Wednesday, December 19, 2012

A non-violent world

If we hope to create 
a non-violent world 
where respect and kindness
replace fear and hatred...

We must begin with
how we treat each other
at the beginning of life

For that is where
our deepest patterns are set

From these roots
grow fear and alienation...
or love and trust

-- Suzanne Arms

Monday, December 3, 2012

Lydia's Birth Story

Congratulations to Divia and Will on the amazing birth of their daughter, Lydia Eden.
Divia has shared her story with us here.

Tuesday, November 20, 2012

Two Essays from the SF Waldorf High School

A week ago, I taught the 10th grade at the San Francisco Waldorf High School about birth and midwifery. Two students sent in their essays. Thank you to Isabel Dow and Madison Evans for contributing to this blog. And, by the way, Aubrey had her baby at home, yesterday! A girl!

Maria’s Classroom Visit
by Isabel Dow

I had been looking forward to Maria’s visit for over a week, and was so excited when Maria found time to come to our class. Last week she had to cancel to attend a birth. I was not disappointed one bit by her visit, and loved feeling how passionate she was about her midwifery. Two days before her visit, our Embryology teacher, Dr. Burkett had led us through all the frightening details of birth, so I thought I knew what I was in for, gritting my teeth in anticipation. While Maria was talking to us and asking us for our input and opinions, my views on birth began to shift. Through her loving, vivid descriptions of the birth process, I realized that the pain of labor pales compared to the bright glowing joy that comes with birth.
            After a short discussion, Maria showed a video of a water birth. In it, the mother suffered through many intense contractions, which looked extremely painful. When the baby finally came out, I watched as the mother, all pain and suffering aside, lifted her child to her chest as pride and joy filled her whole being. I laughed with happiness for her. That was the moment that I realized why mothers are so willing to go through pregnancy and birth, for the sake of a new miraculous birth.
            After recovering from watching the video, we put on gloves, and Maria showed us, and let us feel, a real placenta and umbilical cord. Although my stomach heaved at first, my curiosity allowed me to move passed that, and I experienced it totally.
            Next we moved over to the couch, where a pregnant woman, her due date coming up any day, lay smiling. She was so kind, letting us prod her tummy, feeling her baby’s bum and hearing its heart beat. Sensing this was an amazing experience, I couldn’t believe I was actually hearing and feeling the baby!
Having Maria visit changes my view of birth radically. Before she came, birthing a baby seemed shockingly scary and horrible. However, now I have realized how wonderful it must be to create and nurture a life within ones own body. Although there is much pain involved, it is all definitely worth the effort.

A Visit from the Midwife
by Madison Evans

I enjoyed and learned a lot from the midwife’s visit. Seeing a video of a mother giving birth helped me realize that birth is natural and amazing. Feeling the baby in its mother’s uterus and hearing the heartbeat helped me realize the wonder that there is a  real baby living inside the mother’s womb. I thought touching the placenta was really interesting and cool because it is rare that you can see and feel something that comes from inside our body. After learning so much about the placenta through our class, it was really neat to see it for myself. Learning about water birth was very interesting. I don’t think water birth is for everyone but I do think it is important that the mother at least knows the person who is going to help her give birth. Before Maria came, I never thought about the baby having good or bad experiences during birth. Now that I have thought about it, I do think it is important for a baby to be born into a good environment with both of its parents there. I now have a new appreciation for pregnant mothers and the birth process.

Tuesday, September 25, 2012

Genette in San Francisco!

Well, all I can say is that we have been on the go! I keep asking Genette if she is tired and she keeps saying no, so we just keep rolling right along! On her first day, we went to our local Peer Review meeting and spent the morning listening to cases. Genette found it really interesting and said it was a good experience for her.

In the afternoon, we did a little introduction of San Francisco. We went to Dina's television station (could that not be more different than life in Hinche?), we found a local food festival where Genette tried everything from gourmet chocolates to cheeses to fish tacos to kamboucha!
We visited my daughter's school, met up with Jenni from MANA who nominated Genette for the award, and explained to Genette that she would receive the Sapling award at the conference. I'm not sure if she understands how important it is, but she'll know at the conference.

On Saturday, we had a welcome brunch for Genette and invited some of the donors, local midwives and clients of mine that are so excited she is here. Genette had crepes for the first time and really liked the sweet crepe with pumpkin butter! In the afternoon, we watched my daughter's volleyball game, went to the Pacific ocean

 and finally, a birthday party for a friend of mine that included a "variety show!" She saw tap dancing, a woman playing saxophone, an opera singer, and lots of others. We got up and sang both Dina's "Kijan ou ye" song and one of the Matron songs. I explained what they meant to my friends (about 50 people were there) and they all felt that it was meaningful and powerful to hear what the songs meant and that Genette was here with us.

So, it hasn't just been playing! On Sunday, we went to Elizabeth Davis' midwifery class. I teach phlebotomy and speak on a panel of midwives about our lives as midwives. Genette helped out with the observations of the students trying the phlebotomy and during lunch we spoke about the Midwives for Haiti program. She was on the panel with us and the students really enjoyed hearing her bio and asking her questions.

Monday morning was an observation day at my local hospital with an OB friend of mine. We are all faring well in Creole, and we are pushing Genette to practice more of her English. She understands a lot.
All in all, we are having a ball! We leave for the conference tomorrow. We have been so busy that I have had little time to post. I will update you with more later.

Thursday, September 6, 2012

Genette to come to the US for MANA conference!

