went ahead and checked me. I was 5cm, 90% effaced, and 0 station. "It's too early to have her come. Tell her nevermind, we'll call her when I'm closer." He went to tell her nevermind but she was already on her way. "Ok," I said, "Then she can just get comfortable on the couch and get some sleep until I'm further along." I was so worried about her being here for hours and hours unnecessarily. I felt bad thinking that she would be at our house for hours in the middle of the night.

Mary arrived, Peggy arrived, and we let Melissa get her beauty rest. I got out of the shower and went downstairs to walk around. My contractions were still quite spaced apart, but again, when they happened, they were certainly getting my attention. Peggy sat on the living room sofa and I walked around the kitchen island, taking big, wide steps and swaying my hips. Eventually my feet were hurting from standing in the shower and the numerous kitchen island laps. I told Peggy and Mary, "I don't know what I should do- keep moving to get these contractions going, or go lay down and rest." Mary started laughing and said, "I know what you would tell a patient." "Yeah? What's that," I asked? "Keep moving," she said! "Nah...I think I would say 'listen to your body.'" With that, I decided to go upstairs to rest. Laying down wasn't an option, so I sat on the birth ball and leaned over on pillows on the bed, as Mary rubbed my back. Glen laid a couple feet away on his side of the bed still sleeping. Eventually I became less aware of his obnoxious snoring and began to float in and out of sleep as Mary caressed my back. There was no sense of time for how long I stayed that way, but 30 minutes would be my guess. My contractions did indeed pick up, now feeling as if they were 2 minutes apart. The next memory I have is the shower being turned on for me and me now on my hands and knees, beside my bed. Mary walks in and asks loudly, "Are you having ANOTHER contraction?!" I think to myself, "ARE YOU REALLY ASKING THIS?! A little bit of observation goes a long way." I kept the thought to myself and kept my mouth shut. I got up and got back in the shower. At some point, Melissa woke up on her own and joined us.

I would intermittently try to sit on the toilet. That wasn't comfortable. I would stand for a contraction. That wasn't comfortable. I would sit back down, stand back up, sit back down. I would literally go up and down throughout my contraction, and this repetitive motion was a coping mechanism in itself.

I look at Mary and ask her, "Will you say some bible verses?" She says the first one that comes to mind:

"Fear not, for I am with you."

I nod. That's a good one.

Mary goes and gets her phone and searches for more applicable bible verses, as she seems to be stumped. She comes back reading them. I look at Melissa and matter-of-factly say, "Tell Mary her bible versus aren't very good."

We laugh at it now but at the time I was dead serious. Her bible versus weren't good enough.

Transition at its finest.

I get in the tub. My contractions were now 2 minutes apart and strong, transition contractions. It was quiet- myself included. Shortly thereafter I was getting the urge to push and began bearing down, silently, at the peak of each contraction. I never announced it to the room and I remember thinking to myself, "I wonder if they can tell that I'm pushing?" At this point the pain was intense and there were three things that made it better: silence, swaying my head, and having Glen close. I ask him if he would get in the tub with me. I needed the comfort of having him there, beside me. It is amazing how you can be in such intense pain that you are incapable of verbalizing, but yet your mind is still sharply aware and processing. I remember assessing, thinking of how I was so quiet and also thinking to myself how I was certain everyone in the room thought I looked like a crazy person, with my head swaying back and forth and my eyes rolling in the back of my head. I remember thinking, "If I had the energy to laugh, I would laugh at myself."
I would continue pushing for nearly 40 minutes, and at some point in the midst of that I had the realization that what I was doing was not working. Callen felt bigger than Adria and I felt like I was trying to push a 10 lb. brick out of my rear that was not budging, despite my best efforts. The midwife in me told me that I needed to change positions, get out of the tub, and go sit on the toilet. Oh, but everyone hates the toilet. The mom in me adamantly said hell no, that is going to hurt more. And so, true to the ways of being human, I stayed where I was. Eventually, probably 5 minutes before birth, I had a come-to-Jesus moment where I thought to myself, "Enough of this. You have got to just push and push HARD, as hard as you can, and get this baby OUT." I started pushing like I had never before in my life done, with any of my other babies, and for the first time in my labor, became vocal. For the first time ever, I felt the "ring of fire"- the burning sensation of my perineum stretching as the baby's head was crowning.

"It burns," I said.
"You're doing great," someone said. "Keep pushing."

I continue pushing, long, strong, as hard as I think is possible...

