Sunday, July 31, 2011

Nou La, Anko!


After a long day of travel yesterday, we are “nou la, anko”! (“We are here, again”, for those who don’t speak Creole.) Dina, Susan, Courtney and I met up in Miami to begin the Haiti 2011 adventure. Susan and Courtney had travelled together overnight from San Francisco, Dina had arrived the night before, and I came from New York. Boarding the plane reminded me of how close Haiti is to the United States. Pow! In less than two hours we would be in Haiti.
Upon arrival in Haiti, the most chaotic part of our trip was sure to be the simple act of getting out of the Port Au Prince airport intact. With Dina’s and my newfound love for Haitian Creole, we were able to fend off those who would lead us astray and finally get picked up for the short ride to Matthew House 25.
Ah, Matthew House. We had only been there two short times before and yet it felt like our Haiti home. Nancy met us with open arms and quickly ensued to tell us updates of the boy with cancer who had lived in the tent city, Darling and baby Matthew, the mother who was in labor while we were here, and other families that we had known. The beautiful, 14 year old amputee that we had interviewed for our video, who was usually at the top of her class, was now having trouble at school. Nancy is worried that she needs psychological support. Hardly surprising after losing her leg and witnessing her brother’s death as a wall fell on them during the earthquake. The soccer field is now completely devoid of tents, cleaned up, walls freshly painted for a soccer tournament that would happen this evening.
Tey, the “president” of the Matthew House tent city, was still there. I showed them photos from last year and passed out photos to Nancy and Tey that I had brought as kado yo (gifts). Back in the states, I printed out 340 prints of photos I had taken the year prior. These would be my ice-breakers for the return trip. I also found my photo book in NY of the Children of Haiti that I had made for my nephews. I brought that along too to show the children, hoping that I would meet them all again.
Soon, the new pink jeep from Midwives for Haiti was here to pick us up. The PINK Jeep! A wonder of modern auto mechanics! 4 wheel drive, rugged all terrain wheels, benches in back like the usual Haitian transport, heavy duty roll bars, luggage rack on top that easily held Courtney’s 3 extra large, 70 and 80 pound bags, 2 extra large suitcases, and a few more large duffles. The area in back was designed to be large enough to carry a stretcher, converting the Jeep into MFH’s homemade village ambulance when needed. The “snorkel” is the muffler, diverted up and over the top of the vehicle, so that when, during the rainy season, Ronel needs to pass through deep water, the water wouldn’t back up into the muffler. The Jeep was donated and made in the US for Midwives for Haiti. Pink matches the color of the students’ scrubs in the hospital and is now, officially, the signature color of Midwives for Haiti.
The road to Hinche from Port Au Prince is mostly paved, such a pleasure! We stopped on our way out of PAP at the brother of our interpreter’s house to buy artwork, witnessing a slice of life on the outskirts of Port Au Prince. For most of the ride, Courtney and I rode in back, speaking every now and then with Peter, the young Haitian driver of our interpreter who was along for the ride. A few hours into the drive, as the terrain was getting more and more lush, we drove through a village that started to look familiar. As we passed through the main market area of town, I saw the familiar sign of Zanmi Lasante and asked the driver to stop. This is Paul Farmer’s model hospital that began as a center to treat tuberculosis and HIV and is now a sprawling wonderland with an art center, a nutrition program, a Women’s health center, dentistry, pediatrics, even a small glass enclosed room that exists as their NICU. We found an American physical therapist who had just arrived 10 days earlier to take us around. I ran back to the pink jeep and found my photos of people I had met there last year and hoped to find a few still there. As I entered the maternity ward, I was met by a familiar face!! It was Marlene, one of last year’s students from Midwives for Haiti!! She remembered me immediately. Having recently learned the Creole word for remember, I told her that I remembered her but did she remember me? She laughed, of course!, and quickly pantomimed playing the ukelele and our singing! She remembered Dina, our big party and the photo year books that I had sent them. I was so excited to see that she had a job in this amazing hospital. We talked excitedly, in my broken Creole. I wanted to know all about her job. Were they paying her well? Was it enough? Was she here on her own? She showed me around, 3 women in labor, 4 or 5 in the postpartum ward. This year, I wanted to go out and speak Creole with some of the midwives. I wanted to know how they were getting on, if they were working as midwives, how were they? Marlene said, “N’a parle en Hinche.” We will talk in Hinche. On August 4th, there will be a continuing education session in Hinche that will bring all of the former midwives back to Midwives for Haiti. We’ll figure out when we can go out and continue our exchange of friendship and midwifery comraderie.
We also toured the pediatric unit where I gave out more photos. The most amazing thing this time was a 50 piece orchestra of kids from Port Au Prince that was practicing on a patio under a tent. The most beautiful, classical music with violins, cellos, 4 stand up basses, the works. So like Paul Farmer, that music and art and beauty are all pieces of healing. We loaded ourselves back into the pink jeep and headed out for our last hour of the drive to Hinche.
Maison Fortune was just as we had left it. Summertime, children everywhere, grabbing your hands are they meet you. We saw familiar faces and were thrilled to see Brother Mike. It struck me that, of course, I would remember them, my first Haiti trip burned into my memory. But how could they remember us, with all the volunteers that come through? It feels good that Haiti recognized us, just as we recognized Haiti.

