Monday, December 6, 2010

Mother of Many

This great little animated piece is in honor of the hospital-based midwife and natural childbirth. Enjoy it here: Mother of Many

Tuesday, November 16, 2010

Emmy's Amazing Birth

I read so many birth stories while I was pregnant. I selected only the ones that were beneficial to my projection of what it would be like. A lot of them came from Ina may gaskin's 'spiritual midwifery' where they would describe each contractions as a “rush” and would describe how psychedelic it was and how tuned in everybody present at the birth was to the energy of the birth. I’m happy to say that my experience of the birth met the expectations that I created for myself through reading birth stories that vibe with that.

I had a feeling the baby would come earlier than the due date. I thought it was possibly wishful thinking, but I was ready, and the baby felt ready. I didn't want him to come too early, though, because I had a huge desire to go swimming with my mom and my big belly, before becoming 3 generations. My mom flew in, we went swimming, and the contractions began as I was drying off. I was surprised at how much it felt like constipation. At first I wasn't exactly sure. Part of me couldn't really believe it, especially because it was the day before my own birthday and I never imagined we'd share a birthday!

I went to the studio where the tub had been set up next to a mattress, and spent time experiencing waves of stomach discomfort. My mom helped for a while by rubbing my back, but soon i had to stand up because my back was feeling stiff. Walking around relieved the pressure. I thought about all the women who i was sharing this experience with, women i'd seen in videos, women in ancient tribes, my ancestors, and all the women around the world in the process of birthing at that very moment.

Maria, my midwife, told me to call her when the contractions were 4 minutes apart and lasting for one minute for an hour. Time seemed to fly by during contractions. I would tell my mom that it felt like 20 seconds, but it would turn out to be over a minute long. Every contraction, my mantra was 'yes, thank you.' I'm grateful that contractions start off small and build gradually. It gives plenty of time to integrate, and to feel that my body would do all the work and I just had to get out of the way.

Maria came. I was having rushes outside of the tub, because I had heard that if you get in before you're at 5cm, you might go back to being smaller. I was holding onto the tub, looking at the water, and really, really looking forward to getting in. After Maria checked how far I'd been dilated, at 4.5cm, i asked if i could go in and Maria said, 'of course.' Getting in the tub was followed by an immediate 'ahh~' and i was so grateful for the tub. The pressure on my back was pretty much eliminated. Later on it would return when it got more intense, but i found then that stretching my thigh muscles and butt muscles helped, and stretching was so much easier in the water than it would have been on land.

The baby's dad started composing soundscapes around 6pm. The way the yoga studio is set up is that the floors have transducers in them so you can feel the low frequency sound vibration through the floor. he was playing a lower volume than usual so that he could hear me and stay tuned in to the birth. It was good that he was playing music because not only did it keep him occupied with something important to do, but it assisted me on a level which i wasn't consciously aware of. Later when i would watch the video, I noticed that the sounds I made were in tune with the music he was playing. The lights were low and the people present (My mom, Maria, and Summer, the doula/apprentice midwife) were napping and hanging around. I found out later that they were taking detailed notes and were actually doing stuff, but at the time i was happy being in the zone and not having any interventions and distractions. I focused on meditating on and expressing gratitude, to my body, to my baby, to the earth, to the universe, to everyone who made the birth as it was possible. Although it was intense, I wasn’t experiencing the sensations as pain. I was committed to not experiencing the sensation of Pain from before the birthing process began. I remember thinking that it felt exactly as it should, and considering that my DNA contains a memory of the birthing experience from all the generations before me. I was thinking, 'even though i haven't experienced birthing in this lifetime, all of this is very familiar."

At around 6cm, i started to get the urge to push. I'm not sure why my body wanted to push if I wasn't supposed to push! I can't figure that out. It contradicts my belief that my body inherently knows what to do! Nevertheless, I trusted Maria and Summer's advice not to push, and they explained to me my cervix would get inflamed and swollen if I did. The energy would build up from my stomach and, similar to the reflex you get when you're dry heaving, where it comes from your stomach and into your head and out from your mouth, i was overcome with a slight urge to push, that built from the stomach and into my head and out from... my mouth if i breathed through it or in the form of pushing if i didn't. Summer stayed close by and would remind me, anytime it seemed like i was pushing. I found that using acu-points on my face and scalp helped release the energy as well. As it got to the intensity of being almost-there, i found that moving myself around the tub with my arms helped distract me from the urge to push as well. I toning to the point that I was losing my voice, but it really helped transmute the sensation. Sometimes I would hear myself and it would sound like a baby crying. I was doing deep grunts and high pitched squeels and lots and lots of Oming. Om, Yes, Thank you. Ohmmmm. Whenever I noticed my thoughts wanting to go negative, I would say “Babyyy~ I’m looking forward to meeting youuu!!” and I would usually find myself laughing or crying tears of joy. I began to get pretty tired at around 7cm, and in between contractions I would go into such an intense state of relaxation that I was drooling. Luckily I wasn't worried about what I looked like.

Opening up took pretty much an hour per centimeter, and at 9.5cm dilation my cervix wasn’t completely open but the baby was descending and Maria got in there to try to lift my cervix around the babe's head while i pushed and the baby tried to descend. The baby's heartrate dipped during a contraction, and so Maria said that she'd like me to leave the tub just in case she had to resuscitate him. I was slightly bummed that the baby wouldn't be born into the water, but eager to get the baby out and wrap it up, as this was all very exhausting and i was ready to rest for more than the time between contractions would allow me! leading up to the birth i processed the possibility that the birth may not proceed as planned. I didn't want to be disappointed in any way, so i had to accept that i may have to go to the hospital, i may end up having to get a c-section, i may ask for an epidural if i'm in the hospital, et cetera. So getting out of the tub and birthing the baby did not seem like such a deviation that warranted disappointment.

I pushed once on the mattress lying sideways but wasn't really into that. Maria invited me onto the birthing stool. Somebody said something along the lines of "he should be out in 20 minutes." and i thought, whaaat? 20 minutes? then i remembered how quickly time had been flying, and how i'd been in active labor for about 10 hours now, and so the initial feeling that 20 minutes was too much became excitement that 20 minutes was a breeze. So i pushed and worked on pushing, and then i more or less pooped him out! Maria kept reminding me to 'push down here' which, though it seems obvious, wasn't, since i don't practice pushng on a regular basis like I practice breathing.

The sensation of the head coming down did not feel like I thought it would. I thought it would be more vaginal, but the sensation was incredibly rectal. I also thought the shoulders and body would be easier after the head opened me up and that it would just slide out, but I had to push the body out too. After the baby came out, he was put in my hands and was a floppy, wet creature. Maria was rubbing him with a towel, stimulating him, and he cried. The crying overwhelmed me because I didn't want him to cry. I wanted the birth to be so peaceful that he would come out breathing peacefully. While I held the baby, i was told to push out the placenta. I was of the mindset that the placenta would eventually come whether i pushed or not and so I wanted to chill. I was on the stool, holding a wet, floppy crying baby, trying to adjust, but i was eventually convinced to give a few pushes to get the placenta out. Baby was left intact until later in the morning. He was born at 4:16am on my birthday, July 22nd... our birthday!

I lay in bed the rest of the day. the cord had been cut. I had been thinking i would do a “lotus birth” and leave the placenta attached until it fell off naturally, but lying there with the placenta, and the cord no longer transferring anything, lifeless, placid, white, with blood clots lining the cord, I asked the baby if it was okay to cut it. He didn’t react to my handling the cord, so I told Maria kind of sheepishly that i changed my mind about the lotus birth. She clamped it, and ceremoniously offered sephen and i the scissors to cut it. I had just birthed the baby so ceremony seemed silly, but i noticed that for stephen it felt significant.

I wasn’t able to sleep that day. I was physically tired but my mind was awake and alert. I wasn’t overcome and flooded with love like i expected, but I didn't beat myself up about it because i was tired and i was pretty certain of my ability to love the baby. I experienced strong feelings of love during the labor, but after the baby was out, i was tired. Awake, and alert, but spiritually, emotionally drained from all that work. I looked at this baby that the universe had placed into my care, and thought about how cute he was. My heart didn't melt into breastmilk like i imagined it would feel like. The sucking felt like nipple clamps were being pulled by a sadist, and i was the masochist who was enjoying it thanks to the lovely hormones of oxytocin guaranteeing the survival of the babe. But oxytocin doesn't feel like the heart-melting love that i think of when i think of love.