"Is his head out," I ask?

"No...keep pushing...," I'm told.

RAWWWWRRRR!!!!! I'm pushing like a multip shouldn't have to push...

"You're to his eyebrows, keep pushing..."

I roar and keep pushing, as hard as I can. I picture what usually happens with a multip, pushing this hard- the baby usually flies out. WHY IS THIS KID NOT FLYING OUT?!

"Top of the ears...keep going..." someone says.

"RAWWWRRR!!!!!!" Pushing as hard as I can...

"To his nose now..."

"Is his chin out," I ask?

"Keep going, give another push." It's Glen that says this.

I am pushing so hard...

Callen's head comes out. I have relief knowing that I'm almost done. Glen sees that Callen doesn't restitute and tells me to push to get the rest of him delivered. I give one last, long push and Callen is born into his Dad's hands. Peggy says, "Reach down and get your baby" and I reach down and lift Callen out of the water, onto me. It's 5:19am on September 30th, 2014.

I thank and praise The Lord, "Thank you Lord, thank you Lord, thank you Lord..." this is all I'm verbalizing, but in my heart and mind I know what I am saying...Thank you for giving me the capability, thank you for giving me the strength, and thank you for blessing me with this life.

It feels good to be done and to have my baby in my arms.

I get out of the tub, walk to my bed, and get tucked in with our new baby. The newborn exam is done with all of us watching, and Callen Grey weighs in at 9 lbs. 8 oz.

At 2 hours postpartum, Glen gets called in for another mom who would have her baby shortly thereafter, and Peggy stays for another hour, leaving Melissa, and Callen & I tucked in bed. Nicole, our nanny, arrives as Peggy is leaving, and I nap all morning off and on, with the big kids playing happily and excitedly downstairs.

Glen arrives home, happy to be back home with his wife, kids, and new son, and basking in how wonderful it feels to have also helped another family welcome their own son on the same day.


We are so blessed.

If These Walls Could Talk

If these walls could talk, perhaps they'd be speechless anyhow
they'd say it's sometimes all for nothing
the nods and smiles and pretense of love,
sometimes he's just bluffing

Growing bellies equate to growing life and not just cell division
tides changing, life enveloping
it's not all that was envisioned

If these walls could talk, they'd share of disintegrated love gushing out of red-rimmed eyes,
a life-full belly pushed against an empty heart,
a liar, a cheater, a leaver
his mind and body miles apart

If these walls could talk, they'd rejoice in happiness and victory,
victorious, glorious, ecstatic
not just a baby born, but a mother
oxytocin drenched, wholly climactic

If these walls could talk, what is it that they'd say
would they tell these stories justly
the excitement, the fear, the love, the betray?

Oh the stories...

Veins of flowing heroin, waking up beside death,
the sun shined bright but she was always in the dark
in the darkness of addiction
she was the prey, and the predator had its mark

A two vessel cord and a fall down the stairs
life is oh so fragile
living on our prayers

Warm midwife hands and a smile to the soul
These walls could tell of our laughs and our cries
You'll be ok...
don't you know?

If these walls could talk perhaps they'd imitate guttural moans in the night
grasping swaying rocking,
bone on bone in the dark, the most challenging mental fight

If these walls could talk, what is it that they'd say?
They'd share the life of a midwife- LIFE-
excitement, fear, love, and betray.

The Waterbirth of Riley Dawn

I often speak of the importance of a strong and trusting patient-provider relationship- what it entails, what it means, and why it is absolutely necessary. Specifically, I often speak of how it's even more so pertinent to our Out-Of-Hospital birth patients.

Out-Of-Hospital birth is an entirely different beast than hospital birth. For the patient, the family, and the providers alike. There are no epidurals, no pain medications- not even the comfort of having it as an easily accessible, immediate option. To do Out-Of-Hospital birth means to have a strong desire and a determined commitment- again, not just for the woman and her family, but her care providers as well. And trust...trust is the cornerstone. To have trust in each other is to know that everything is out on the table- concerns, fears, desires, expectations- and that we can mutually work together through it and for it. Trust is when the shit hits the fan and you think you may very well be dying because you are in the thick of it, but we look at you with guidance and reassurance and well, you ARE reassured that yes, it's ok, and yes, you CAN do this.

This morning was a perfect example of trust and commitment and how the patient-provider relationship carries that.