Thursday, July 28, 2011

Cudos to Courtney!

Yay Courtney for bringing 3-100 pound bags of donated items to Haiti! We should arrive in Port Au Prince on Saturday morning if all goes as planned. Courtney has packed 100 pairs of shoes, 40 newborn blankets, formula and diapers for the orphans at the Azile, a volley ball net for the girls at Maison Fortune, over the counter meds, lots of toothbrushes, kid and baby clothes, a couple of hacky sacs and an Uno deck! Yee ha, you go girl, Courtney!

For those of you interested in details about the state of midwifery in Haiti, here is UNFPA's most recent report:

http://www.unfpa.org/sowmy/resources/docs/country_info/profile/en_Haiti_SoWMy_Profile.pdf

In the mean time, I say goodbye to my nephews:

Daniel


Matthew
 
Mark


 
Nicholas

as I prepare for the trip to Miami tomorrow.

Sunday, July 24, 2011

Testing the email to blog option from my iPhone in NY. This year we are going to try to blog live from Haiti using a tethering option instead of the data card. Had to purchase an international data plan. Still crossing my fingers that it will work!

Sent from my iPhone

Friday, July 22, 2011

Emmett's Arrival

Rebecca and I are overjoyed to announce the birth of our son, Emmett Levi Harris.  He came into the world at 3:59 AM on July 1, 2011, clocking in at 6 lbs 12 oz and 18 3/4 inches.

Rebecca starting laboring around noon on Thursday. We called our midwife, Maria, at around 4.  When she arrived, she checked Rebecca, who was, to our surprise, already dilated to 9 cm.  Expecting a quick birth, we got ready for the delivery.  Once fully dilated, she began pushing.  She was amazing.  With perseverance you had to witness to believe, she pushed for three hours.  But the baby was not descending.  He was just stuck at "station 1," and no amount or walking, pushing, or position changes was moving him along.  At the three-hour mark, we had a frank discussion and all agreed transfer was appropriate.  We made the 5 minute drive to UCSF in Maria's car.  Once we got there, Rebecca made it to the 15th floor, stopping to kneel on hands and knees several times along the way.  The plan was to get her an epidural and some pitocin and hope for some passive descent before pushing again.  After a three hour "rest," Rebecca started pushing again. By this point, the doctors were mentioning c-section as a possible option, and even as a possible outcome.  They were keeping a close eye on Emmett's heart rate, and said it was OK for Rebecca to push as long as she could, so long as the baby was hanging in there.  

It turns out that the problem was one of simple geometry.  Emmett's head was turned to the right, rather than chin to chest.  That meant that his head could not fit through Rebecca's pelvic bone, no matter how hard or how long she pushed.  In other words, this was not going to be a home birth because Emmett had other plans.  

Rebecca pushed for three more hours.  Somehow she managed to get Emmett to station 2, which was far enough along to allow the doctors to offer an assisted delivery using a vacuum device.  They placed the vacuum pump on the baby's head and Rebecca pushed like all hell.  Our baby was delivered vaginally at 3:59am, just before the sun rose over San Francisco. 

This was obviously not the birth plan we had in mind.  But it didn't matter.  We had a dream team of friends supporting Rebecca throughout the night.  Maria was critical to help us through the hospital world, and to keep us focused on our goal: a vaginal birth.  We refused some interventions (like the electrode clip on the baby's head) but decided on the assisted delivery as a last option to avoid a c-section.  After it was all over, the doctor told Rebecca she had never seen a woman push that hard for that long, and said that Rebecca saved herself and our baby from a c-section.  