I'm writing this now 4 hours before he turns 5 days old, and I'm happy to say that I'm falling in love. Yesterday I separated from him for 15 minutes while I took a shower, and I missed him incredibly and couldn't wait to see him again. Later he stared transfixed at the shadows of my hands on the wall as I made shadow puppets of angels, birds, hearts, circles, and mudras. Today I saw the beginnings of a smile in the form of a series of quick grins, some of them lopsided and some of them fully delighted. His emotionally expressive dreamlife is the source of my neck pain, and my arms are sore from carrying him all the time when I could probably put him down. My body feels great, and i'm lying on my stomach, beginning to strengthen my stomach and back again, and enjoying my body's flexibility. I imitate my baby's dramatic back bends and neck curls and arm movements and find my bones and joints cracking much more than they did before. I can't wait to see my chiropractor again for the best adjustment ever. I am in total awe of my body and have never felt so good about myself, my body, and my body's abilities. I watched my body change, and now there is this helpless, basic little creature whose entire days consist of sleeping, resting, feeding, and processing body functions. And i am completely in awe of life-force that will grow this child into a laughing, smiling, thinking, running, jumping boy... and then a climbing, dancing, kayaking, swimming, diving, creative man.

I've embraced polyphasic sleeping and find myself having so much time, and awaiting for the baby to wake up so I can breastfeed him again and interact with him more than just watching his dream-expressions. He is so incredibly cute. He has the same mouth that my sister had as a baby. When his eyes are closed he looks like a little asian baby, but when he opens his eyes, he has big, dark blue eyes that retain the cat-like, almond-shaped quality of asian eyes and the size of alien eyes. Every day is going to be different, and time is going to fly even faster now. Pretty soon he'll be taller than me and he'll teach me things I didn't know. For now I'm letting him know that he's here, he's safe, and good things are coming his way.

To see more incredible photos from this birth, click here.

Thursday, November 4, 2010

The Natural Induction Bender

By Carolyn Goossen

One week past my due date, I experienced an internal shift from zen mama to mildly nervous nail biter. The baby was still squirming and stretching in my belly the same way he had been for the past few months, and I was still peeing every hour or so.  “When is this baby gonna pop already?” I kept asking myself. 

The next morning (day 8 post-due date) I went to an antenatal test appointment at my back-up hospital, St. Lukes, where my nervousness transformed into a more acute state of anxiety.

In general, the medical community is in agreement that most healthy women are very capable of having a natural birth until 42 weeks of pregnancy. Starting at 42 weeks, however, experts agree that there are increased health risks to the baby and to the mother, which is why many hospitals and midwives advise women to have their labor induced at that point. 

At my back-up hospital St. Lukes, however, some recently published research about the optimum birth time period has led the hospital to officially change their policy.  They no longer induce a woman at 42 weeks. The deadline to have your baby induced is now 41.5 weeks- or 11 days post-due date.  If a woman wanted to be induced, they would only provide induction up until 11 days post-due date. If the woman chose to bypass this date, then she could no longer request an induction at St. Luke’s and would have to have their birth elsewhere.

The antenatal test showed that the baby was fine, but the nurse-midwife told me that my amniotic fluid was on the “low end” of the scale. She then explained the new hospital policy to me. She stressed that the policy was developed in the best interest of the baby, but that I could always go to another hospital at 42 weeks for an induction, should I not want to get induced at 11 days post due date.

This information left me feeling agitated.  I hated the idea of getting induced, and staying in the hospital, but then I also wondered if I was self-indulgent for wanting to have a home birth when there were potential risks involved.  Knowing I had less than optimal fluid in me didn’t help either.

So, with some trepidation, I agreed to schedule a hospital induction in three days time- the 11 day deadline- at the latest possible time permitted- 7pm.

On the way home, I tried to convince myself and my partner that I didn’t really mind going in for a hospital induction, although I was already beginning to dread it.

The fact was, I really did not want to be induced. Yet I was starting to panic and started doubting myself and my body. What if 42 weeks passed and the baby still hadn’t arrived? What about at 43 weeks? What would be my options then?  My mind started racing, and a powerful surge of maternal guilt overcame me- guilt for wanting to stick to my original home birth plan.

I had booked a midwife appointment that same afternoon, so I headed over there. During that meeting, I explained my nervousness and my resignation about getting induced should labor not begin by 7pm on the 11th date post- due date. My midwife, Maria, said it was entirely up to me, but reminded me that I was a “good birther”, and urged me to trust in my body’s ability to birth.   My first child, Ella Zhao, now 6 years old,  arrived 10 days after her due date after all, and I had her at home without complications or tearing, after 14 hours of healthy labor.  I nodded my head in agreement and took a deep breath- I had for so long looked upon my first birth as a “lucky” experience- not as a product of my body’s innate ability to birth. It was time for me to reframe that first birth in my mind.  

She urged me not to make any final decisions at this point, especially considering my desire to have a home birth.  Worst case scenerio, she said, she would help me induce my labor by having me drink a castor oil milkshake on the 11th day mark. And we could always go to another hospital for an induction at 42 weeks, should it come to that.

I left that appointment feeling like I still had options. I felt much more secure.   And I felt determined to do whatever I could to get this baby out! I went home and embarked on a natural induction bender.

By poking around on the internet (man, the Internet is great in moments like this!), I found a huge amount of information on natural birth induction methods, including what herbs to take (chilis, oregano, basil), what acupressure points to press, what kind of foot massage to get, and other natural induction tips such as having plentiful sex, orgasms, nipple tweaking sessions, and strenuous walks. 

That night I started with the herbs, (had a massive bowl of spaghetti with meat balls), the acupressure points, the orgasms and the nipple tweaking.  I also made an acupuncture appointment for the next day, and a foot massage appointment for the day after that.

I also spent an hour’s time reading about women’s success with natural induction. I was particularly interested in the first-person narratives of women who gave birth at least 10 days after their due date. I discovered dozens of accounts by British women who had had successful homebirths between 10 and 20 days- some even more- after their due date.

The next day (day 9 post due date), I went for a hike with my mother and daughter, had an acupuncture treatment, ate a juicy burger with extra chili, and just tried to relax and enjoy myself as I poked my acupressure points and tweaked my nipples.

The following day (day 10 post-due date), I ran some errands,  chugged some nasty Chinese herbs the acupuncturist had given me, and treated myself to a glorious foot massage at a dimly lit massage parlor whose other clients all consisted of middle aged men.

That night, my daughter went to sleep over at her grandparent’s house, and I was laying on the couch topless, watching the HBO series Rome and tweaking my nipples (not a bad Saturday night all considering). Out of the blue, I started to get cramps. Real menstrual-type cramps!  I called to my partner and we gave my nipples ample attention together. It was midnight at this point, and with every tweak and suck my cramps came on stronger.  He suggested that we go to bed and start again in the morning, since I should ideally get some sleep before heading into labor. (With my daughter, labor went through the night, and it was indeed exhausting not to have slept at all.)

I agreed, and went to the bathroom to start getting ready for bed.  Then all of a sudden, at about 12:15am, the wave of a contraction took over my body from the middle of my back stretching both up into my neck and down into the core of my belly.   BAM! It was on.  There was no early labor really- it went straight into intense contractions with very little in-between relaxing time.   We called my midwife, and she said to call her again once my contractions were at least 4 minutes apart. We called her again 15 minutes later and by 1:15am or so, my midwife arrived. She set up her things, looked at me, smiled, and told me that it was time to push. 

My baby was born at 2:15am, after 45 minutes of pushing. I admit I was surprised by the intensity of the pain, even though it was my second time around.  But, as with my last labor, just at the point where I didn’t think I could do it any longer, that I was somehow physically incapable, the baby arrived. Bruno Tai Ming was born at 8 lbs 5 ounces, lovely and healthy and covered in goo.

My entire labor was less than 2.5 hours total.  Most likely, this is due to the fact that this was my second child. But I like to think that my natural induction bender helped nature along.

Thursday, October 28, 2010

Welcome Diane Ondine!