I helped support a family in welcoming their 3rd baby; not only their first Out-Of-Hospital birth, but their first unmedicated birth. I didn't see them at all throughout their pregnancy and therefore didn't (and don't) really know them in the way that I know my own patients. But what made them special is that they have been long-time patients of Glen's.

I remember first meeting Randi- at a childbirth class I taught at the office. Afterward we stood and chatted briefly. She hadn't previously considered a birth center birth, but after learning of her options and wanting the same doctor- her doctor- she changed her plans for birth. She looked at me and said, very matter-of-factly, "We've had two babies with Dr. Elrod. I'm not having a baby without him. If I need to have a birth center birth to guarantee that he'll be there, then I'm having my baby here. I'll go wherever he is."

I remember going home and being amazed, repeating those words to Glen. Yes, a relationship and trust are very strong things.

Just like any woman experiencing natural childbirth- there were a few- but brief- intense moments. It may have been her 3rd baby, but Randi had never felt THIS before. In the small birth room, in the corner tub, surrounded by the decor I myself love and deliberately selected, with her husband by the side of the tub, and Glen and myself kneeling in front, with the urge to push and not knowing what to do she exclaimed, "Dr. Elrod, please help me!"

The room was dimly lit by the sconces that light up on each side of the bed. The same sconces we have in our home. The wood headboard that was made locally. A room that not only has what is needed to practice evidence-based care and safely have a baby, but that also feels like the kind of environment that is conducive to a family actively working together and welcoming their new baby.

Glen looked at her and reassured her that her baby's head was right there. She pushed 3 times and the baby's head was out. She looked at me- directly and intentionally- and said entirely calm and collected, yet every bit as intense as the words she spoke,

"Tara, I'm scared. I'm so scared."

Her eyes were wide and intensely locked on mine.

"You're ok. It's just your baby's head. Everything is ok, " I reassured her.

And with that, one more push and she delivered her baby girl- into the water, into Glen's hands and then immediately up to her chest. Even though she was admittedly scared, she was strong, and SHE DID IT!

Riley Dawn was born today- an uncomplicated, unmedicated, beautiful waterbirth. Mom and baby are doing great, and Dr. Elrod is pretty proud too!

Baby, Bloom, and Beyond

We don’t usually update this blog with events of our life- specifically, our personal life and daily adventures, but I thought it would be a nice change to give such an update. Life has been busy, with a lot of excitement and good around us!

The weather in Alaska has been beautiful- mostly warm days and not too much rain. With our long, sunny and mild days, it leaves the world buzzing. We have our work days but still seem to have plenty of time to enjoy our “down time.” Parades, festivals, markets, fishing, outside lunches at our local brewhouse, and the various classes and meet-ups that we have at our office have left us busy and enjoying our summer.

 I’m now 31 weeks pregnant and feeling excited about the upcoming addition to our family. This baby boy has yet to get a name, but I’m sure that will come in time. Afterall, I have yet to meet a person with no name. ;) We have been blessed so far to have had a healthy and uneventful pregnancy and have enjoyed having a midwife for our prenatal care, including the home visits that she does for us. It’s been amazing for us to see how much Adria (our 2 year old) has really seemed to understand. She certainly seems to understand that a baby is growing inside of me and that we will soon have a baby join us, to feed and to care for. Though it’s been awhile since she herself nursed, she seems to be familiar with the idea that mom will be breastfeeding the new baby, as shown by her demonstrations. Perhaps it’s a testament to her exposure of pregnant and nursing women that she sees in the office.

 As for birth, we are looking forward to another homebirth, in the company of our midwife, Peggy, the bigger kids (minus Candice who will still be finishing up the Fall semester), and our two other support people- my cousin Melissa, and our friend Mary. I can’t honestly say that I look forward to the challenge that labor brings (yes, even if it is my 4^th time around, it’s still the biggest challenge!), but I do take comfort in knowing that I’ll be surrounded by these very special people.

 Last week we celebrated a milestone for our practice- the beginning of offering medical spa services. Glen has wanted to venture into medical esthetics for some time now, but with being a solo practitioner for so long and focusing on building the practice, there was little extra time to focus on anything else. Now, with various changes in our practice and in life in general, now was the time. It has been such an interesting and fun time to develop this aspect of the practice, and one I’m happy to see become a reality- for Glen as well as for the women who will utilize it.