It was a perfect birth.

Love to all,

Cody, Rebecca, & Emmett

The Birth of Finley Royalton Prassas by Calen




                                                 
My labor came with no warning, at least no warning signs that I recognized. The day prior, my partner Pilar, my mom Janfra and I took a day trip to Pescadero for lunch and we stopped in Pacifica on the way back to the city.  In Pacifica, we took an hour and a half hike along the beach and to the top of the cliff overlooking the ocean.  It was the warmest day that Pilar and I could remember experiencing in Pacifica, so the gentle breeze at the cliff’s edge was a welcomed, rejuvenating yet soothing caress.  We screamed at the top of our lungs into the wind.  I often like to do this at mountain tops or into strong winds because you cannot be heard and feel complete liberty to let go…something I struggle with and would soon need to do regardless of who could hear me.  It is very cleansing.  This was day 7 past our due date and earlier that day we had gone to St. Luke’s, our backup hospital, for a Non- Stress Test.  Although everything looked great, talks of what to do in case induction was necessary had already begun.  We started to get nervous, so by the time we were at our Midwife Maria’s office the next morning for a 9:30am appointment we were visibly anxious.  Maria calmed us by reminding us that most first time deliveries occurred 8 days past due date.  Currently we were exactly 8 days past our due date.  So much of my pregnancy was text book…why should this piece be any different!? Maria also said that the next six days until we were at our two weeks post due date Dooms Day were a very long six days and anything could happen during that time. 
Before the end of our appointment I told Maria that the slight cramping I had been feeling for weeks occasionally felt a little stronger, three times this had occurred to be exact; once the night before while sleeping, once early that morning, and once in her office.  By the time we were walking to the car I felt it again.  Driving home Pilar said something that really changed my attitude. She said “we lost sight of our goal; to have an amazing homebirth.” She was right, and that sealed my resolve to proceed with our original homebirth plan and put the whole non stress test and thoughts of induction at the hospital out of my mind.  I didn’t have much time to think about it because within a half hour I was feeling regular contractions.  I decided to vacuum the apartment and clean the bathroom- stopping only to have the contraction and then start cleaning again.  At this point I was still convinced that this could be false labor so I told Pilar to continue working and wait to call Maria- we had just left her office merely an hour ago!  I apparently convinced Pilar it was also false, or at least early labor because she suggested taking a walk. My mother said that I might not want to do that to which I replied “I am definitely taking a walk!”  It had been part of our “plan,” to take a walk during early labor.  After the next contraction I whispered to Pilar “we can’t take a walk.”  Pilar knew then to call into work and let them know that they would not hear from her again that day. 
The contractions were frequent enough that I started to keep track at 11am.  They were every 4 minutes apart and lasted 45-60 seconds. At 12:30pm I ate a little greens and beans (Kale and cannellini beans) and we decided to call Maria. She said to call back when the contractions were 4 min apart for an entire hour.  The contractions were already 4 minutes apart for the past hour, but we decided to wait another hour to be sure.  An hour later Pilar called Maria to let her know that the contractions were every 3 minutes apart.  I was moving about the apartment these initial hours trying out new spots to find my comfortable space.  I found the chair my grandmother Sylvia made in the hallway at the time Maria walked in at 3:30pm.  I remember her asking if we had set up this as a birthing station, we had not, and she said “see, that’s what happens!” 
Five hours had gone by already but I remember it as a much shorter period of time.  Maria checked me and I was at 5 cm.  I remember feeling like I had worked too hard to only be “halfway…” as if you can really say that 5 cm is halfway.  Maria stripped my membranes again- a midwife at St. Luke’s had done the same during our non stress test the day before.  At St. Luke’s I was at 2 cm and my cervix was very soft.  During my next contraction Maria “encouraged” my cervix to open and in a few moments I was at 6 cm.  I decided to stay on the bed where Maria examined me for a few minutes longer.  This was one of the very few times that I got an extra minute break in between contractions and I slept and woke to the next contraction having completely forgotten that I was even in labor.  From then on I only went back to the bed for examinations and never to labor.  Maria had told us that she would mostly hang back during labor unless she saw that we needed her.  Of course she continually monitored me and the baby, but otherwise she only stepped in to make suggestions like getting into the shower or to say some encouraging words, but mostly she let Pilar and I work together. The best part about that is that Pilar and I actually felt safe doing that work because Maria not only prepared us for this day, but her experience and calm demeanour in the room during labor put us at total ease.