For those who have been following Women in Charge, we are going to come back now to homebirths in the US. Here is Francine's story of the birth of her second daughter, Diane Ondine:

When we woke up on Friday June 11th, a hummingbird stayed behind our window during long seconds, staring at us and announcing the wonderful day to come…

We had a homebirth 2 years before with Maria as our midwife who delivered our daughter Elia and we had explained to her about the birth for a couple of months : the water-tub, the groaning/screaming sounds mama will make, the baby who will come out of mama’s belly…

It was the same schedule as 2 years ago : an appointment with Maria in the morning, non-stress screening at UCSF at noon, and the contractions began there… I was on my own and drove back home feeling happy, very grounded and “in charge”, looking at the clock in the car and mentally writing down how far apart the contractions were coming, at that time they were ten minutes apart.
It had turned into the sunniest day we had had all year in San Francisco.  I came back home, cooked some Miso soup, got a snack ready for Elia, swept the floor and pushed the table and chairs away from the center of the room so we would have room for the birth tub.
I called Maria to let her know the baby was on his/her way, called my husband Bryce for him to pick up our daughter at the nannies’ and come home.   I then called our friend Kristin who was the one who would be looking after Elia during the birth.

Everybody arrived in between 5.30pm and 6pm, right when I entered in real labor with stronger and closer contractions. Elia asked me to put some butter on her cracker and I had to stop at some point to let the contraction pass, she imitated me bending over, moving her hips and groaning and said “no that mama, I want butter cracker!”
That was so nice and sweet to have her around: she was holding my hand when I was in the water and later she wanted me to hear her belly with Maria’s stethoscope.

 The ambiance was very sweet, warm and intimate.  We lit candles and once again the midwives team was discreet, I loved that. I can feel Maria’s presence, I knew her focus and strength was all there but she did not step into my/our intimacy at all.

My water-bag never broke and our baby was born in the water and the sack (caul) at 10.03pm. Elia was falling asleep in the bedroom with our friend Kristin and as soon as she heard the baby crying, she came to us. She was a little bit concerned with the crying and the baby suddenly there and the rest of the activity.  Bryce put her back to bed after a little while and she fell asleep.
I think I asked at least 2 times if it was a girl or a boy and nobody answered me! Now I realize that Maria’s job was to check if the baby was healthy and breathing correctly and the gender was not the priority of the first minutes!
And she was a girl : 7.2lb and 21inches long, with dark hair and long fingers. Our little Diane Ondine.

We had her first name picked up but wanted to be sure it was the right one so she was called ”baby sister” for the first 48 hours of her life - guess who chose this name?!
And then we picked up her middle name related to the way she was born : in French, Ondine means ‘Spirit of the water”,  or water fairy.

We are so impressed by Elia, how she handled this big event and welcomed her sister, that was a great experience for her and she still talks about it : “baby cried, Maria Babies (that the nickname she gave to our midwife) with the light, mama in the water…”

Elia’s first words when she saw Diane in the morning after the birth were “pretty, pretty!”

I can only wish every woman have a so nice and happy birth as we did…

Sunday, September 12, 2010

From Illysa Foster

I have disallowed comments due to a plethora of spam/pharmaceutical industry comments. So I want to add some here:

Thank you, Maria, for sharing your long days and nights in Haiti with the public. Having been there myself just six weeks before, I found tremendous solace in your stories of triumph and loss. Hooray for you, Ami and Dina for bridging the divide of language and culture to see the lovely midwives of Haiti for who they are-women in service of other women and their families. I hear hope in your voice that rises in me as I remember the joy in working with bright students there and in seeing the beauty of Haitians-those with the most authentic smiles one can have the honor of witnessing. Thanks for sharing the pain, too. That resonates deeply, as well.

Blessings to you and your work,

Illysa Foster

Thursday, September 9, 2010

Haitian Women Need Mesh Panties

I never cared too much for the white mesh panties that every American woman adorns after giving birth, whether having given birth in a hospital or at home. The Haitian midwives have nicknamed them "sexy coulottes." I have a newfound love for these American throw-aways.

The Midwives for Haiti program is stocked with the weekly supplies brought in by the American volunteer midwives. Ami and I brought head lamps, wrist watches, rain ponchos, fetoscopes, baby clothes and blankets, 100 units of pitocin, 3 bottles of misoprostol, suture material, and the miscellaneous supplies donated by midwives -- cord clamps, gauze, syringes, tape.

There will always be demand for these items. Yet, this is the bare-bones minimum.

What I really wanted to give the women giving birth was a simple, clean pair of mesh panties and a single Kotex pad. Whenever we found these items in the storage room, we brought them to the hospital and gave them out. The women always received them as a gift. I saw it as a moment of dignity. Finally getting up off of the birthing table, to be able to feel clean and complete was a simple dignity that only one who has given birth can describe. The cushioned GYN tables of the Hinche hospital are only minimally cleaned after each birth. There are no pillows or sheets. Often I saw the mother resting her head on the metal rail at the head of the bed in between contractions.

The cloth that the mother brings for the birth is soiled quickly from the normal fluids of a baby being born. Blood stains her skirt that she has drawn up to have the baby. Sometimes, if she's lucky, a sister will come in after the birth with a clean set of clothes for the mother and the baby. Cotton cloths, usually from a torn sheet, are placed in her underwear to absorb the lochia of postpartum.

The simple, bright white of a clean mesh pantie and Kotex felt like a luxury each time it was placed. I especially wanted to give them to the mothers who lost their babies. I felt that they were leaving with nothing. I desperately wanted to give them something to express our compassion, to honor their work.

The other thing we gave out was water. While we were organizing the storage room, I found a bag of water. It was a black shoulder bag filled with approximately 15 small, plastic sacs of water. Upon seeing them, I could tell that this is how they sell clean water in the market. A commodity. When I inquired about the water, I was told they weren't being given out because then everyone would want them. I packed them up to bring to the hospital.

Whenever Ami and I were working, we made an impromptu policy that each woman in labor would receive a sack of water. In the heat and the relentless work of labor, the water was gulped with gratitude. Before we left Hinche, Ami and I bought two large plastic bags of water sacks from the market and left them in the Maternity ward. It was our final gift.

Paul Farmer's guiding premise is to care for the poor with dignity and commitment. If a TB patient was living under a leaky roof, well, of course, they wouldn't get better. Therefore, a prescription for a roof repair was written and carried through by Haitian carpenters.

In birth, women need respect and dignity as well as anti-hemorrhagic drugs.  They need clean mesh panties and Kotex. They need water, not only to prevent dehydration, but to honor their hard work. As a woman would shuffle out of the maternity ward, adorned in her new mesh undies like her American sisters, I would feel the tiniest glimmer of relief -- we had given back.

Matthew House 25

Here is the You Tube link to Dina's piece on Matthew House 25.

Sunday, September 5, 2010

Journal Entry: September 4, 2010

I rarely slept later than 4:30am in Haiti. With the heat and the roosters and the dogs barking, by 4:30am, I was done for the night. Most of Haiti wakes up by 5 anyway. If I went outside by 5:30am, there was always a soccer game in full swing. The equatorial light was bright by this hour and the day had begun.

The roosters. I didn't tell you about the roosters. There are roosters everywhere in Haiti and they call back and forth to each other all night long. Sometimes there's a lull and you fall into a deep sleep, only to be abruptly awakened by a cock-a-doodle-do that seems to come from about 3 feet from your head. 3 or 4 more roosters will call in response, each one more and more distant.

I would wake up at this hour under our mosquito net and contemplate getting up. The heat was already heavy and the best thing was to just get up and sit on the porch. Some mornings I would get up and write on the computer, other times I would just get ready for the day.

Today was no different. For our last night in Haiti, we slept on the roof of Matthew House 25 in a tent. It seemed quite appropriate given the thousands of families in tents all over PAP.

Yesterday we took our small, 6-seater plane from Hinche to Port Au Prince. While waiting on the dirt and rock airstrip for our plane to arrive, Esther ran up for one final good bye. She was dressed for work and I was utterly thrilled to see her wearing my Birkenstock clogs that I had given her at the party the night before. I had wanted to give a few things away, but when the party started rockin', I forgot. At the end of the evening, Esther pulled my aside and asked me about the clogs. I was so glad that she mentioned it. They fit her perfectly and will be so much more comfortable that the thin and worn plastic sandals that most people wear.