I am so excited to say that Genette got her visa on Tuesday! I really think the efforts at the embassy and some critical emails to the embassy really made a difference. She is the first midwife from the Midwives for Haiti program that has successfully acquired a visa to come to the US. One of the criteria that the US embassy looks at to consider granting a visa is a person's salary. Now, of course, the Haitian midwife salaries are nothing like US salaries. Genette makes $6000 per year. This is not to her advantage in trying to come to the US. The embassy looks at this as a sign that she might see how much more she can make in the US and attempt to stay. I am sure that this is why Esther's visa application was rejected. In my emails to the embassy, I emphasized Genette's commitment and dedication to midwifery in Haiti. She is so deserving of this continuing education opportunity.

I think that this will be a significant step in developing Genette's leadership potential. She is already hired as the Clinical Director of the Midwives for Haiti program and is one of the main leaders of the Matron program. Along with Magdala, Dina calls them the power couple. They developed the Matron program which is a 20 week education program for traditional birth attendants in the small village of Haiti where still the majority of babies are being born. You can see what a difference Magdala and Genette are making in terms of education, empowerment and continuity in the Midwives for Haiti program. By bringing Genette to the US, I am hoping that she will be able to expand her vision of midwifery-learning skills and concepts through the conference and in San Francisco.

If you would like to help fund Genette's trip, please send checks to my address: Maria Iorillo, 206 27th St. San Francisco, CA 94131. Write your check out to Midwives for Haiti and put Genette Thelusmond in the memo line. Thanks!!

Monday, September 3, 2012

A Party with the Student Midwives

Midwifery Student Suzette and I, we worked together the first week

Me and my good friend, Esther

Guerlie and I

One of the things that was most different for me on this trip was my own deeper connection with the midwives. Many of the senior midwives are truly becoming friends as we get to know each other year after year. Genette, Magdala, Filomen, Guerlie, Marie Denise, Esther. The first year that I came to Haiti, I was excited to get to know them all, but had little facilitation of that process. The in-country coordinator of the Midwives for Haiti program went on vacation hours after our arrival and just said what amounted to, “You can handle it, right?” Ami and I did a great job of just jumping in, even without any Kreyol. Half way through our 2-week stay, I thought, the program should have some sort of get-together for the future volunteers to meet the Haitian students and midwives. I should recommend this in my feedback to the program. Not long after thinking that I thought, well, why don’t WE have a party?
So, that’s how our partying with the Haitian midwives began. This year, we had the party at the new Midwives for Haiti compound. It is a large, beautiful house with room for their classroom, guest rooms, kitchen, dining room, nice bathroom and shower. Upstairs, a whole second apartment is where Marthonie, the Haitian nurse-midwife and Director of the program stays. The cook at the house prepared the food for the party that amounted to larger amounts of what we always eat: rice, sauce, fried chicken legs, fritay (fried plantains and acra) and pikliz. I made a chocolate cake from a cake mix that I bought at the Ebenezer grocery story. The Ebenezer is an air-conditioned grocery that caters largely to foreigners and wealthier Haitians. Although it is the biggest grocery store in Hinche (or maybe the only), it still only had 3 aisles. Most Haitians buy their provisions at the outdoor market: produce; spaghetti; beans; Magi bouillon cubes which are put in EVERYTHING; canned tomato paste; large, round disks of manioc cracker bread; beef, goat, chicken both live and parts; 50 pound bags of American rice. Carrie made brownies from a coveted box of brownie mix brought from the states. The cook made two more strawberry cakes with actual frosting and decorations.
The party got to a slow start since in the beginning the food was not ready. I showed a slide show of photos of the current class that everyone enjoyed. Then, Ami, Dina and I sang them an updated version of our Kreyol song. We created the song the first year from all of the Kreyol that we knew which was very little. The song says: How are you? How are you? I don’t know, Not know. Then it goes into many of the Haitian greetings for each other: Pa pi mal, Nou la, Na boule, etc. It is a very funny little song that every one really loves because Dina plays ukelele and everyone joins in. This year we added a couple of verses:
Nou konnen plis  (We know more)
Kreyol pou nou  (Creole for you)
Pou chante nou (To sing to you)
Pi bon chante   (A better song)
Le nou travay  (When we work)
Pou bebe yo  (with the babies)
Se la vi  (It’s their lives)
N’ap sove  (We are saving!)
Kijan ou ye?  (How are you?)
N’ap kenbe.  (We’re holding on.)
Pral retorne  (We will return)
Ane procien  (Next year)
Pral sonje nou  (We will remember you)
E espere  (and we hope)
Ki nou ka sonje nou!  (That you can remember us!)

It was a big hit and we have it all on video. I’ll see if we can get it up on YouTube.
Needless to say, we all had a ball at the party, the food was demolished and everyone went home content. The midwives sang us their song of thanks at the end which was the perfect ending to our stay with them. As we were leaving, we noticed the huge pile of dishes in the sink and the two cooks preparing to do the clean up. We felt bad to leave all the mess, but then we noticed that they were happy and singing our song. It was a good day for all.