 When this practice was a fledging practice and when we first began planning the building we are now in, we envisioned that it would be a mecca for women- a place for health and wellness, encompassing preventative care, treatment, education, beauty, and other complimentary services. We still have so much that we envision, but to think that much of what was only a vision 3 years ago is now a reality, is a beautiful thing.

June 2012- the view from our property, which had yet to be cleared.

July 2013

 

The open house for Bloom, the Medical Spa at Integrated Women’s Wellness, was a huge success. HUGE. So many women from our community came out to enjoy a night out and learn about the services that the medical spa is offering. Even though technically us and our staff were working, we all truly had fun. We dressed up, ate, drank, got to show off our Integrated Women’s Wellness home, and talk about esthetics. In just two short hours, we booked about $10,000 in services. Amazing to me, because in the back of my mind I always wondered how successful a medical spa would be in Alaska. Afterall, we are not in San Diego or Los Angeles! It’s a bit of a different climate...literally and figuratively. At the end of the day, however, Californian or Alaskan, women are women, and to feel good on the inside as well as the out seems to be universal. While to be financially successful is of desire and benefit to us, at the end of the day, the most satisfaction comes from offering a service that will make a difference in the lives of women…and to be the best at doing so. ;) This concept is a cornerstone of Integrated Women’s Wellness.

 

So, what’s next? We will continue to build up the esthetic aspect of the practice, continue to add various classes to our class offerings, countdown the days until we meet our new baby, prepare for our upcoming birth center inspection, host a Betula Baby table at the Alaska State Fair, and bid farewell to Dr. Wayman as she relocates back home, at the end of next month. In September I’ll celebrate my two year anniversary of being a licensed midwife. I have several repeat clients right now, and to have the experience of being a woman’s midwife throughout more than one pregnancy is truly special.

There is plenty to come- both personally and professionally- and we are excited about it all!

 

 

 

My Cloth Diapering 101

While cloth diapering seems to be growing more and more in popularity, it seems there are no shortage of people who are still scratching their heads and mind.blown. when they find out that we cloth diaper. [Insert the Whats?! and the Whys? And the 'That is disgusting!'] I mean really, why WOULD any sane parent want to subject themselves to not only more contact with pee and poop, but also...more work? Well, read on.

We haven't always cloth diapered. In fact, prior to my last baby (Adria, now 2 1/2) when I envisioned cloth diapers, I seriously envisioned a prefold with metal safety pins, all held in to place by good ol' rubber pants. And, I'm not even sure I've ever seen a pair of real-life rubber pants, but that's what I had in my mind. Leave It To Beaver days.

Little did I know that these aren't the days of my momma's cloth diaper. Things have changed. Cloth diapers are not only not scary...they are wonderful. And cute. And addictive.

One day, in the earlier part of my pregnancy with Adria while I was meandering through a baby fair, I came upon the display of a diaper service business. The lady was nice and the information was profound. I took the information and then I went home and researched it. I knew soon thereafter that we were going to be cloth diapering. My husband- the doctor and also a man of convenience- surprisingly didn't bat an eye...once it was explained to him that he would not have to wash them.


THE BENEFITS OF CLOTH DIAPERING

- Avoidance of the chemicals that are found in most disposable diapers...Bleach, chlorine, 'superabsorbent' gel, dyes, and fragrance.

- Environmentally friendly:
Cloth dipes are much less of a strain on Mother Earth than disposable dipes. If you do a bit of research, you'll find the more than 200,000 trees each year are lost due to the manufacturing of disposable diapers for babies (in the U.S. alone!). In addition, it takes 3.4 billion gallons of fuel oil every year to make diapers. It's estimated that disposable diapers require 20 times more raw materials, two times more water and three times more energy to make than cloth diapers. Pure cotton, bamboo, or hemp are much friendlier for Earth Momma!

Also, cloth diapers equate to reduced waste in our landfills. It's thought that disposable diapers take hundreds of years to decompose in our landfills (though we don't know how long, exactly). Think of all of the diapers your little one goes through each day...now each week...each month...and each year. Yep, that's a lot of diapers. Cloth stays out of the landfills!

- Less diaper rash.
Why? Refer back to the first benefit discussed. Yep...no artifical chemicals and dyes means nothing to irritate baby. Also, because cloth diapers have none of those 'superabsorbent' gel beads or lining to soak up urine for hours, it does require more frequent changing. This is a good thing, I swear! This also attributes to less incidence of diaper rash.