I gave Magdala a dress. Here in Port Au Prince, I gave my sneakers to the boy I promised them to, Paolo. I gave the amputee who "saved" me when I was giving the kids lollipops and got swarmed, an umbrella. I gave the 14 year old amputee girl a flashlight as well as the young mom with the 5 month old with malaria. We gave onesies, a G diaper cover, and body wipes to Roseman, the woman who was in labor in the tent city on the first day we arrived. She labored all night, a 7th baby, with progressing beyond 7 cm.

We ended up transferring her which really meant: 1) she went to the nearest maternity hospital and the gates were closed for the night so she couldn't get in; 2) she went to another hospital where they refused her care because she wasn't registered there; 3) she came back to Matthew House while a young, well-connected medical student called around to find a place that would take her. She made calls to Sean Penn's camp, while I re-evaluated how we could take her back. Maybe if she birthed in Matthew house instead of her tent, if she had a bad hemorrhage, we would be better able to see what was going on. And 4) she was finally allowed to go to a Red Cross hospital in a "sketchy" part of town. A driver brought her there. She labored all night and didn't progress. In the morning, she was given pitocin and delivered a healthy baby boy.

Seeing the baby at 9 days old, he seemed small to me, under 6 pounds. He also seemed hot and lethargic. The mother said that he was nursing well. A medical doctor from the US had checked him out today in the tent city, said he was fine and gave him vaccinations.

As we were saying our goodbyes in the tent city, Darling, Matthew's young mother, began chanting Ami/Zamni (zamni means friend in Haitian Creole). We vocal boom boxed our Kijon ou ye and "the rain/comes down." It was a spontaneous outpouring of celebration in our meeting. Bennis, a young boy, loved our "How are you?" song. As we were leaving, he continually asked me for a soccer ball. I joked with him, showing him that I didn't have a soccer ball in the small purse that I was wearing. In the end, I ran and got him a baseball cap.

The rest of the clothes donations were left at Matthew House for Tey to distribute as needed. I am wondering if I will ever see these people again. Dina, Ami and I all fell in love with Haiti. I told Esther that I would come back next year. Yes, I would like to come back. I would like to continue the exchange that we began. At the end of our party, SheLove said that we were their favorite midwives even from day one. We asked her why and she said the we had given them the most love. Yes, I felt that. The love flowed both ways. We bonded through our hard work, our grief, our joy, our long, hot nights together, our vision for women and their babies. Midwives are the same throughout the world. We give of ourselves to be with women in their most vulnerable moments. We believe there is power in birth. We believe that women should be treated with honor and respect and that these simple gifts will provide lasting effects on a mother's ability to do her job well. Kindness, love, respect are all for free. Even the lowest resourced areas can give these away to any mother.

Brother Michael at the Maison Fortune often would ask in the evening circle, "What has Haiti given you today?" It is a question to punctuate the fact that we, as Americans, as foreigners, are receiving, more than giving ourselves while we are here. Haiti has given me  a glimpse into the harsh realities of global midwifery. Haiti has shown me hope through the smiles of the children. Haiti has given me an opportunity to witness the strength of women, midwives, who go back to work, day after day, not knowing whether the day will be weighted heavy with joy or grief.

Thank you.

Saturday, September 4, 2010

I'm back in the US. Stuck in Miami International Airport without a computer. Will blog tomorrow.

Friday, September 3, 2010

Last Night in the Hospital in Hinche and A Party

Ami and I deliver a stillborn baby each on our last night in the Hinche hospital.
Sonise is the first. She is young. She says she’s 20 but I still think these women may be younger than they say they are. She is pre-eclamptic. She’s received Mag Sulfate but her baby is already dead. She doesn’t believe it when she’s told the news.  We put the Doppler to her belly and can not find a heart beat.
She pushes for awhile in the usual Haiti-style — on her back. It’s taking a long time and she’s quite uncomfortable. She asks if she can get up and use her bucket. I say that she can be in whatever position she would like.
She ends up squatting by the side of the bed and pushes the baby out on the floor. We quickly grab a blue surgical sheet to place on the floor underneath her. It’s really the first birth we’ve seen that is not on the GYN table. The placenta is born easily a few moments later. We move the mom back up to the table. Now, the 39 week baby is on the floor and the mother is looking down at her. Ami and I have developed a pattern of wiping off the baby and half wrapping the baby up, swaddle style, in a blue paper towel. Sonise wants to see and hold her daughter. Her sister is with her and is arguing loudly that she shouldn’t hold the baby. For a moment, there is chaos as the sister is protesting and Ami and I are insisting that this mother can process whatever way she needs too. Adeline, the midwife, is also arguing against holding the baby. We win the argument and Sonise holds her baby girl for a long time. It really seems like a rarity for someone here to bond with their stillborn baby. Sonise takes her time. It is good. Denial, anger, she’s blaming another hospital for the death of her baby. I know that she is going through the appropriate steps and I wait patiently for the grief.
I tell Sonise, “No, it is not the other hospital’s fault. These things happen and it is so sad.” Sonise insists that she wants to take a photo of the baby. After some difficulty, she gets 3 photos of the child on her cell phone. She seems happy with that. She wants to dress the baby. Again, the arguing ensues from her sister. Again, Ami and I support this woman’s choices. This is all she has of this baby. She puts a small hat and white cotton dress on the baby. She doesn’t seem put off or repulsed by that fact that her baby is dead.
Another photo. We tell Sonise that we will always remember her and her baby. She will always remember her baby. Sonise names her Daphne.
Ami’s stillbirth is in the over-flow postpartum room because the mother stayed there too long and now the baby is coming. We move some supplies down the hall to where they are. The woman is resting her head in her husband’s lap, not unlike many of our births in the states. The dark brown amniotic fluid of death is becoming all too familiar to me. The small, macerated baby girl is born soon. The mother and father only look at her for a short while and do not hold the baby. It is all very sad. This is our first birth with a father in attendance.
The rest of the night at St. Therese is unusually quiet, interrupted only once with the prayerful singing in the postpartum ward as Sonise and her family grieve for the lost baby. I am happy that she is processing this death in a very conscious and real way. Both of the babies tonite had been the mother’s first. We have another woman in labor tonite —it is her fourth. None of her babies have been born alive. We are hoping this one will be different.


I want you to leave Hinche with a story of life and hope. It is the story about our fete, our party.
I didn’t even have time to blog yesterday because Ami and I planned a big party at the Maison for the midwives. Midway through the week in Hinche I thought that it would be a good idea for future teams of midwives to have an American party to get to know the Haitian midwives. I knew that Ami and I were connecting so well with them, we laughed and joked in Creole at the end of each shift. We took photos together. We processed the death of our mother that had died on a deep level, together. Our relationship with them was strong and loving. I was afraid that many of the other teams were missing this true exchange. Thus, maybe a party would help them break the ice.
But then the next day I realized, I want to have a party for them. Ami was immediately game. We asked Brother Michael at the orphanage if he would ask the cook to make food for us. We wanted fried plantains and the crispy, fried potatoes sticks, hot dogs. We wanted the cook to buy avocados and eggs at the market so that we could make deviled eggs and guacamole. Ami, Dina and I would go to the market the next day and buy Haitian caramels and limes. We ordered up 6 cokes, 6 Sprites and 12 beers. Jean Louis’ brother would get that for us. Jean Louis is the founder and head of the orphanage. Everyone was amazed and excited that we were throwing a party. No one had ever done this before at the orphanage. We invited all the student midwives and the graduates that we had been working with. They all said they would come and seemed truly excited about it.
Yesterday was the party. After our night in the hospital, we came home and cleaned up a bit. Then we left at 8am to go on the mobile clinic. We drove 45 minutes out of Hinche and then walked for 25 minutes until we reached a small building that looked like a typical Haitian school. Dirt floor, wooden benches. This is where we would see the women and three were already waiting. By the end of the morning, Magdala and Philomen, as well as two student midwives, had seen around 25 women. Ami and I mostly observed, tired from the night before. We got home around 1:30pm and the party was at 3. We scurried around trying to find a CD player, worrying that the drinks hadn’t arrived yet. They would have to be put on ice in a cooler. The cook had made an amazing spread for the party — besides what we had ordered, she had made a beet salad, a pasta salad, the spicy cole slaw that we often ate, and popcorn. POPCORN!! We were so psyched!! The kitchen table was full of food. I got to work making the deviled eggs. I even showed the cook how to pipe in the filling by cutting a corner off of a zip-lock bag, filling the bag and oilá, you’ve got a pastry bag. I made her taste one, she liked it.