After this point I don’t remember much in the order that it occurred.  I remember getting into the shower, into the birthing tub, out of the tub, back into the tub.  I remember the tub being a little too warm during the contractions, so I stood up for many of them with just knees to feet covered with warm water.  But what I remember most of all is the feeling of Pilar by my side during every contraction.  As long as she was there stroking my arm, massaging me, and making me sip fluids, whatever it was, she was my anchor.  She made me sip coconut water.  I had never tried it before and I thought she was giving me the sweetest nectar on earth.  Pilar’s hand resting on my body meant I was safe and I had the freedom to do what I needed to do without fear.  I remember Pilar leaving my side only 3 - 4 times and ONLY between contractions.  It was the only time that I felt fear and needed to talk myself down, breathing and telling myself she would be back before the next contraction.  I remember hugging her and burying my face in her neck.  I remember Pilar’s encouraging words; “you can do this,” “you are doing so great.”  I also remember her supportive silence which was just as useful and amazingly comforting.  Every time Maria would listen to the baby’s heartbeat Pilar would tell me how great the baby was doing…I came to find out later that Pilar really didn’t know if it sounded good or not but she told me it did anyway.  Lucky for us the baby’s heartbeat remained steady.  That was so reassuring because I focused on the fact that the baby was doing his job so I could do mine! 
Sadly, I also remember my guilt but in a way my guilt was kind of sweet.  I remember screaming “Fuck” once and then apologizing for it.  Swear words became especially ugly to me during labor and I didn’t want them at the birth.  I vividly remember Pilar being in the shower with me and I remember moving her out of the way so that I could lean against the back wall.  She stepped out of the shower and never returned.  I wanted her back in but I didn’t have the energy to tell her that.  I only had the energy to tell her when something was not working.  Two more occasions that come to mind was when I was rocking and Pilar was also trying to rock with me.  Our rocking kept getting out of sync and I had to tell her not to rock me…that one broke my heart because all I wanted to do is tell her how much I love her and how much she was helping me through the entire process.  But again, I had no energy for that.  Last was when I was in the tub and she asked if she could come in.  I didn’t answer because I was thinking about it.  I DID want her in the tub, but I was conflicted because that would mean she would have to leave my focus point.  I had my head buried in her neck and my arms draped over her shoulders.  Could I give that up?  I wanted her in both places. 
I felt a lot of pressure in my pelvis all of a sudden and asked Maria about pushing.  She checked me and I was only at 7 cm.  I couldn’t believe that I was only 1 cm more.  Through the next contraction Maria helped my cervix reach 8 cm.  I was moving at about 1 cm per hour which is good, but in my head I couldn’t believe that so much work was done for what seemed liked little progress.  Each time I was baffled that I hadn’t magically jumped to 9 or 10 cm.  My labor never stalled.  9hrs at 3 minutes apart is about 180 contractions.  Yes, I did the math.  That is the true scientist in me.  Maria said to me that I was moving into transition and that this next stage would be the most intense.  For some reason I was completely ok with that.  Maybe I expected it, or maybe I was just na├»ve because transition is most definitely intense and this is where I lost it a little bit.  I never used a lot of the tools I learned through my readings, or that Pilar and I practiced during our Birth class save 2.  #1) Pilar was my anchor, period.  And #2) I continually told myself to breath low, keep my tone low and in my pelvis to keep those muscles soft and relaxed.  Transition was when I particularly used these ideas, but what my body did was very different.  I found myself moaning the word “ouch!”  Ouch does not seem like a very positive word to focus on and I probably could have used another but the vowel sound in what I needed.  Then I started screaming, high resonating screaming.  I knew it was not constructive, I knew I would lose my voice, yet I felt like there was very little I could do about it. Maria stepped in at this point to very directly tell me that I needed to calm down and bring my tone back down.  It was frustrating because I knew she was right but I felt like I was disappointing her and myself for not being able to do it.  Another time I remember my body acting without my brain was in the tub.  There were 3 - 4 contractions in a row when I was on my knees that I skated around the tub from side to side in spastic animal like movements.  In my head I thought “What just happened?  That was so strange.”  Up until this point my movements had been spastic sometimes but all were deliberate.  These new movements skipped the involvement of my brain all together. Maria checked me again and said that I was at 9 cm and told me to try not to push for a little while.  I asked if pushing was easier than transition and she told me that it was just different and that people described it as better because it involved actively doing something.  I would soon find out that pushing is not easier.  For the next 20 or so minutes (I actually don’t know the real time, it just felt that long) the contractions were so intense that I started to think “I need help,” “I can’t do this.”  I didn’t really want to say these things out loud because I didn’t want these feelings to be taken seriously...but I did say them because I knew someone would talk me out of it with encouraging words which I needed right then. 