Thursday, August 30, 2012

Nou La

Midwifery students and their teacher, Marthonie

Nou La is we are here.
Tomorrow is our last day in Hinche. I feel like the time has flown by. I feel like I haven’t posted enough. I feel less of an observer, recorder than the two previous visits. We are in the groove with life in Hinche—St. Therese at night, the orphanage during the day; bumpy rides in the pink jeep, halting Kreyol that makes me feel like I am tripping over myself when I open my mouth. Dina says this is not true and she is impressed that I am speaking in “paragraphs.” Dina tells jokes in Kreyol, so we are even.
The first two births of last night’s shift came within 15 minutes of our arrival. Two healthy babies. Then, I slept. Earlier in the day, I had travelled to Port Au Prince with Genette, the young and inspired clinical director who I am trying to bring to the MANA conference. We left Hinche at 4am to arrive in Port Au Prince by 6:30. We went to the US embassy to try to get her passport. It is always by appointment only at the embassy. Even so, there is a long line that you need to wait in. I had come along, hoping that I could speak on her behalf and confirm her reasons for travel. But, I didn’t have an appointment. Either did Genette. Her appointment had been last Friday, the day that the “hurricane” was supposed to pass through. The day they closed the embassy. She had heard on the radio that all those with Friday appointments needed to arrive on Wednesday for their rescheduled appointment.
I worked my way up the line for Americans and simply told them that I had had an appointment on Friday that was cancelled and that was why I didn’t have an appointment for today. They let me through the security gate and I passed onto American soil.
The American embassy is a solid-looking structure compared to all the other cement and rebar buildings in Haiti. It looked like the outside was granite and the doors were heavy glass. Inside it was air-conditioned, clean and electronic. Each person hoping for a visa needs to get in line to speak with one of the cashiers. The cashiers sit on the other side of a glass window and speak to you through an intercom. It is here that I learned that today’s rescheduled visits were only for Immigrant visas – not the kind we were looking for for Genette.
I told the cashier my story: that we had come a long way; that I am leaving on Saturday; that I want to be here for the appointment. Isn’t there some way that she can be seen today? No. You will need to send us an email to try to expedite her appointment. But who receives those emails? Can’t I just talk to them today? No. You will need to send an email. Can I speak to a supervisor? Oh, you were supposed to have an appointment on Friday, the day of the hurricane? Then, you will need to send an email. You see where this was going.
Strike one. Not out yet though. Genette never even made it through the security gate. To take advantage of our trip to PAP, I asked Genette’s brother Gito, who had driven us to PAP, if he could show me the Neg Mawon. It is a famous statue outside of the President’s palace in Petionville. The Neg Mawon symbolizes the freed slave who was now marooned on this tropical island. It is a symbol of strength and commitment for the Haiti people. 

I also saw the damaged presidential palace. 

After a small bite to eat, we headed home. When I arrived back at Maison Fortune, I sent an email.

Needless to say, I was tired that night, and, after our first two births, I slept for 4 hours. Soon after I woke up, a woman came in with a small hand peaking out of her vagina. This was not good news in any way. She was only 30 weeks pregnant, dangerously premature. The baby was thought to be in a transverse position, but as the baby began it’s descent to be born, the hand retreated and a small rump appeared. The staff midwife and the students could not find a heart beat, so the baby was presumed dead.
With a stillbirth in a breech position, the students know that the best thing is patience and to let the birth proceed at it’s own pace. The baby’s limp and lifeless body slowly emerged. There is always a point in a breech birth that looks odd because the body is out and the head is still inside the mother. With a complete lack of muscle tone, the baby’s body slowly crumpled in a small heap as we waited for the head to be born. Then, a small convulsion of the baby’s body. Was that for real? Is this baby alive and fighting for life? It happened again. Yes, this was a faint sign of life in a baby that we thought was no longer living. But truly, this movement was only a reflexive action of the baby’s nervous system. There was no muscle tone, no reflexes, when the baby was finally born, no breathing effort.
So here was the flip side of the coin of our experience with the baby, Miracle. Was this baby in need of a massive resuscitation effort that couldn’t be sustained and that would ultimately not save the baby’s life? Was a day or two of living worth the effort? This baby was unresponsive, not breathing, unconscious, but had a slow heartbeat. Without words, we all knew that this baby wouldn’t make it. It was too early, too difficult a delivery, too far gone. We were the ones who had to suffer through the 20 minutes of its short life. Who gets to decide who lives and dies? Is a massive, heroic American effort to resuscitate a baby the right thing to do when there is absolutely no ongoing care here for premies? Even if the baby were to live, the risk of brain damage is great. Is it fair to ask an already impoverished family to take on child that will always be a burden? The answers are impossible to know, so instead you go with your gut. For me, I knew that this baby wouldn’t make it and that instead, it might be better to have the mother just hold the baby for the few minutes of its life. Except in Haiti, most mothers don’t even look at their babies that are born healthy and alive. The mother declined the offer to hold her baby.
We wrapped the baby in a small, blue surgical towel, giving some semblance of comfort. The baby lived for 20 minutes and never made a breathing effort except for its spasmodic, occasional agonal breaths. Later, the mother stood in her white mesh “culotte,” unsure of the next steps when you are leaving the maternity ward empty handed. It was her first baby.
The next, and final, baby of the night was born healthy, if not full of drama. The mother was reluctant to open her legs and was quite loud in her travail. The mother’s name is Darling and she named her baby girl, Guerline. She smiled when I asked to take a photo of her and her baby. A moment of pride.