The drinks came at a little after three. On Jean Louis’ recommendation, we changed the order to a case of Cokes, a case of Sprite and a case of beer. He told us that with what we had ordered at first, that wasn’t a Haitian party. We were expecting 20 people. Our driver, Ronel, was meeting everyone at the hospital and would drive them to the Maison. At about 3:10pm, the thunder rolled in and it began to rain. At 3:15pm, the truck load of midwives showed up, all of them crowded into the back of the truck, now with 6 or 7 umbrellas providing shelter. We were delighted!
The midwives arrived, dressed to the nines — make-up and jewelry. We had told them to not come in scrubs, this was a party! One woman came in a long, lavender dress that looked like a maid-of-honor gown in the US. She was gorgeous. Everyone was excited and happy. I had a slide show running on the laptop of the pictures of our time with them. They were immediately drawn in, laughing and hooting when they would see themselves in the show. I offered drinks all around. The food was devoured in no time. Small plates piled high with all of the offerings. I saw many people going back for seconds. We had even found a bag of Oreos that had been left behind by some other midwives. I told them in Creole that I made the deviled eggs and the Ami made the guacamole, but the cook had made everything else. I also told them that I am Italian, so I really like it when they ate a lot. Everyone loved the food and drinks.
Now, Dina, of course, had been playing ukelele all week. On our first night in the Maison, we heard some kids playing the ukeleles, so Dina tuned them and played one off and on all week. She wrote a song in Haitian Creole that we now sang to the midwives. The song was made up of all the simple and common phrases that we had been using all week. Here’s the translation in English (of course we sang in Haitian Creole):

How are you?
How are you?
I don’t know.
How are you?
Not now.
Not now.
How are you?
Not now.
How are you?
Not worse.
How are you?
We are here.
How are you?
I’m fine and you.
Oh, we are chillin’.
(Maria’s solo)
        Don’t cry because we are going.
        Don’t cry because we are going.
        Don’t cry because we are going.
        (repeat from the top.)

The response was obvious, immediately. Everyone was hooting and hollering and joining in the chorus. They loved watching the crazy Americans, singing their silly song with Dina on the ukelele. They clapped and cheered when we told them that Dina wrote the song herself. We laughed together, truly joyous and grateful for meeting each other. The Haitian midwives got together and sang us a song back. It was a beautiful song of thanks. I couldn’t understand the words, but I understood the sentiment and “Merci.”
After more chatting and socializing, exchanging emails and telephone numbers, the midwives piled back into the truck and said goodbye. The rain had only lasted about 10 minutes, so the truck was dry. I watched them leave from the second story porch, trying to capture one last photo. Esther, Genette, Adeline, Fedeline, Bien Aime, Marthonie, Anise, Monide, Magdala. Would I remember them all?

I will remember them in my heart. I will remember Haiti.


Wednesday, September 1, 2010

Nou La

Haitians have another response to "how are you?" that reflects their resilience and optimism. Kijon ou ye? How are you? Nou la. We are here. We are here reflects their affirmation that they are still alive, here today, that is good. I have noticed that death is talked about without emotion. My father died. The baby died at nine months. Death is as hard a fact around here as life. We have already seen two funeral processions — the first was through the center of Hinche. Hundreds of uniformed men and women slow-stepped in time while a band played. Their was one line of people on each side of the street. At first we thought it was a church parade, but then it became clear that there was a hearse at the very back of the line. There were uniformed men and women first, and then children, all dressed in white. The band was next, followed by the hearse and the family. It felt very much like a New Orleans jazz procession. Ami says it is called a Second Line. The hearse driver was tapping his hand out the the car window in time with the music. The second procession was much less ornate. We simply saw a band of people carrying an ornate coffin down the street. There was no crying or talking. They were just doing what they needed to do. One night in the hospital, when there was a lull in births, I took a walk around the courtyard to get out of the stuffy, clawing heat of the labor ward. I started to hear a loud commotion and someone yelling loudly. It was a woman’s voice and I thought it was a new woman in the throes of labor. I went towards the sound to see what was going on. As I approached, a woman was wailing, “Mama, mama.” Over and over, interspersed with sounds of grief and heart-break. I would occasionally understand a few words in Creole, like please and leave. Mostly she just cried Mama over and over. This is the second time I had heard the keening in as many times as I had been at the hospital. The grief was so clear and pure, a total consumption of this woman’s body. They were people gathered around her, but no one tried to stop her process. She occasionally would spread her arms wide, bearing her soul in her willingness to bargain her mother’s life back. I stood with the group, watching the woman. It didn’t seem rude or disrespectful, on the contrary. It seemed that the more people who gathered around, the more this woman was honored and held in her space of sorrow. Sure enough, not long into this, the same men who had carried out our pregnant woman on the stretcher came trotting along with a small body wrapped in a white body covering. A Ford Explorer had pulled up that had all the seats taken out of the back. They put the whole stretcher into the truck and then the men got into the truck as well. I can only assume that they were bringing the body to a funeral home, or home. The next stop on it’s journey. The rest of the family were able to load the keening woman into the front seat of an old pick-up truck. Her keening quieted to a soft focus stare. The family climbed into the back of the truck and drove after the Ford Explorer. The hospital was quiet again.

Ami and I have settled into a routine of going to the hospital every other night to help out. The students were not there on the weekend, which made it a little different. Still, we connected with the midwives and shared with them more as peers. On Friday night, we went over for about 5 hours and I delivered a baby because they wanted to see how I did it. A healthy baby girl. At the end, I asked if I had lived up to the Haitian standard. We all smile and joke after a long night at the hospital, relieved and tired. On Monday night, the students were there, Josette and Marie Denise. I am so impressed with their skill and professionalism. They are almost done with their year long training program and I am confident that they will do well. Josette and I dealt with two second degree tears together. She is a girl after my own heart. Her suturing is meticulous and precise. We did the suturing together on the second mom because the sulcus tear was deep. She asked me if I would do the deep part and then she would take over. So we did it together. I also showed her a few new ways to hold her needle holder “to make her life easier.” She totally got it and I was so comforted to know that these women will be sutured well. I continually reminded them that where there is a question about access to clean water, it is very important that the tear is completely closed to avoid infection. Josette and I were two peas in a pod, figuring out our suturing job. I love being a perfectionist about suturing and obviously she did too. At the end, I told her I loved her in French. She smiled back and said, “I love you, too,” in English.

The same night we had a ninth timer and a second timer. All healthy baby girls. Active management of third stage has contained the onslaught of postpartum hemorrhage. So many women here are having there 6th, 7th, 9th babies.

I also tried out a new technique that I was so excited about. We found a whole bunch of clear plastic bags with drawstrings in the storage room. They looked like bags that may have been used in the US to hold women’s belongings while in labor or maybe the freebies that women leave the hospital with. Basically, here in Hinche, we have what we have and if we don’t use the stuff, it just sits in the storage closet. So I had an idea. We are going to use the bags to set underneath the mothers to collect the blood, amniotic fluid, everything including the placenta during and after the birth. Then we can take away the bag, the same way that they do it in US hospitals with the big, blue cone shaped drapes that collect and measure blood. I felt that using these bags would keep the women’s cloth cleaner, keep the beds cleaner, make the midwives' lives and the cleaning lady’s life easier. But most of all, it would allow the women more dignity in birth. By not having to sit in the puddle of their own blood and body fluids, the mother’s would feel cleaner and more dignified. It’s the little things.

So we tried the technique on the three women that delivered that night. All the midwives were thrilled with how it worked. They noticed that the table was cleaner, there was less mess to deal with afterwards. They were happy and I asked them to show the other midwives our new plan too. I told them to use up all the bags that we had and that we would try to get more. I felt happy with a good night in the Hinche hospital.