- Fashion.
        If you haven't already checked out some styles and prints of cloth diapers, do it. But prepared to become obsessed. There are many different styles, colors, sizes, and prints. At my shop, Betula Baby (who I run alongside the Tidy Tush, a local diaper service), we keep it simple and carry Thirties, Rumparooz, and Alva.

LET'S TALK MONEY

Being the owner of a baby boutique, I of course love to help out moms and dads support their cloth diaper addiction. But even with all the fun and funky prints and accessories taken into consideration, cloth diapering can equate to SAVING money! I did a quick online store price eval and found that it's pretty average for mid-range diapers in a value pack to be about .25 cents each. If you cloth diaper and choose to wash your own, the yearly cost of diapering can be significantly less than those disposables. If you're like me and choose to use a a diaper service, it still ends up being slightly cheaper (though, depending on where you live and the price of your service, it could end up being about the same or slightly more. BUT- refer back to the aforementioned benefits of cloth diapering. My vote is- it's still worth it.)

Our local diaper service is Tidy Tush and the yearly fee is $900. For $900 you get all the pre-folds that you need, tote bags for pick up and drop off, and the luxury of getting your diapers freshly and beautifully laundered and delivered right back to your door. And, if you're blessed like me, your very own lovely Tidy Tush diaper lady is also included and at your disposal for all of your diapering and baby questions. ;-)


THE HOW TO'S (Let's not  make mountains out of molehills...it's pretty uncomplicated. Really.)

Remove diaper from baby.
Put the diaper in the diaper pail or wet bag. Yes. Nastiness and all. (No worries, you have a get out of jail free card until about 6 months or whenever you begin solids. Then the turds come.)
Put pre-fold diaper insert into diaper cover. Snap (or velco) shut.
Put dirties out on porch on diaper day.

Ok...there's my regimen. That was easy!

But what if you choose to wash them yourself? Then continue on.

4. Throw diapers (and wet bag, if you use one) into wash. Wash twice on Heavy Duty (some choose to use a bit of bleach, some don't and just use a basic detergent), and if all is well and no ammonia smell is present (then that calls for a simple vinegar soak, if so), then put through another cycle, but with no detergent or bleach. This is the in-depth rinse cycle, getting the diapers agitated, spinning, and rinsing in just plain water. Repeat again.

5. Dry. (Some hang dry, our 'diaper lady' puts them in the dryer.)

And lastly...

ISN'T IT COMPLICATED TO CLOTH DIAPER?
(Yeah...no. If we can do it, so can you!)

There are many options when it comes to brands and types of cloth diapers, but we keep it simple and use two things: A waterproof cover (Thirsties, Rumparooz) and a cotton pre-fold. Put the pre-fold inside the liner and wa-la! You've done it.

Why do I personally prefer covers and prefolds? Well, because it's less bulk for the wet bag and less wash (even if I don't technically wash them myself, I still care.). Unless the baby has pooped or seriously messed up the cover, it is easily wipeable and then made new by a fresh pre-fold.

So...for all the moms and dads who are shocked or fascinated or even curious about cloth diapering, now you know. We aren't the most 'crunchy granola', we don't exactly have oodles of spare time on our hands (if you know us, this statement is funny...), and we don't particularly like extra poop exposure or extra work...but, WE LOVE CLOTH DIAPERING, for oh so many reasons!

<3

 

Beauty Is Everywhere

The night before last we worked a night shift at St. Therese. Glen and I were accompanied by Keri, the doula from Connecticut who we have been blessed to meet and share this trip with, and our translator Shelly.



When the sun sets over St. Therese, the vibe noticeably changes. The unrelenting heat that beats upon the dirt and the concrete, and the thick, heavy stench of dehydrated urine, feces, amniotic fluid, blood, and unbathed, moist bodies give way to the night sky. The scorching sun departs, and the Haitian sky welcomes the moon, which brings a yet still warm night, but one that gives the comfort of an intermittent cool breeze.

The hustle and bustle slowly dissipate as the hours draw by, consistent with the slow but steady drop in temperature. We can feel the difference in the air even in just a couple degrees, and for that, we are thankful. The patients who are here to stay retreat to their beds for not only the comfort of a soft place to lay and potential sleep, but for the protection that the mosquito net brings. Each ward closes its doors, guests and family retreat for the night, and the metal gate to the hospital is shut to the outside world. The moans, yells, and shouts to Jesus of the day no longer occur, but are now replaced with cries that are coming from the new Haitian lives residing in the postpartum unit- the babies that were born today and yesterday.