Monday, August 27, 2012

Just a few photos.....

at the end of a long day. We went out on the mobile clinic in the morning, interviewed Magdala after lunch, met Genette at Maison Fortune, and had another dance party with the girls. I'm tired!
Mobile clinic

Sunday, August 26, 2012

Hurricane Isaac Means Get Your Soap

August 23, 2012

Brother Harry is wearing a sweater this morning. I celebrated the weather as well and put on my one long-sleeve, travel shirt. The central plateau in Haiti never really gets the full effect of a hurricane because it is surrounded by mountains. The mountains break up the pressure system enough so that Hinche lives in relative weather security.
Yesterday as the hurricane began, we had a full 15 minutes of spectacular rainfall. The prepubescent boys stripped off their clothes and splashed around the outdoor basketball court. Others soaped up underneath a cascade coming from the roof drainage system of our two-story guest house and administration building. The soccer field flooded which was an invitation for two boys to slip around playing Frisbee in the rain. Nearly as quickly as the rain had started, it finished. Was that it?

We awoke in the middle of the night to fierce winds. Dina and I got up and took the clothes off of the line on the veranda. This morning it is cool and breezy with a light rain falling. The girls are wrapped in small blankets as they venture out of their dormitory. Maybe it is 70 degrees.

My second shift at the hospital was a constant barrage of births and medical crises. At one point, a pre-eclamptic woman gave birth unexpectedly in the antepartum room. Her premature baby lay lifeless on her chest when Ami joined the other midwives attending to the scene. No one seemed to be paying much attention to the baby. Ami immediately grabbed the child in a torn sheet and brought her into the labor ward to resuscitate her. I joined her in the effort.
We worked on the lifeless little one for at least 20 minutes. She was unresponsive and limp but her heart beat never faltered. She could have been that way because of the Magnesium Sulfate given to the mother for her pre-eclampic condition. The little girl looked to be only about 3 pounds, 36 weeks by dates but looking like a 32 or 33 weeker. At some point in the resuscitation we knew that we couldn’t just ventilate her forever. At some point, you just have to decide that you’ve done enough and see if the baby will breathe on her own. We let her try a couple of times, only to begin the resuscitation again. Eventually, however, she held her own tentative breathing pattern. Still, she had not responded to stimulation and her eyes were glossed over.
We watched her for over an hour before we started to think about bringing her back to her mother. Would the mother want to spend time with her baby who might have only a few hours to live? Would the baby survive a disruption of her stabilized state? Ami and I agreed that the baby was stable enough to move and that the mother should get a chance to see her alive and decide for herself what to do next.
The mother was lying emotionless on her cot in the antepartum room. We brought in the tiny child and lay her down next to her mother. The baby was snuggled inside a receiving blanket and just her little face was visible, her eyes were closed. The mother barely looked at her. When we discussed her daughter’s tentative vitality, she placed her arm over her eyes, hiding her response. We asked her whether she would like the baby to stay with her, or whether she wanted us to take the child back into the labor room with us for observation. She wanted us to take the baby away. We did and simply watched and waited to see if the baby would survive.
Within a couple of hours, it was clear that our little one was holding on and that she could safely stay with her mother without observation. Of course, this is all relative because in the states, this baby would have been in the NICU for weeks. We brought the baby back to the mother and they both slept. Whenever I went in to check on the baby, she was still breathing. By morning, she was opening and closing her eyes and moving around, just a bit. Without ongoing care, this one will have a hard time surviving the first week, the first month. But she survived through the night and that says a lot. In Haiti, one of the greetings is “N’ap kenbe” – we are holding on. Against all odds, the littlest Haitians embody their country’s affirmation of life.
The rest of the shift was a steady stream of mostly first timers. Two babies were stillborn and 3 babies were healthy. Honestly, I can’t exactly remember how many births we had that night. At one point, I took a 2 hour nap on the hard cement floor; the rest of the night was busy.
 At the orphanage, we have been learning Creole with Kenel, the young man who is full of hope and potential. He just passed his 12th grade state finals which means that he is officially a high school graduate. We celebrated at a night club in town where a live band was playing Kompe music. He said it was his best night out ever.

During one of our Creole lessons, our favorite little boy, Oday, sat in with us which he is want to do. Distracted from the Creole lesson, Oday had figured out how to use the flashlight that hung from Dina’s belt loop. She said that she hadn’t known how to turn it on continuously and was glad that Oday had figured it out. Mind you, he’s 6 years old. He returned with the following question in Creole, “Pou ki sa ou te achte yon ti flach e ou pa konnen kijan ou kapab itilize li?” Why did you buy that little flashlight and you don’t even know how you can use it?

Postscript, Sunday August 26, 2012:
Our little one, that we affectionately named "Miracle," lived for about 30 hours. We walked up to the hospital yesterday during a break in the rain to check on her condition. The midwife on duty told us that the baby had died around 6:00am. The family hadn't told the mother yet, only saying that the baby had been transported to a better hospital. As far as we could understand, they will tell the mother about the death once she is at home. Perhaps they are looking for some privacy to break the news. We told the mother's cousin that we had done everything that we could do, but that the baby was just to weak and little. We told her that we would pray for them.