We walked home in the morning. By 5:30am, the sun was up and the day had begun. Families were here to see their loved ones in the hospital. We had brought Cokes with us the night before, for the midwives and SheLove, our interpreter. They don’t drink coffee here, mostly running on adrenaline and allowing some of the midwives to sleep, on the floor. Two midwives slept on the countertops. I was nursing the last Coke as we left the hospital. We passed the vendors setting up, one woman asked me for the Coke. “Blanc.” White girl. She motioned for the hand out. I gave her the Coke and said, “Bon jour.”

Nou La. We are here.

Monday, August 30, 2010

Journal Entry: Aug 27-28, 2010

The women come and come. Very few moments in the labor ward at night are quiet and without a woman in labor. The women come into the delivery rooms when they think they are ready to deliver. They are checked by a midwife or student. If she’s 9 cm or more, she stays and waits to feel the urge to push. If she is less than 8cm, she is sent back walking. Tonite we arrive and there are no sterile instruments. The autoclave is packed and I press the button that turns it on (once we have electricity again, that is). I’m not sure if it’s really working though. The midwives are not sure how the autoclave functions.

We can’t find cord clamps either. I know we had a huge bag full the other day. Ami and I will need to go to the storage room tomorrow and restock. Of the delivery areas, room 5 has two delivery tables. We still need to teach the midwives to use a private room as long as one is open. They gravitate towards putting the women in the same room.
The first mom this evening is having her second child. She pushes out a strong, healthy boy. She doesn’t loot at the baby. I tell her congratulations and that she’s done a good job. The baby is big and beautiful and healthy. My Creole for birth is improving every day. I place the mother’s hands on the baby on her chest. She does not engage.

I am reminded of how harsh these conditions are. Can you really fall in love with your baby if it’s chance of surviving its first 5 years is questionable. Can you open up to your baby if there is another woman laboring 3 feet away from you?
I pull the Haitian midwife aside to scheme about how to get this mom to bond with her newborn. The midwife hasn’t been so nice to her, so I want to engage the midwife on a different level too. In a whisper, I tell the midwife that the mother isn’t bonding well with the baby. I suggest that if she talks to the mother, telling her that she did a good job, that her baby is so beautiful, that her baby is so smart, that the mother will bond with the baby. If the mother is happy, the baby will be happy. If the mother is sad, the baby will be sad. Not far from her years as a student, the midwife complies. She talks to the mother. The midwife is more animated and engaged in the joy of a live birth. I see her smile.
The mother begins to respond when we tell her the good news — she has a healthy baby. 
Baby number 2 is a 17 year old mother, having her first baby. She screams so loud on her final push that I have to walk away from her for a second. The screaming brings the baby and she has a healthy baby girl.

I can tell that this mom has a small tear. I ask Bieneme, the midwife, if she would like to sew or would she like me to do it. She says she knows how to sew and that I can do it.
I want Esther and Bieneme, the midwives, to watch the suturing. I am here to teach. I tell them that I have been a midwife for 24 years and I still watch other people suture. Esther is eager to watch, she was with me on the first night as well. She thanks me a lot for showing her. I get the feeling that they don’t suture often because few women actually tear. Bieneme says she practiced a lot in class on foam. I say that it is different on people and that we should always watch so that we can show each other new tricks.
The third baby of the night, a healthy baby girl, is born in the postpartum ward.
The postpartum ward is a large room with 10 beds. Every bed is full with at least one person and some women are sleeping on the floor. This is also where some of the women wait while they are in labor.
Adeline and Bieneme are chatting in Room 1 when we all hear the loud grunting of a baby coming from across the courtyard. Bieneme springs into action and is out in a flash. Before I even get up from where I am sitting, I hear the lusty cries of a fresh baby from the other room.
It’s a girl, big, strong, covered in vernix. The mom’s fifth girl. I can sense she is a little disappointed. She also has two boys at home. Being a 7th time mom, her labor had putzed and putzed, and she had been continually sent out of the labor ward, not ready. As oft will happen with grand multips, with one final wave of intensity, the baby was born.
A mouse scampers across the floor of the delivery ward. It is 1:30am and 3 babies have been born since we arrived at 8. Thankfully, they are all beautiful and healthy. The pace tonite is steady but manageable. The albino gecko is on the ceiling.

At 3:10am, the 7th time mom is brought in from the postpartum ward. She is having heavy bleeding. Bieneme does an exam and removes about 250cc of clots. The mother has already lost at least 500cc. The midwife is discussing cytotec in Creole. I wake SheLove to help me with the translation. I get 800 mg of cytotec from the Cabinet. I motion to hand the tablets to Bieneme. She says, “You do it.” I place the tablets rectally that are known to be the savior of mothers in the developing world. The husband comes in and brings the tubing and Lactated Ringers that he bought at the pharmacy. This means we can give her IV pitocin. The women are required to buy their own IV supplies because all the other patients in the hospital have to do it that way and they do not want the pregnant women to set a precedent. The injustice of this seems absurd to me. Are they really going to withhold a simple life-saving treatment because they are afraid of offending the other patients? Isn’t a maternal death from postpartum hemorrhage far more offensive?

Thankfully this woman had the resources. We give her the IV. Soon she is snoring and her vitals are very stable. We let her sleep. I tell Bieneme that since she is a grand multip and has lost more than the usual amount of blood, that we need to check her vitals and bleeding every 15 minutes for about an hour or so. Bieneme looks at me and simply says that she is going to sleep. Bieneme is not a student, she is one of the paid midwifery staff. Thus, I can’t really instruct her what to do. Instead, I model, “I’ll watch her then.” Thankfully, the mom’s vitals stay stable and the modeling may have worked. Sometime in the morning I see Bieneme go in to check in on the mom. I asked Ami, “Is she going to check her blood pressure?” As Ami nods her head, I say, “Bon.”

A fourth baby is born before the night is over, another girl. Around 4am, the electricity goes off in the hospital in anticipation of the light of day. We have to work by flashlight and headlamps until the sun comes up. By morning, with all the baby’s born and the 7th timer sleeping, the midwives congregate in Room 3, our usual charting station. We chat, take photos and relax now that all is quiet and the shift is almost over.

Ami and I walk home at around 6am. It is bright daylight and cooler than midday. There is a pick-up soccer game already in action across from the hospital. The field is also where the dirt runway is for the small, 6-seater planes that fly into Hinche.

Women are selling food along the side of the road — fried plantains, avocados, hard boiled eggs, sundries. As we pass the empty churches, the ethereal sound of the church choirs practicing seeps onto the street.

The mile and a half walk home is grounding and peaceful. We are happy to be here in Hinche.

Sunday, August 29, 2010

A Day in Hinche

Our second night shift in the Hinche hospital produced 4 healthy and alive babies. Three girls and one boy. What gratitude for a good night. I showed the midwives my suturing technique on a young 17 year old girl who had the only boy of the evening. Most women here do not tear, so I think the midwives don't get a lot of experience suturing. We also dealt with a grand multip (this was her 7th baby) who had a postpartum hemorrhage. This is my personal developing world nightmare. I placed the cytotec, which has been life-saving here and globally. I also helped the midwife set up the IV, placing the catheter for her and demonstrating an easier way than what she was attempting. This woman only received IV pitocin because her husband went to the pharmacy and purchased the tubing and fluids. Correcting the injustice that these women have to buy these life-saving medications before they will receive them is one of the personal missions that I am willing to take on.

All in all, we had a good night at the hospital. We walked home in the morning at about 6:30am, hearing the high voices of the church choirs practicing already.

Here are some photos from Hinche:
Esther was with us on our first night at the hospital as well. She is quickly becoming one of my favorite midwives. She is already asking us if we can stay longer.

A little girl that we met when we were walking home from the store
There was a soccer game at the orphanage complete with uniforms and a coach. Meanwhile some other boys played music on the sidelines throughtout the game. Mostly drumming, the leader was singing and using a ukelele as a percussive instrument.
These boys preferred watching the musicians to the soccer game!
Without electricity, this woman uses a match to find a Coke in her "cooler" at her corner store.