Then I said “I can’t help the feeling to push.”  It was still just a feeling at this point because it was certainly not the involuntary pushing which my friend Rachel has equated to throwing up.  Maria gave me permission to gently push during those contractions.  Next I knew Pilar was in the tub with me…though I don’t remember her getting in.  I was leaning back on her; she was holding my hips swaying me back and forth.  It was some of the best pain relief I had felt in hours.  Then I felt the overwhelming and completely involuntary sensations of pushing.  It was not aided by me at first; it was more like I was just along for the ride.  I quickly learned how to help it out a little.  I finally found my low resonating groan again…more like a growl actually.  Growling felt good.  I tried to use the growls during the pushes to bear down and move our baby to the outside world.  It felt so good to rest my ankles on the edge of the tub, but Maria wanted them inside so I could use the resistance during pushing.  So for a few minutes there was a funny little dance of feet in tub, feet out of the tub.  Maria then suggested that I move to the birthing stool to which I blatantly said “No,” but really I just needed a moment to think about it.  I stood up and immediately had to stop.  I had a huge pushing contraction while standing - then moved to the stool which was wedged between the birthing tub and our large dining room table.  Sue Baelen, the other midwife who came in about 30 minutes before pushing got stuck behind me.  She ended up soothing me from behind.  Sue is like Mother Earth and I melted into her (her words) as she sent energy through my body from her hands.  Pilar and Maria were in front of me.  Maria directed Pilar to hold pressure on my perineum (I just realized, this was told to me after- this is not from my memory), to prevent tearing.  I did tear, but elsewhere (labia), so Pilar did an excellent job!  I think in all I pushed for about 30 minutes.  Pushing is intense and no one ever told me it feels like birthing a baby through your rectum. 
I then felt the dreaded “ring of fire.”  It strangely kind of felt good to me.  At least it meant that the head was crowning and that it would just be a few minutes more until we could meet our little one.  Maria got the head and shoulder out (I presume) and Pilar caught the baby and brought it up to my chest.  The three of us just snuggled.  Maria said “don’t drop the baby.”  I guess we looked shaky, but this made me laugh because I had no fear about dropping the baby, no fear about there being anything wrong at all…the endorphins were amazing!  I didn’t even cry.  Pilar cried which is very rare and kept telling me “I am so proud of you!”  We just stared at the little face as the baby started to cry and use its lungs for the first time.  His eyes were open and he was looking around.  We just stared for 5 minutes before even looking to see if it was a boy or girl.  It is a boy!  We could not lift him too high because the umbilical cord was not very long.  Pilar did lift him a little too high once and she said that I started to explain, as if I were a teacher, how everything was still attached.  I find this very funny, but I don’t remember this conversation at all.  I do vividly remember Pilar cutting the cord, however, and then delivering the placenta in one push.  I would have liked to see the cord pulsing…but by 5 minutes it had certainly stopped.  Sue brought my placenta over to us so that we could see how beautiful it was.  She showed us the “tree of life” which describes the main veins running through the organ.  She asked us what we planned to do with it and we hesitantly said that we wanted to cut it up and freeze it for smoothies.  Sue didn’t flinch and offered to cut it up for us!  It wasn’t until a few days later when we discovered the glass Pyrex container in the fridge. She perfectly wrapped each and every little piece in parchment paper so it would be easy to separate. Pilar said it was wrapped like a dream since she was the one who actually made me smoothies for 30 days straight! 
The hormones made me feel ecstatic.  You know when something is so wonderful it makes you cry?  Well, this was so wonderful it was beyond happiness, it surpassed tears, and ended someplace in ecstasy.  Pilar and I named this beautiful little boy Finley Royalton Prassas.  The name came from looking at his face and was never actually on our list…but it just suited him.  And finally we were three.  

Wednesday, July 6, 2011

Homebirth up 20%!!

Yippee! Read the latest AP article on SF Gate here!