Wednesday, August 22, 2012

First Shift at St. Therese

Ami and I worked in the hospital last night with 3 students: Suzette, Marie Rose and Sonis. I was surprised at my reaction this morning as we finished up our shift. I felt speechless and overwhelmed. In contrast to my ease with the orphanage and the flow of Haitian life, I felt despondent and discouraged at the familiar hospital scene. Three women gave birth in the wee hours of the morning after a slow start to our shift. With each one, I felt moments of regret; this shouldn’t be happening like this.
The first mother to give birth was a young, first timer who accidentally gave birth in the antepartum room. Antepartum, postpartum and post-op are large rooms with 12 beds, one woman to a bed. The rooms were completely full all night. The other two women who gave birth through the night had to stay in the labor ward because we had no empty beds. The young mother gave birth almost painlessly. Her sister told us that she was sleeping when the baby started coming. The mother looked no more than 17 years old, although the midwife claimed she was 22.
She gave birth in the antepartum room, without opportunity for privacy or modesty. We had to clean up the baby and mother without the simple luxury of a partition or sheet to separate her from the other 11 women in the room. Thankfully, the baby was gwo e asante (big and healthy). As the midwife in charge rubbed the baby to a hearty cry, the mother looked away, disconnected and masked. Her face gave no hint of what thoughts lay within. This is a familiar response to birth in Haiti. The mothers seem overwhelmed and disconnected to their babies. The only explanation that I proposed my first year here was that there is so much infant death. Still birth, infant death, children not reaching the age of 5. Giving birth risks her own life as well. With such odds, mothers bond tentatively and slowly, too familiar with the pain of loss.
It is also poverty. I have no idea what it may mean for a mother to have a child here. We so rarely witness joy as a reaction to birth. A baby means another mouth to feed, school and clothe. An already impoverished family may not see a new baby as a blessing. My first year here, I tried to emphasize each healthy birth. We encouraged the mother to speak to and touch her child. “This baby is so big and healthy,” we would exclaim. “Look, how beautiful, a girl, a boy.” Could we possible teach a mother how to bond?
The other two births this morning also produced healthy babies. One woman had been literally wailing for what seemed like hours. She had been coming to the hospital for the last 5 days; a long, early labor that was possibly indicative of a posterior baby. At the peak of her labor, the midwife on staff examined her and said she was 5 cms dilated. I was outside at the time, trying to nap sitting up in a chair. I finally went in to really understand why this woman was literally screaming. She seemed to be pushing with each contraction. I asked again how far dilated she was and why she was pushing at 5 cms. The staff midwife, a student from the prior class, seemed disinterested in the pushing effort in front of her. I told them I wanted to do an exam. Sure enough, the woman was completely dilated and the baby was minutes away from being born. I felt disturbed by the lack of competence and follow through that ultimately led to a chaotic rush to prepare for the birth. This shouldn’t be happening this way.
When the woman actually gave birth, meconium-stained amniotic fluid flooded the floor and the top of my sneaker. The baby needed to be suctioned with a DeLee, which the students had never seen used before. I was glad to show them a new skill. Sonis did a fine job suturing.
The third mom was rushed also; a general understanding of preparedness will be our teaching theme for the week. Ami and I walked home at 6:30am, grateful for the 3 healthy babies, but not without noting the small, taped up cardboard box on the counter all night that stood sentinel to the truth that neonatal mortality is a constant tragedy here in Haiti.
Watson is a 7 year old orphan boy at Maison Fortune. His nick name is Wa Wa. Here is the letter that he “sent” me yesterday:

Kreyol Lesson

Tuesday, August 21, 2012

There's Blood on the Floor

Yesterday was our first day working at St. Therese, the regional hospital in Hinche where Midwives for Haiti is headquartered. Things have seemed so familiar this time around; WE are the ones who are less wide-eyed than before. So, of course, it was death that met us at the door. The first and only birth that we witnessed Monday morning was a 24 week stillbirth. The baby had a genetic defect that undoubtedly contributed to his demise. Ami helped with this birth while I worked with the other midwives. We had many women in labor that morning. Each shower-curtained stall had a woman in it. Some women were accompanied by family, most were being cared for by one or two Midwives for Haiti students in their signature pink scrubs.
I was assigned to work with Marie Rose for the morning. She is an older woman, perhaps in her 50s, which is unusual. Most of the students are young women in their late 20s or early 30s, eager and willing to work hard and upgrade their knowledge and skills. Marie Rose is more old school. She is set in her ways that are sometimes incorrect. I soon learned that if I just showed her the correct way, she was totally competent. She thrives on the small tricks of the trade. If I can follow her for the two weeks that I am here, I hope I can bring her up to speed with the rest of the class.
The majority of students are competent and sweet. They have learned how to place IVs, treat pre-eclampsia, deliver babies, rub a woman’s back in labor. Yet, it still seems that there are cultural and professional differences in the Haitian way and the American way.  Most of the work space is untidy, simple wrappers from hypodermic needles and gloves strewn about. Medicines are in disarray. The blood is still on the floor as the next woman comes into the stall to deliver her baby. We observe, we teach, we wonder how much will be retained.
When the steady flow of laboring women eased, I cleaned and organized the supplies. I remember this from last year. Modelling, I am hoping, is the best way of teaching. 

It is always the orphanage that allows us moments of pure joy here in Haiti. Last night as we went over to the girls' compound, Dina and I were immediately swarmed by 20 or 30 girls, no exaggeration! They were so excited to see us that they began chanting our names, "MA-REE-A, MA-REE-A, DEE-NA, DEE-NA!" We had to squeeze up the stairs to the third floor with two girls on each arm, many in front and back. En masse, we slowly made our way up and up until we reached the small room where we showed them photos of themselves from 2010 and 2011. We handed out piwilis (lollipops) and the atmosphere was animated and energized as the girls saw photos of themselves and their friends. One little girl, Joska, glued herself to me, at times rocking back and forth as we stood watching the show. I sense a loss of adult nurturing; most of the girls have to be independent and take care of themselves from such a young age. Of course, the girls (60 in all) take care of each other. But if there is a substitute mother around, many of them take advantage of a cuddle or hug to soothe a wordless ache. I feel lucky to experience a moment of tenderness with any of them. They fuel my  resolve for a better experience for the Haitian mothers and babies.