Saturday, August 28, 2010

Pa Pi Mal

Being in Haiti is full of highs and lows. From one day to the next, we view tragedy and then so much joy and life. The day after Day One, we rested. I finally cried when I got home and was retelling the story about how, after the mother had died, I requested that we all get together and talk. It was the 4 graduate midwives, the two students and the two American midwives. We were all now bonded through our grief. I told them the story about how I went to the Symposium for Midwives and the Women Deliver Conference. I told them that the whole world is trying to figure out this problem of maternal mortality. I told them that they are not alone. "You are the ones who will make this better." I told the students that this is why they need to study hard, get good grades and become full-fledged midwives. I told them all that we need to work harder, stay strong for the women. Globally, many women leave midwifery because it is too hard. The conditions are so intense. They burn out. I told them that they need to talk about the tragedies, about the stress of the job. We can help each other through by supporting each other. Cashmere, one of the graduate students, said that from my words, she could tell that we loved them and that as midwives, we are all the same. Yes. That is it. That is why I am here.

The children of Haiti are keeping me grounded. They are so open and happy. Taking pictures is actually opening doors for us to meet people and to be with them. They all know about digital photography, so you can show them their photo right after you've taken it. They all crowd around and want their picture taken.

Ami and Dina and I went for a walk to the store in Hinche. We are very safe here. The worst thing that seems to be happening is that Ami gets lots of men following her and asking for her number phone. Dina and I don't seem to be drawing the same attention.

We are having a good time, sinking in deeper and deeper to the reality of Haiti. As we walk home from the store, a woman asks me if I want to give her $2 to take her photo. In my broken Creole, I say, "No, I only take photos for happiness." She gets it and asks me to take her photo. She is sitting on the porch of her house with her friends, she is obviously the gregarious one who talks to strangers. She laughs easily and draws the community towards her. Soon, I am taking pictures of all the women and the children. I take a group photo. Many people in Haiti have email addresses and want us to send them the photos. One of the women on the porch runs inside to bring out a flash drive. Wow. So strange, but of course, we can put all the photos on the flash drive for her. She may not have electricty nor running water, but she has a flash drive. She walked with us a few blocks down to the orphanage and we gave her the flash drive and a CD full of the photos.

The orphanage is the most vibrant of all. The children play all day. Our house is located on the boys campus but across the street is where the girls are housed. We go over to visit them everyday. 53 orphaned girls stay there with two house mothers. When we arrive, they swarm over to us, testing out their English, asking us our names, holding our hands. Yesterday before dinner we taught them the bump. Dina and I would show them a move and then they would all take turns dancing with us. It's exhausting doing the bump with 25 little girls before dinner! They are the joy and the hope of Haiti.

There is a way that the Haitians greet each other. When you ask them how they are doing, they say, "Pa pi mal." The littlest 3 year olds, the women in labor, the elders. Pa pi mal means "It's not too bad," or "It's not worse." Living with so little, with such tragedy, with such poverty, they rise up and say, "It's not worse."

Friday, August 27, 2010

Day One in Hinche

WARNING: Graphic content. Read at your own discretion. This is the real Haiti.

It’s 1am in Hinche and there’s no one here in labor. It is a moment of peace and rest. A few of the midwives are chatting while the rest of them sleep in the front room on the hard floor. Four midwives who have graduated from Midwives for Haiti are working tonite, as well as the two students who are in training.

The Hinche Maternity ward of this public hospital consists of two rooms. The front room has a gyn table and hutch which stores the midwives’ equipment. The next room is newly “renovated” from just an empty room with rows of delivery beds to 4 partitioned areas for births. Each delivery bed is an old GYN table with stirrups. Some look like they were from the 1950s, others are a little newer. A square piece of plastic covers the bottom of some of the tables, cleaned and reused after each birth. Plastic shower curtains serve as mild privacy enhancers around each delivery area. This allows each woman to deliver in a somewhat contained area. The women labor by walking around the hospital and return to the delivery ward when they think they are close to the baby coming.

Ami, Dina and I arrived in Hinche this morning and were given the hospital tour by Reina, the American CPM who is employed by Midwives for Haiti. She showed us the postpartum ward which is a large room with 10 beds, each with a mother resting. There is an similar antepartum room where some of the women stay if they are laboring or live too far away to go home. There is no clean running water in this hospital and no bathrooms for the women. Each woman is required to bring her own bucket which she will use for elimination as well as catching any blood, amniotic fluid, the placenta and dirtied clothes or sheets that she has brought along to  have at the birth. The woman usually bring a small cloth or sheet to place on the table as well as clothes or a blanket for the baby and cloths to use for their bleeding postpartum. And their bucket. Some women are too poor to even have these few things. Then we deal.

As Reina is giving us the tour of the Maternity ward, she brings us through the front room where of the delivery area where there is a woman lying on the gyn table with her abdomen exposed. I later learned that she was post-op CSEC. In one of the back areas is a mother who is pre-eclamptic. She had already had 2 eclamptic seizures and was awaiting a CSEC. The midwives had already been waiting for 2 hours and didn’t know when the doctor would arrive. Before we left, she seized again. I saw her naked, slumped body shaking with the involuntary movements of eclampsia. The midwives are trying to hold her up, the woman had seized by the side of the bed and had slumped into a sitting position. I went over to them, asking how I could help. Reina was trying to access the woman’s IV in order to push Magnesium Sulfate and slow the eclampsia. I handed her a new angiocath and was looking for gloves. Where are they? Where is anything around here? Dina and Ami had walked out, not knowing what had occurred, but when they came back to find me, I said, “She’s seizing.” Dina looked pale and I tried to catch her eye to reassure her amongst the chaos. I made Dina run out to the pick up truck to grab our medical bag, if only to get gloves for myself and feel more of service.

The midwives hauled the woman, who was quiet now, with postictal foam on her face and chest, onto the bed. I ended up at the head of the bed, pressed into a corner. Reina inserted the new IV and “pushed the mag” while the other midwives tried to hold the woman down, her thrashing with contractions threatened to dislodge her poorly taped IV catheter. Poorly taped because resources are scarce. The IV was placed, Mag on board, and I squeezed my way passed the midwives in order to leave. When would the doctor arrive? If ever.

The Midwives for Haiti truck takes us back to Maison Fortune, the orphanage where we are staying. Lunch was small fried fish, white rice, white bean sauce and a beet salad. I am hungry and happy for the food- it seems a far cry from rice and beans.

In the afternoon, Ami and I go with Cara to the storage room that is a ride away. Cara is a CNM and Harvard trained-public health PhD who is personal friends with Paul Farmer, the legendary tuberculosis doctor who has changed the face of global public health. She is our “cruise director” for our time with Midwives for Haiti. Both Ami and I have hauled 50 pounds of donated medical supplies and baby supplies. We sort supplies and take back as much as we brought, vowing to stock the “cabinets” this evening.

Ami and I arrive at the hospital after dinner. There are already 5 laboring women in the delivery ward.

 Sandie is the woman in what I will call Room One. It is a three-sided area that has a long countertop below a bank of windows. The walls are painted green two-thirds of the way up the walls which off sets the rust on an old medicine cabinet that houses the “sterilized” instruments. A GYN table with rusted metal stirrups is where Sandie is lying. She is on her back, knees up. In labor. The student midwife, Lidemila is taking care of her but she is not with her now. Sandie is alone, legs open. This is her third baby.

Next to Sandie is Denise. She’s 23 and this is her second child. She is quiet but lying in the same position as Sandie, on her back, knees up and open. I can’t tell where her labor is because she is not making any noise. She is in Room 2.

Room 3 is a GYN table that is being used as our charting station. The midwives sit here and document each birth in the big maternity register.

Room 4 has a woman, Christiane — same position. There is a plastic sheet underneath her and a small piece of colorful cloth that she has brought to lie her bottom on. The GYN table is bare, thankfully all of them are cushioned. But that’s the extent of the amenity. Women are required to bring their own cloth or towel to lie on, a blanket for the baby, any clothes for the baby. Midwives for Haiti supplies most of the medical supplies, all from donations from the US. However, if you have a postpartum hemorrhage, you need to supply your own tubing and IV fluids — available at the pharmacy.

Christiane’s baby is dead and preterm at about 32 weeks. I didn’t know that when the head was crowning and noone was with her. Ami and I stepped closer to deliver the baby. The head was small and misshapen. Maybe that was when Ami told me it was a stillbirth. We delivered a small girl, stillborn. Our first official birth in Haiti. The rag-doll limp of preterm death mocked a perfectly formed baby girl. We rested her body on the table underneath the mother’s bent knee. The placenta soon followed. I wrapped the baby in a blue surgical cloth and we showed the mother the baby. She murmured quietly in Haitian Creole, showing no demonstrative grief, simply compassion for the “poor little one.”

