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.

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

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 12^th 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.

Oday

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.

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.

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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

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.

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

Ayiti Anko

Genette

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.

Magdala

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

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.

Making Mothers Visible

For the next 2 weeks, you can view yours truly and 55 other mothers and midwives on display on the outside of the SF Public Library. It is part of a project of the International Museum of Women called Making Mothers Visible. Here is the link to the Noe Valley Voice article about the show :
Making Mothers Visible.

Sekou's Birth by Fiona

 

On the night of the 4th of December I was 41 weeks pregnant. We lay in bed and Nancy, my partner, searched the Internet for ways to induce labor. I was scheduled for a “no stress test” at the hospital the following day to be sure our little one was healthy inside me. Nancy found an article on nipple stimulation that suggested if you stimulate your nipples for 45 minutes then with in 48 hours labor is likely. We tried this and within fifteen minutes I was in labor.

At 9:44 pm I said, “I think this is what a contraction feels like.” It felt like a mild to moderate menstrual cramp. The cramps continued varying in length from one minute to three minutes. The resting time between contractions varied from six to ten minutes. Nancy kept track of my contractions in a little book documenting the frequency and intensity. We called our Midwife Maria and informed her that we were in labor. Maria told us to call her when the contractions were four minutes apart one minute long and in that pattern for an hour. “In the mean time” she said, “Get some rest.”

At about 2am the pain during contractions became intense. I began to throw up with each contraction. Nancy massaged my back in long strokes from my shoulders to my lower back and she pressed my hips together. We lit the candles that our friends and extended community made for us.

I lay on my side in bed and tried to rest and then got up in excruciating pain and ran to the bathroom to throw up repeatedly. At some point I had nothing left to throw up. Nancy made frozen recharge drink cubes, which I sucked between contractions. With each contraction I lost the recharge I had managed to swallow. I could not sleep and neither did Nancy. At one point I stood up and bent over the baby-changing table, Nancy came behind me and compressed my hips. “I don’t know if I can do this,” I said. Nancy said, “You are doing so well.” After this Nancy often told me that I was amazing and I could do it. My confidence came back a little bit with her encouragement.

At  4:25am  I went to the bathroom and a jelly-like clot of clear mucus and blood came out. “Baby I lost my mucus plug,” I shouted from the bathroom to the bedroom. Nancy wanted to see and I showed her.  I felt excitement at labor progressing and my body opening. I thought that I should call my friend Ellen so that she and her partner Carmen could prepare to come the next day but I wanted them to have some rest.

At 5:00am I called Ellen and told her that I was in labor. I said that it would probably be a while but it would be good if she came by 5:00pm. I asked her to tell Carmen and prepare to stay a long time. In our preparation Ellen and Carmen were responsible for setting up the birth tub.

Contractions became more and more intense. In the morning at about 8 or 9 my phone rang and it was the nurse from Kaiser calling to confirm my “no stress test”. I told her I was in labor and then began having a contraction while on the phone. Her name was Jill and she told me exactly when to breathe in and when to breathe out and she coached me through the contraction. It was exactly what I needed to keep going. After the phone call I used the deep breathing shown to me. I felt light headed but able to continue.

I asked Nancy to call Maria and Nancy said that my contractions were still far apart. I called Maria and asked her to come by when she could to check the baby’s heart beat. Maria said that she would come by at noon. At some point Nancy called the rest of our birth team Ellen Carmen and Carol and asked them to come.

Maria arrived before the others, I remember saying, “The contractions are really bad”. Maria said in an enthusiastic voice, “No they are strong that’s good!”

Maria called an assistant midwife named Nile who arrived with a tool belt slung low across her hips and filled with midwife tools.

Maria checked how far I was dilated in the bedroom. I lay back on the bed and she reached her hand inside and felt around. When she removed her hand she said, “You are eight centimeters dilated we are going to have a baby.”

When the support team arrived they began to assemble and fill the birth tub in the kitchen. Nancy stayed with me in the bedroom. I bent over the bed and my acupuncturist Carol Francois came in and massaged acupressure points on one side of my body, she showed Nancy how to massage the other side. The points helped my body open and sped delivery.

Maria asked if I wanted to go in the water tub to give birth and I could not imagine moving from where I was. It turns out that the tub was only half full anyway. Maria invited my support team into the bedroom and said, “Do what you have to do.”  Carmen documented the birth; I felt Carol’s presence near me. Ellen said later that she thought to herself, “What do I have to do?” Ellen brushed my tangled and wild hair back into a neat ponytail at the back of my head.

   Maria put a birth stool at the side of our bed. Nancy sat on the bed and I sat between Nancy’s legs on the birth stool, she put her arms under my arms for support. I held onto Nancy’s hands and squeezed them tightly.  Maria said, “When you feel the urge to push PUSH.” I remembered the story of another mamma who did not feel the urge to push and was transferred to the hospital. I pushed even though I did not feel a strong urge.  I felt something pop and then water gushed out. Maria wiped it away with a chuck pad, she also discretely wiped away the little bit of poop that came out as well.