Saturday, August 18, 2012

Matthew 25 and Maison Fortune

We arrived quite smoothly into Port Au Prince yesterday morning. The 1 hour and 45 minute flight was quicker than it took for us to get from Port Jefferson, Long Island to LaGuardia airport. Upon arriving in PAP, we needed to gather our bags and make it through the aggressively eager porters to find our ride. This time, it was surprisingly calm and uneventful. We were met at the doors and whisked through the travelers to an awaiting Matthew 25 vehicle and Ricardo, a familiar face. Within 20 minutes, we were at the traveler’s lodge.
Matthew 25 is the place that I wrote about 3 years ago. A tent city was erected in the soccer field next to them that at one point, immediately after the earthquake, hosted 2000 people. Today it is being used for a different purpose – the local soccer championships! So wonderful to see life back to normal.

Nancy, our friend at Matthew 25, says that the big success story here is a young girl named Reginette. She lost part of her leg in the earthquake and was part of a video that Dina made our first year here. You can see the video here. Today Reginette works at Matthew 25 as part of the housekeeping staff. She is a straight A student and says she wants to become a journalist. Most importantly, when she started working here, she was very shy and reserved. She was 13 when the earthquake struck. Today, Nancy says that she plays Uno and Sorry with the staff and is coming out of her shell. She was all smiles for us as we showed her the video of herself.  She uses the money that she earns at Matthew 25 to pay for her school books and to support her mother at home. 

Having arrived a day ahead of our departure for Hinche, we did some much desired exploring of Port Au Prince. We went to the outskirts of the city where they make the metal art that is signature Haitian. We ate at a local restaurant – fritay, which means fried. They sell fried meats, plantains, potatoes covered in pikliz, which is their spicy coleslaw. We also stopped at the Italian hospital, St. Damien’s, looking for my friend Esther. We found Anise instead and chatted in our very rusty Creole.
Today we arrived in Hinche at Maison Fortune. The girls remember us and remember my name!! Dina, Ami, and I went over to the girls compound and were immediately swarmed by children. We were surrounded by about 12 girls each. Ami ended up being covered in glitter and admired for her tattoos. Dina started writing down the girls’ names and pretending to be their teacher. I practiced my Creole, while the girls told me their names in English. I showed them photos on my iPhone which prompted them to gather even closer. If I have your photo on my iPhone, you were a star in Haiti today. I called Dina to rescue me when my swarm was nearly on top of me.
We are so happy to be here. The children are a year older, they have learned more English, we have learned more Creole. We can already see the power of continuity on their smiling faces.
Donating 10 pairs of shoes to the orphanage

Tuesday, August 14, 2012

Ayiti Anko


Dina and I are careening toward our Haiti departure date this Friday. We spend our time weighing baggage to make sure we don't go over the 50 pound limits, buying last minute items like lollipops, beef jerky and Imodium D, calling airlines who won't waive our baggage fees even though they've done it before. Genette emailed me and knows that we are coming soon. We leave for Miami on Thursday night so that we can be in Florida for a 7am departure to Haiti on Friday morning. I'm getting excited.

This year will be a continuation of our work with Midwives for Haiti. We will follow up with Magdala who is the lead midwife for the mobile clinics. She also runs a school for 600 children, has taken in 12 orphans, hosts a cholera encampment on her land and works her shifts as a midwife at St. Terese hospital. We were hoping to find her a major donor to help with her dreams of building an orphanage on her land but so far we haven't found the right funder.

Genette is one of the clinical instructors for Midwives for Haiti that I am trying to bring to California for the MANA conference. The visa interview was delayed until August 24th. That is problematic since by the time we even know if they approve the visa, it may be hard to get airline tickets for a mid-September visit to the US. I am hoping that my presence in Haiti when she goes to the interview will lend legitimacy to her proposal and that we won't have any snags. Haiti logisitics are always tentative and unpredictable.

As usual, we will try to blog live from Haiti using a personal hotspot from my iPhone. As long as it is all working, you'll be able to follow along with our trip. In the meantime, be sure to check out Dina's videos on my YouTube channel. Here are the links:

2011 Midwives for Haiti Update

2010 Midwives for Haiti Update

2010 Port-au-Prince Tent City

Friday, June 22, 2012

The Birth of Evan

  At 40 weeks, Maria said that the baby was still pretty high and recommended to walk. I started to climb Bernal Hill every day and it felt really good! She also recommended to go back to my Zumba classes, which I have been taking until 37 weeks... and she even came with me! :)

I was a bit surprised to reach 41 weeks, on March 22nd. My daughter was born on her exact due date, 3.5 years ago, and I guess I was expecting this baby boy to come out close to the guess time as well. My french due date was actually passed only 2 days ago, so I was then relying on this one. I went for a non-stress at the hospital (Kaiser) on that day and it went very well. An induction was scheduled for the following week.