Now what? What do they do here with the bodies, so many bodies. Quickly one of the midwives brought in a small cardboard box. Even at her 1.5 kilos, the baby girl needed to be folded up to fit. Her coffin and resting place. I was told to just put the box aside. Where? Just leave it there along the wall, they will throw it out in the morning.

From my knowing that things can be different, I insist that we treat this baby with dignity. From my knowing that change comes slowly, I leave the box by the wall, covering the baby completely with the blue towel. Later, when the room is emptied and another laboring woman assumes the position, I insist on moving the box into the front room, onto a metal table. This is her final resting place, quiet and away from other women’s travail.

No one was with Christiane because everyone’s attention is on Anise in Room 5. Even a young doctor named Carlos is here. Anise is receiving blood — a rarity here. Her hemoglobin is 4, she is dangerously anemic.

But Carlos is not staying. This is not his shift and he’s going home. Anise is not in labor but her baby is dead and she is sick. Her mother is with her, mopping Anise’s neck and face.

Back in Room 1, Sandie has a normal birth — a baby girl at 8:55pm. I witness the birth and am impressed with the student midwife’s skills. Bon travaille to both midwife and mother.

But Anise’s condition has worsened. She seems to be having a bad reaction to the blood transfusion. Her pupils are non-reactive, pulse 100, respirations 32 and very labored. Her lungs sound wet as she breathes heavily in and out. There is no oxygen here to give her. A doctor is listening to her lungs. Her mother is at her side — silent, mopping.

Anise is 26 years old and 26 weeks pregnant. This is her 6th pregnancy. She has 5 living children at home. At 9:10pm, I count her respirations to be 36, too fast. I am much more in EMT mode than midwife mode for the moment. The medications that the doctor prescribes are unavailable at the pharmacy. She is in critical condition.

I leave to check in on one of the women in one of the rooms. Christiane, who had the stillbirth, has gotten up and dressed and is walking out the door. I thought she was going home, but I was reassured that she was just going over to the postpartum ward.

Then I heard SheLove, our interpreter say, “She died.” I flew around to look at Anise and her labored breathing. She was still, eyes wide. I was drawn to her, incredulous. It is 9:20pm. We had only been in the hospital for 80 minutes and already we had delivered a stillborn, witnessed a live birth, and now a maternal death.

She died.

There was no chaos, no uproar, no kicking and screaming about this untimely death. Mothers die here trying to give birth. Women risk their lives by becoming pregnant.

Anise laid there on the table. Her mother was gone. Anise’s body was naked and alone. I moved closer to touch her foot — urgently feeling the need to honor her, give her some dignity in her passing. I was so inadequate. I moved to her side and began to cover her body with the blue surgical paper that was beneath her. Someone had moved to close her eyes. We crossed her arms over her body.

She was brought to the morgue by two men who came by with an army stretcher. I followed them out, through the hospital pavilion guided by the light of my headlamp. We passed people sleeping on benches and broken hospital beds. I followed them out, wanting to know what they would do with her body. I was the procession as we walked out back behind the hospital to the tomb-like morgue. As we turned the corner to get to the back of the hospital, the men carrying the stretcher began singing, low. The moon had been full the night before so the night light was indigo blue. A few other women were following too. As we watched them open the morgue and bring her in, they asked me questions about what happened. “M’ pas comprend Kreyol.” I don’t understand Creole. I guessed what they were asking and told them the baby was still inside. Anise’s mother’s keening had begun from somewhere in the hospital.

At 10:12pm, Denise had a big, healthy boy. He is alive.

At 4:00am, Melange is here. First baby. 33 weeks. Baby stopped moving a week ago. The baby is dead and she was given a drug to induce the labor at another hospital, then referred to Hinche. Now she is having trouble giving birth.

Melange says she is 20 years old, but since many Haitians do not have a birth certificate, this is just a rough estimate. She looks younger to me. She wants something for the pain, but of course we have none. She does not like any exams, so we let her labor on her own and wait.

At 5:50am, Melange’s baby is born having presented arm first.

This is Day One in Hinche.

Thursday, August 26, 2010

I'm in!!

The first day in Haiti was a whirlwind of cultural integration. We sailed through customs and the Port Au Prince airport with no problems. Sister Mary from Matthew house was waiting there to pick us up. Sister Mary is a small, tough woman who has been in Haiti for 5 years. She was formerly a professor of nursing at the University of Buffalo. She is 78.
Our first drive through downtown Port Au Prince was a dusty, trafficky ride, fighting our way through the crowded streets, sharing the roads with tap-taps, people, vendors and UN vehicles. The air is white-dusty, the humidity clinging. We passed piles of rubble, viewing a few buildings that had been destroyed by the earthquake. Sister Mary patiently answers our questions as we try to get up to speed about Haiti.
We arrive at Matthew House to find a virtual developing world oasis. There is filtered bottled water, electricity, fans, screens, clean beds and towels and a newly tiled bathroom. I love Haiti already.
We ask Sister Mary if we can interview some of the families that are living in the tent city. She knows exactly who can help us -- Tey. Tey is the President of the tent city community. Basically that means that he is the go-to-guy for everything. He took us on a tour of the water filtering system at Matthew House, then brought us over to the tent city. It is mid-day, so most of the adults are out working. The children are contained in a safe place and look after themselves. The tent city was constructed on a soccer field that belongs to Matthew House. 70 tents were donated by the Lions Club and maybe ten or twenty more have added on. It is estimated that 700 people live here now. That's down from the 5000 that were here after the earthquake. This is deemed temporary housing and will be taken down in December. 
The children are happy and that is the hope of Haiti. Within the walled-in perimeter of the tent city, the children play, jump rope, go to school. The above picture is of some of the girls waiting on line for milk. Matthew house offers milk to all of the children every morning. Tey mixes up the milk from powder at around 6am. The children wait on line with a cup in hand. They each get a glass of milk. 
The tent city also offers a special larger handicapped tent. 10 people stay there, all amputees from the quake. We talked with a beautiful 14 year old girl who lost her leg.
A young family found us and wanted to show me their baby. We worked our way through the tents to where they were. A beautiful, chubby 3 month old was sleeping. They woke him up and dressed him so that we could take a picture of him. So proud.

We saw so many smiles. We are learning Creole. We are experiencing Haiti. We're in!

Wednesday, August 25, 2010

Night shift at the hospital tonite. Will go to Internet Cafe tomorrow.
Efforting Internet access with Data card. Worked in Miami. Nothing yet here.
We had an amazing first day in Haiti. 700 people living in a tent city the size of a soccer field. We met the children. Woman in labor overnite. Today w
e fly to Hinche.

Monday, August 23, 2010

Thank you, Sharon!

Sharon Hamilton, former President of the Midwives Association of Florida, is the hostess with the mostest here in Miami. She took us to the beach, the giant Whole Foods for last minute provisions, the local Borders for a Haitian Creole dictionary (too heavy, we didn't buy it, don't they have a pocket-size?). Ami Burnam has joined us and a final 45-minute call to AT&T should put us in good Internet access while we're away. We leave first thing tomorrow morning and should be in Port Au Prince before noon. The heat and humidity here in Miami are breaking us in, one last night of air-conditioning though. Clothes are all sprayed, ready to go.
Check in tomorrow!
At JFK in NY. The big bags weighed exactly 50 pounds each. Dina's camera equipment weighed 33 pounds and my medical bag weighed 30.

Sunday, August 22, 2010

50 years!

Yesterday, we celebrated Dina's parents' 50th wedding anniversary with a big shindig in Port Jeff. My mom and dad came down from Rye with Viola and Mary. There were about 70 people there with music and food and a good time had by all. Dina's parents are in love after 50 years of marriage. They renewed their vows and Walter kissed his "gorgeous bride."
This was our last big event before we leave for Haiti. Today is being spent registering online with the State Department, packing up, making copies of passports and tying up loose ends. We can only bring 75 pounds of stuff each, so I hope we are not over limit. By tomorrow evening, we will be in Miami, hopefully drinking a cool one on the beach before our 12 days without easy water and air-conditioning.