What I notice for the first time in this sanctuary lull, is the sweet aroma that fills the air. Gone is the invasion of bodily fluids, but now the air is filled with the presence of sweet flowers. It is Heaven on earth. I take deep breaths of the fresh air and I speak to Glen of how beautiful it smells. I wonder why we have never noticed it? Funny how when darkness falls, when your world and heart are quiet, you become more aware of what surrounds you. Beauty is in the little things, yet so often we fail to see them through the busy or the bad of everything else that is occurring. But it's still there.


Earlier today, at about 1pm, a woman in labor walked into the maternity unit. I took one look at her and said to my translator, "That is a big belly for a Haitian belly! She has to have twins." I would bask in my observation skills, as minutes later we would find that she was indeed carrying twins. And term twins at that. Glen did an ultrasound and confirmed that Baby A was vertex and Baby B was breech. She would be 5cm then, and when we returned for the night shift, she had not yet delivered.  At about midnight, I asked if I could check her and found that she was 8cm, Baby A was nearly +3 station, and a tight bulging bag right inside her introitus. I told Glen and the midwife to prepare for delivery, as once that bag broke, we would be having babies. While Glen made sure Pitocin was drawn up, clean instruments were out, and the PPV mask was out, I geared up in the makeshift delivery garb, to help wherever needed. I stood there, feeling how I imagine new Haitian babies must feel- hot in the stagnant heat, yet swaddled in layers of non-breathable clothing. Within minutes a pop and explosion, a powerful burst of amniotic fluid ruptured 3 feet across the room, followed immediately by Baby A's head. I was the only one gowned and gloved. I stepped over and immediately caught Baby A. Glen garbed up in the protective gown and gloves and stepped in for Baby B, as we knew this baby was frank breech. Just a few minutes later, this second baby made her way into the world, rump first, to join her sister. Mom would go on to have a postpartum hemorrhage, which would be controlled with Pitocin and Cytotec. She, and her two new girls, would do just fine.

After mom was stable and moved to the postpartum unit, Glen and I would go to lay down to get some rest. Two hours later, we would hear commotion outside in the corridor. Glen said to me, "We better go out there. I think I heard someone say something about a mom pushing in the car." I grabbed my supplies and ran out to the exterior of the building, Keri and Shelly already two beats ahead of me.

What I see is gut wrenching. There are men lifting a woman from the van, trying to get her into a wheelchair. She is contorting, bucking, violently thrashing, in the black abyss of seizure after seizure. I throw gloves on as I yell over the commotion, "Is she pushing? Did she deliver?!" Shelly says to me that she has already delivered. I yell, "Where is the baby? Is the baby alive?!" I have no idea if she is 24 weeks or 40. IS THE BABY ALIVE?!" I must yell it three more times, as no one hears me, there is such commotion and attention on the violently seizing mom. Finally Shelly says, "Yes, the baby is alive." She is so calm, almost too calm. She talks and moves in slow motion, and I know that this is because her eyes and ears are acclimated to scenes such as this. Shelly points to a man, still in the van, and I see he has a bundle of miscellaneous cloth in his arms- shirts, scarves, I am sure anything they could find to keep the baby warm. I step to the open door of the van- as mom continues to thrash like a wild animal that the men are trying to tame- and I see the blood. There is a sea of red blood on the floor of this van, spilling onto the dry dirt ground that I am standing on. I grab the cloth bundle and prepare in my mind for what I might see. I have no idea what the condition of this baby will be. I take the bundle and immediately something falls down out of the cloth- the placenta hits the filthy, bloody floor of the van, acting as an anchor in this Red Sea. I have no extra hands to pick it up, and I we are tethered to the van. Keri instinctually steps forward as if to grab it for me, but immediately halts, as if in line with the shout in my head that has exclaimed, NO! She realizes, as I realize, that she has no gloves on and has broken fbe cardinal rule of universal precautions. She sees a clean, dry towel sitting on the seat, and uses that to pick up the placenta. Together, stride for stride, we walk as quickly as we can back to the maternity unit. The baby is alive and breathing well, has good color, but feels as cool as I imagine a cadaver must feel.

We remove the baby from the sopping wet garments and clamp and cut the cord, detaching the placenta. I look to see what this baby is...she is a girl. It is the least of my concerns, but as I dress her in what I have brought in my backpack, I am sad that all I have are boy clothes. The scene is stark in my mind- a new Haitian baby, whose mother continues to seize in the background, is getting cared for and dressed for the first time by a disheveled, hot mess of an American who is dressing her in boy clothes.