I was having some mild cramping and had two false start at night during the last few days, so I was optimistic and staying confident that this "false" or "pre" labor was leading somewhere sometime soon - at least before the induction. I was tired though, as it was difficult to sleep through it. That evening, I asked Maria what I could do and she suggested to take a bath and have a glass of wine. That's what I did and the glass of wine was amazing! It took me some time to drink it but I was definitely feeling more relaxed and sleepy. I went to sleep around 11pm.

I woke up at 2:30am and I was having my first 'real' contractions. I felt some leaking so I had to wake up my husband to protect the mattress and the floor so I can stand up and go the bathroom without making a mess (in case my waters would break). I was not able to go back to sleep in between the contractions, and may have been afraid that they could go away if I was falling asleep! I was happy and hopeful to be in labor as I deeply wanted this homebirth. I knew it was real labor because they were not going away even though I was changing positions, eating, etc. I started to time them. At some point I went into the baby's room and labored in there, sending my husband back to sleep. I wanted everyone in the house (including my daughter and in laws) to sleep so I was very quiet.

Everybody started to wake up in the morning and I went back to bed around 8am. I was tired. I was waiting for the contractions to get into a regular and active pattern but this was not really happening. They were sometimes close together but short, some other time further apart but more intense, but I was not getting a 4-1-1 pattern yet. I first called my dear friend and birth doula, Ti, so she knows I was in labor and probably needing her on that day. She told me to call her back when I needed her to come. Then I called Maria, she asked me if I wanted her to come and I wanted to say YES but I knew it was still early and we agreed to stay in touch in the morning.

My daughter left with her grand parents to go to preschool. Maria said to start filling up the birth tub by the phone and Yann did that, but it was a bit more complicated than when we did it before labor started, 'to try it out'. I was getting tired to be on my own as my husband was busy with the tub so I called Ti and asked her to come. When she arrived she helped me to realize that I was still in early labor and that it could be long... which was so difficult to hear! She suggested to stop timing the contractions and focus so much on them, and to go for a walk. I'm glad she suggested that and I wanted to do it, but I was a bit scared to deal with the contractions in the outside world. We went out thinking we'd go one block away from the house. I had a few contractions and was able to manage them. So we decided to go on Cortland Street a few blocks away to the coffee shop. We stopped at the pizzeria because it was smelling good and I had a few bites of a slice, in between two contractions. Then we decided to go up the hill... which I have been doing every day for a week. I was hanging from houses' fences and my husband when I had contractions. I didn't really mind what people could think. I climbed some stairs at the top of the hill and we came back. It took us a long time! The weather was really nice.

When we were almost back home, I know I needed to go to the bathroom. Ti told me that a change could occur after I went to pee. I had a strong contraction on my outside stairs. And indeed, everything changed as soon as I went to the bathroom. Contractions began to be every 3 minutes and at least 1 minute long, there was a clear pattern change as they were stronger and closer apart. Everybody was trying to have a few bites of food in between contractions in the kitchen. We called Maria and asked her to come, she arrived less than 30 minutes later.

Maria checked me and I was 5 centimeters, exactly what I was thinking and hoping for! But she also said that my cervix was thin and soft and that I could dilate easily the next centimeters... I think this few words set up a new tone and direction in my labor. It took me 12 hours to dilate until 5cm, and only 4 hours more after that until the baby was born.

At this point I labored standing up and doing squats when I was having contractions, leaning on my husband or Ti. Ti was massaging me in the back and legs and it felt great. Then something strange and very pleasant happened. I felt like a hormone rush and very confident. The beginning of a contraction was painful, then I was working hard on relaxing my pelvis and cervix as much as I could, until reaching a point in physical relaxation that was making the pain disappear, making me feel so powerful and happy! I was laughing, in the middle of the contraction, kind of a laugh and cry at the same time, because it was so good!! I was working with my body, with my baby, and everything was in harmony. I was feeling the pressure and the baby coming down at each contraction.

I started to feel tired on my legs and moved into the bed. One contraction later I was feeling hot and cold, a bit dizzy and nauseous. I almost threw up but didn't (which was one of my fears, with tearing, though at the moment I was okay with it!). I thought I was in transition because it was exactly how I felt when I was in transition during the labor of my first child. Then I decided to lay down in the bed, on my side. I wanted to rest, but it took me a few contractions to feel okay dealing with the contractions in this position. I think Maria checked me again to see if it was a good time to go in the pool. I was 8-9 centimeters.

I went into the pool and it felt AMAZING! I didn't want to work anymore! I just wanted to relax and enjoy the sensations of being in the water... Contractions slowed down. Maria encouraged me to go back into a squat position, in the tub, and I was reluctant because I knew it would bring more pain and stronger contractions. It took me a little while but I did it and it definitely brought back strong contractions. Then Maria checked me again and I was fully dilated. She could feel the bag of waters and I asked to break it to facilitate the pushing phase... she managed doing it in the water with her fingers. I was getting impatient, and scared. It turns out this baby was bigger than my first one (8lb6oz over 7lb10oz) and I could feel stronger sensations/pressure while the baby was descending. I couldn't see the pushing phase coming. I was asking for help and getting a little bit dramatic... In retrospective I think it was my way to stay connected to my birth team, I needed them to know I was struggling and needed their support, and they all responded to it.

