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

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.

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.

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.

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!!

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.

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.

*************************************************

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