Keri and I would take turns holding her up against ourselves, with an electric warming pad pressed up against her back. This is how we kept her warm, bringing her temperature up from the 95 degrees it was on arrival.

The following day, the mom would be stable, conscious, and alert. Keri and I would go visit with her and help to get her baby girl latched to the breast. The importance of breastfeeding...it can be the difference between life or death here. To see a woman who I thought may very well die just the night before, now alive and nursing her baby, this was amazing. Even in a room overflowing with sadness and terrible things, this was a beautiful, wonderful thing to see and to be a part of.

There is beauty everywhere. Even when we are in the midst of bad, even when we are too overwhelmed or busy to take notice.

Priority of Life

It started like any other morning in Hiche; cereal, coffee, some quiet banter about what everyone was going to do for the day. Tara and I were not supposed to be headed to the hospital until the PM shift-2 to 8pm. We took our time in the morning, getting some relaxation and ultimately looking for something to do to pass the time.

We found out they needed cord ties made. Once 100 were made, they would autoclave them to sterilize them. These cord ties consisted of 3 pieces of string, each 7-8 inches long, rolled up into a ball, then wrapped in paper. Tedious work, but it was keeping us occupied for a few hours.

Suddenly, Nadene comes down with an urgent phone call from Wendy. There was an ectopic on the unit and she was headed to surgery soon and the Haitian OB wanted my help. I took about 2 seconds for me to hop up, gather my gear for the day and head out. My only mistake was forgetting to fill up my water bottle. In this heat, that wasn't a good mistake to make.

The moto ride is usually a casual, leisurely ride from the house. This ride was no different, although I was imagining this mom having a ruptured ectopic and bleeding out as I was taking a gentle stroll though town. I need to go faster!!!

I get to the unit and things seem relatively calm. The OR is on hold because of a general surgery case. I learn later that it is a radical mastectomy being done. Recurrent breast cancer, apparently. I'm shocked to see such a surgery done here. But, I digress. The mom with the ectopic is stable, thankfully. She is obviously in pain, but vitals seem normal and no immediate distress. And due to the delay, it's a good thing she is stable.

I sit and wait for the OR to come get this mom for surgery. I turn my head toward the door because there seems to be some commotion. A mom was being helped in to L&D by two men. She's in pain and sounds like she is in labor. She takes a few steps and blood is pouring from her onto the floor. Flowing from her, steadily running down her legs and onto the already filthy floor...it is truly a horrifying sight to see. Regardless of the cause, she most likely needs to be delivered quickly. First, I find heart tones...baby was alive. Next, I use the crude ultrasound and rule out a previa. I her IV fluids that she walked over with- two IVs hanging- LR and magnesium. Her blood pressure was 170/120. Imagine that...another preeclamptic. Another complication from preeclampsia. There was no doubt she was abrupting and urgently needed to be delivered. But...so did the ectopic. And there was still that pesky mastectomy going on.

I looked at Wendy and said, “This might be very bad. With the delay, we could easily lose all three (meaning the ectopic mom, the pregnant mom and the baby.)” And it could be quickly.

I thought of this were my decision to make, who would be the first priority? The ectopic could go bad quickly, but it also would be a relatively quick surgery. The abruption, though stable at the current moment, had both the lives of mother and baby at stake. There is a prioritization of life being contemplated...and the Haitian OB makes the call that the ectopic gets to go first.

A bubbly, Hispanic guy named 'Romero' came bounding into L&D and introduced himself. It turns our Romero is our anesthesiologist. He has come to see the ectopic. I assumed at this point that the general surgery case is done. I was wrong! Romero left the OR, came to see the ectopic, got her back to the OR and placed her spinal, all while the mastectomy was taking place. As crazy as it sounds, that is exactly what needed to happen here. Time was ticking and there was none to be spared if a life was not to be lost.

I am caring for the ectopic with Jean Baptiste, the only other Haitian OB that I had not yet met. He is a very nice man. You can tell he cares about his work and his patients. As we prepare to begin the case, he reaches over and firmly grabs my hands...holding hands with a man I have just met and whom I do not understand his language, he says a prayer in Creole. This work and situations such as these, transcend the expertise and skill of any surgeon. We need all the help we can get.