I couldn't feel the pressure and the urge to push in the tub as I probably could have felt it outside. Maria offered to go sit on the toilet and I didn't want to, I wanted to give birth to my baby in the water! I started pushing and I was feeling like I didn't know what I was doing. I was feeling unstable in the tub and asked my husband to come in so he can support me, which he did right away. Finally and very suddenly I felt the head coming and decided to get it out through the same contraction no matter what. I was crowning and asking what to do, my husband I think reminded me to do the horse lips like I told him to... I tried to breathe and relax my jaw which was so difficult... but it was fast and the head was out. I put my hands on his head and felt his hair. Another contraction and the rest of the body came out. My baby boy came on my chest and he looked perfect... He was covered of vernix and so soft! I loved his smell. The pushing phase lasted 23 minutes. My husband was crying, telling me that our son was beautiful.

I was loosing some blood so Maria wanted me out of the water pretty quickly, to know how much I was loosing. Maria clamped the cord and Yann cut it. The second midwife Sue took my baby while I was getting out of the tub to sit on a birthing stool, where I delivered the placenta. Sue gave me my baby back very quickly. I was helped to go in my bed after that. The bleeding stopped quickly and everything was okay. Baby was doing very well. I had 2 stitches first degree and Maria did a great job with it. It was the busiest time for the midwives who were making sure both of us were doing okay and very focused on what they had to do.
Before and after that, they were so relaxed and confident in what was happening! That was very reassuring to me and made me feel everything was normal, reminding me this was a joyful event. My boy latched on on both breasts and was sucking very actively for a while. After about one hour, my daughter came to meet the baby and this was a very strong and emotional moment to me.

A few reflections

Before wanting a homebirth, I wanted midwife care for this pregnancy. I wanted continuous care, choose/know the person who will be there when I give birth, and get some postpartum care (6 visits instead of 1 through the regular hospital care...). When I realized that midwife care was going along with homebirth, I started to think about it, get more information, go to Meet the Midwives at Natural Resources and watch homebirth videos on YouTube. I was already a few months pregnant. After meeting some midwives with my husband (and getting his support about doing it), it suddenly became obvious that it is what I wanted to do.

During the last 2-3 weeks of my pregnancy, I really needed to be surrounded by other women who had a homebirth or where also planning on having one. I needed to hear about their stories in details or share our plans/excitement/concerns when they were expecting too. I have two friends who had a successful homebirths and I wanted to hear again about their stories. I established quick and strong connections with some other women under the care of Maria as well, met through the group that she is facilitating in her office twice a month. At some point I couldn't hear about other people's questions or fears about our birth plans, even coming from close friends or family, I just needed to protect myself and feel part of a community who was sharing the same goals and birth philosophy.

I think women who plan on a homebirth are even more educated about the birth process. Watching many videos is part of the preparation, and I learned so much through them... Can the baby stay safely in the water when the head is out but not the rest of the body? What does the placenta looks like and what are the ways to birth it? What are the best pushing positions to avoid tearing? Also, a homebirth includes material preparation. My midwife gave me a full list of supplies to get ready and believe me, you learn a lot while figuring out why each item is asked for... You need to think about where and how you want to deliver in your home, find a bowl in your kitchen to receive your placenta, buy some plastic tarp to protect your floors and mattress, and so on! You are in charge of your own birth event.

I had a non-medicated birth at the hospital with my first. Although everything went accordingly to my birth plan without any complications, I needed to tell mybirth story as often as possible and probably provided more details than people wanted to hear :) I think I was a bit in shock, because of the intensity of it. It also lasted 30 hours + and I was exhausted at the end. Whatever is the reason, I do not feel the same about this birth. I feel much more at peace with it. I needed to ask a few questions to Maria and to Ti a few days after the birth, but that's about it. It don't feel able to relate the simplicity of the story. I feel like I'm sharing a secret with the people who were there. They know.

It looks like I was very suggestible during this birth. When Ti told me to expect a possible change when we came back home after the walk and going to pee, my contractions began suddenly much stronger and closer, Ti called Maria within 10 minutes after that. When Maria checked on me the first time, she said I was 5 cm and that my cervix was so thin and ready that I could dilate very fast if I wanted to - and it took me 'only' a few hours to be complete. When Maria told me that the head would be out a 'handful of contractions' later, I almost got angry at her because I didn't want her to give me false expectations or hope... but only one contraction later the head was out! I don't think these are coincidences. I think I had so much faith, love and respect for all the people around me that they were really able to influence me - my labor and my body. Considerably! Trusted people and familiar environment are invaluable.

Midwives are amazing. They know exactly what to do and what to say, at the exact right time, to help you get going, reassure you, or just help you to keep trusting your body. They are not necessarily talking or doing that much... but when you need them they are here! A few times during the pushing phase I screamed "Mariaaaaaaaaa, help me!' and she did. They have a very safe presence and never give you the feeling that they know better than you what is going on. They let you take the lead so you feel powerful and able to push this baby out.

Someone asked me if there were some disadvantages of giving birth at home. I would say:
- there is quite some work to do during the first few days after birth for the dad, in terms of cleaning up (doing laundry to wash the sheets and the towels), especially if it was a water birth, and you can't really wait and let this sit for a while ;)
- it is wise to make plans ahead for the first few days: since you are at home and more likely walking fine, people around (or yourself!) may start doing things on day one that nobody would expect you to do if you were in a hospital... it was almost like nothing happened and I realized it was wrong, I was not ready to go back to 'normal' life especially with a toddler around, so I forced myself to take the time to heal, recover, and enjoy those precious few days (but I wish I had envisioned it ahead of time)
- financially: since we are at Kaiser, we had to pay out of the pocket all costs (somewhere around $5000). We have no regrets at all, of course, but that's an aspect to consider.