I felt a tightness around my opening that burned, I stood partially up instead of pushing and thought to myself “you are a wimp.” Both Maria and Nancy encouraged me to squat down, both told me I was doing a good job; this helped. Then the assistant midwife Nile, young caring and confident took a fan from her tool belt on her hip and fanned my hot face. It felt amazing.

Together Maria and Nile listened to Sekou’s heartbeat. Maria looked me in the eye and said, “Your baby’s heart rate went down, and we are going to want to get him out in the next push or two. It is time to work really hard!” After this I do not remember feeling pain; I cared only about getting Sekou out safely. I remember pushing very hard. We have a video and in the video in these final moments of pushing I was quiet and concentrated.

I reached down and felt Sekou’s hair between my legs, it was slimy. I pushed again and felt his head and then his body slide out of me. Maria said “Nancy, Fiona -somebody catch your baby!” Maria caught Sekou and put him in my arms. “Well hello” I said “you made it.” Sekou cried and then was quiet against my breast. Nancy kissed me, we  both had tears running down our faces. Then Nile and Maria wiped the blood from Sekou’s body.  They clamped his umbilical cord and Nancy cut it. He was born at 2:41pm. Ellen sent a picture of him just born to our friends and announced his birth.

The midwives asked Nancy to take off her shirt and they put Sekou on her chest for skin-to-skin bonding. I stayed seated on the birth stool to birth the placenta. The placenta slipped out easily into a large bowel and looked a little like an organ to me or an enormous blood clot.

I had a little tearing and Maria prepared to give me stitches. She asked me to lie back on the bed. Someone put Sekou on my chest. Maria asked my friends to distract me.  Ellen lay to my right and Carol sat to my left. I closed my eyes and felt Carol stroking my forehead. Maria strapped a headlamp to her head, she sprayed between my legs with something that stung and then numbed the area then she began to carefully sew up my tears. I remember an overwhelming feeling of wellbeing. As Maria stitched the tears my friends sang, “Maria, I once knew a midwife named Maria.”

Next Maria put an ice pack between my legs and I lay with my head at the headboard. At the foot of the bed the Midwifes examined Sekou from head to foot and weighed him in a hanging cloth scale. Maria asked Nancy to put her little finger in Sekou’s mouth and he began to suck on it. Sekou weighed 8lbs and 3oz.

A few significant things about preparing for our homebirth:

My partner Nancy and I conceived Sekou March 8th 2011 with a little help from a sperm donor and alternative insemination. The date of Sekou’s conception is significant to me because it stands between the anniversary of my mother’s birth date on March 7th and her death date on March 9th.

My mother used to say about my birth, “I was in labor 48 hours and they almost lost us both.”  My mother was 39 when she birthed me caesarian and 42 when she birthed my little brother Ian. I am the age of my mother when she had her second child. I expected 48 hours of labor, I expected pain and I was prepared for the possibility of transferring to Kaiser Hospital if need be. In fact we toured Kaiser to see what it was like. I also had the example of two of my friends Alli and Michelle who gave birth at home with Maria as their midwife.

My ability to birth my son at home felt bigger than me. I felt carried by the people in our lives and the extensive preparation that Nancy and I underwent. Several things significantly helped me to prepare to give birth.

To start we met with Maria our midwife regularly, her coaching about everything from nutrition to how to work as a team was invaluable. The fact of her experience having delivered over 1000 babies gave me confidence. Maria’s coaching before and during the birth of Sekou and especially after his birth was the ground on which I stood. A great doctor at Kaiser Sarah Mendel followed me in addition to Maria and she supported my decision to birth at home.

I was also part of a mamma’s group of four women. In the group we shared experiences and we read the book “Birthing from within.” We did an art exercise from this book in which we each drew our ideal labor as a landscape. The picture I drew greatly resembled the birth I had.

The preparation I did with my acupuncturist Carol Francois helped me to carry a strong healthy baby. Carol attended the birth and her presence helped me immensely.

Other mamma’s birth stories helped me to prepare as well especially Raynell’s story, which made clear the importance of staying hydrated and partner encouragement. I enjoyed going to a potluck at Maria our midwife’s house at the beginning of my pregnancy and hearing so many home birth stories. It felt like a complete circle to go again after Sekou’s birth and share our experience for others preparing for home birth.

Most helpful to Nancy and my work as a team during labor was the home birth preparation class we took taught by Jane Austin. I also did prenatal yoga with her.

My friend Ellen was there for me through out my pregnancy and she and her partner Carmen attended Sekou’s birth. She threw a shower for us in Dolores Park; at the shower friends decorated candles to light during labor, they also took a candle home with them to light. Ellen sent a message to our friends to light their candles while I labored. An altar held the lighted candles from our community as well as the picture I drew in the mamma’s group during labor. The physical reminder that I was not alone and had support from our friends and ancestors helped me.

Carmen documented Sekou’s birth leaving us incredible photographs and video we will one-day share with him.