We start and as soon as we open her belly we know that it is a ruptured ectopic, blood fills her belly. The right tube was distended and ruptured. We take it out. The left tube was severely damaged and we both agree she may never have kids. My guess is that she had an STD at some point that has ruined her tubes. Sad, but it is the reality.

Ruptured right fallopian tube.

Headed back to L&D I'm hopeful that the patient with the abruption is still stable. She is, only now we still wait for her turn. This time we do wait for the mastectomy to finish, probably another hour at this point. All together it was nearly 4 hours between when she came in with an 'emergent' reason for delivery and when she actually delivered. Lucky for her, she maintained stabilty for the duration.

Surgery was uneventful. Dr. Celestin let me do the case and it was like any other c-section. Baby did great and mom did great. Her placenta didn't exactly look like an abruption, but her uterus had ecchymosis (bruising) that appeared to be a classic Couvelaire uterus with bleeding into the uterus. A good call to deliver by section.

By this time, Tara and Kerri (a doula from Connecticut) had arrived to work the PM shift. Things were oddly quiet for a while. As it usually happens, more commotion. This time it is several men and one tiny woman carrying in a mom on a stretcher. It was her first baby. She was 30 weeks by their discussion, but looked more close to term. She had been in labor and had been under the care of a Matron (a local, traditional birth attendant) and she had apparently seized several times prior to being brought to the hospital.

Matrons are traditional birth attendants. These are both men and women that have grown up watching others in their village attend births. They have learned their skills by observation, being taught by matrons before them. Matrons often have had no formal training in birth at all. Yet, because of the long history of using matrons, these women are very much a trusted part of the community. (Midwives for Haiti has begun a series of classes to teach the basic medical skills needed to provide safer care to the women in these remote village without access to midwives.)

On first evaluation, her blood pressure was 140/120, baby's heart beat was 120 and she was complete and plus 2. All in all, she was pretty stable. She continues to labor as the midwives work to start her IV, hang magnesium, and wait for her to deliver. Over the next hour or so, it becomes clear that her seizures have left her exhausted and her pushing efforts are non-existent. Tara wonders and questions o the Haitian midwife whether a section would be in order at this point. She unobtrusively asks how long they will wait before making that decision. Of course she is too wanting an uncomplicated vaginal delivery for this patient, but I can see the reasoning behind questioning for a cesarean. A first-time mom who has knowingly seized several times and while now arguably relatively stable, she is not coherent and hardly conscious. I can tell she feels this should be happening. One of the Haitian OB doctors checks the patient and says that he will give her a bit more time before ordering pitocin.

I can't say that listening to heart tones is a regular thing here. There doesn't seem to be a protocol. We tried as best as possible to listen consistently every 20-30 minutes, but in an environment of chaos and a lack of staff, it is difficult. In this case, we listen and find the heart rate in the 70s! It stays in the 70s. We set in motion the means to get a section done. I notify the anesthesiologist, the midwives call the Haitian OB. The heart tones have come up a bit to the 100s, but are still low. I was very surprised, pleasantly surprised, that things went very quickly towards section. Within minutes of my notification the OR was in the room to get her. Within a few more minutes she was off to the OR. In the OR, she had a spinal placed mostly on her side, but I'm fairly certain that he nearly put it in with her on her belly. For those that know OB anesthesia, you'll know this is no easy task when they can't sit straight up or lie still on their side.

The only thing missing was the Haitian OB. Once her spinal was in, the anesthesiologist and scrub tech yell at me and motion for me to just start. “You...go!!!' Hesitantly, not wanting to break any rules we agreed on at the beginning of the week, I decide to scrub. It is either that, or we might lose this baby. Just as I'm prepping the belly, the Haitian OB walks in and motions for me to continue. It looks like I'm on my own. He doesn't scrub.

I quickly get to the uterus and open it. Mec...lots and lots of thick meconium. Not terribly unexpected, but also not a great indicator of what I'll find. The baby was limp and apparently lifeless. I knew, however, that there was a set up for resucitation handy, just in another room. I quickly hand the baby off and finish the section. All is well with the mom. I find out that the baby has actually done well. Initial heart rate was 130 and only needed bag mask to get started.

All in all, a busy day. I have found that the willingness to call for a pediatric nurse and have them called for every birth has truly been a life saver. There is no doubt in my mind that without a skilled pediatric nurse for this last baby, she would have died. For that one change since we were here last, I am grateful, as well as proud of this program. There is change being made.

Until tomorrow.

Glen