Tuesday, April 3, 2012

Got politics?

Delivery Room One

Midwives here run the show!  (Woot! Woot! Loud applause and deep respect!) Through the course of a normal delivery, there are no docs in the delivery rooms to assist, no respiratory therapists, no baby nurses, no body else but the laboring woman and the midwife.  They are excellent at what they do; they are competent, capable, loving  (in their stern sort of Caribbean way) & know how to get down to business.  Their laughter and joy allow one to move with ease through these hot and humid days.  I admire these women and hope to wander with such confidence one day.  Necessity is the mother of invention...

These midwives each have their own proverbial bag of tricks.  I want one of these! Much like Hermione Granger’s magic handbag, holding infinite bits and pieces to navigate one’s way through these variations of normal.  When infinite meets the end of the road, the docs will come to check out the situation and to offer additional guidance and support to what everyone hopes to be a healthy end.  And when it does, the happy dance that ensues motivates a rather large smile on my face.  I have yet to encounter anything other than the happy dance and do not look forward to the alternative.

The docs here are either ‘juniors’ (those that have not yet specialized) or “consultants” (some have been practicing here for a lifetime according to these ladies). They all “round” on these ladies throughout the week.  In addition, they see them “immediately” postpartum to check on their well-being, particularly if there are variations from normal.  The midwives and docs get along well and seem to have a very collegial relationship, I dare say even friendly and familiar.  I envy them.  I hope there is a day that I get to experience this in my own professional world, from a place of collaboration and mutual respect.

However, the autonomy of the midwives here is being threatened, as is the normalcy of pregnancy and childbirth.  I get a sense the proposed changes are coming from some higher up place and will impact the way that these women can care for the women in their ward.  Interventions and procedures that have historically been reserved for pathology are being considered for routine admissions.  Non-stress tests, for example, typically utilized to monitor fetal well being in the face of things like post-dates pregnancies, trauma, decreased fetal movement and other such concerns, are routinely performed on all low-risk, healthy admissions to the labor ward.  Some of these midwives have some very strong opinions about the way things are changing. I cannot blame them.

Discussions on the ward of creating a midwives association are reminiscent of those that have gone rounds in the states.  There is a “Midwifery Interest Group” here on St. Lucia and, in its infancy, is rather small in numbers.  “We don’t need a GROUP, we need and ASSOCIATION!!!” This coming from a woman whose passion is clear and commitment to autonomy, deep.  It is this kind of spirit, matched with her brilliance, that will motivate change. 

In other news...

I feel like a broken record here but have to give a shout out to the midwives and Sisters on the ward that have so warmly welcomed this brown eyed stranger replete with beaming (and perhaps foolish at times) smile, into their world.  I have been made to feel like part of their team, to enmesh myself into the weave of their fabric. 

They look out for me, urging caution while trying to avoid inspiring a riot of fear in my being.  Concern for my personal safety is their highest priority, followed second by their desire for my to have an abundant learning opportunity while I am here. These both saddled with a reminder that I must find time for “leisure” while I am in St. Lucia as the beauty is abundant.  All work and no play...

I take it all to heart.  “Work” in the hospital during the daylight hours, for now.  Most evenings are spent with a farewell to the day on the rooftop terrace, or in the pool (or both) communing with the bats as they pass swiftly by trying to navigate a dip or two while effectively navigating a path to avoid a collision with my head as I bob along in the cool water.

Looking forward to enjoying a mango or three soon enough, they are too green as yet but are blushing.  The bats have beaten me to the hanging fruit already. The trees are robustly full and promise (or perhaps tease) a deluge before I depart.  What a bounty it will be, if not for me then for the ladies who will be arriving here in May after I leave.
Tantalizing treats!

Thank you all for your continued support, donations and enthusiastic delight! 

Signing off in gratitude!

Rodney Bay


  1. You just reminded me of the huge mango trees that thrived on Maui. And avocados. Guava. Yum! Enjoy some for me....

  2. I have rather vague recollections of a certain mango tree by the condos in Kihei. I like to imagine that I spent quite a bit of time there foraging around for the offerings. And consequently wandering with mango fiber betwixt my teeth for days after gnawing all the flesh from the seed. :)

  3. So great to read your posts, Merka! Sounds like you are really soaking up all experiences there.