Tuesday, April 17, 2012

Heartbreak Hotel

Find a warm cuppa joe, get comfy and settle in for what might possibly be the longest blog post – EVER. (Brevity has never been one of my strengths...)

I wandered into work yesterday on a mission to find out about a particular baby... 

His mama came in a few days ago like a four alarm fire; her husband driving like a tsunami was on his heels and layin’ on the horn loud enough for all of St. Lucia to hear.  By the looks, and sounds of this woman, I was prepared to meet her baby in the hallway.  Her delivery, however, was just the opposite.  Once within the confines of the ward her labor shifted into low gear, her contractions spaced out some and she found “relief” in some of the deep breathes in between. Her labor song was robust, loudly sung and was like a train rumblin’ down the tracks.   You could hear it coming from far away as you shudder and turn your head the other way while covering your ears as you wait for the windstorm that follows the train as it passes by.   And, like a game of dominoes the Rasta woman next door would begin her own sweet song, making its way to the 16 year old laboring alone in an observation room in the labor ward. 

At which time the woman in labor room one would begin again.  It carried on like this for some time.... The midwife switched on a small radio as if to drown out the sounds of three women getting’ down with their birth songs.  The addition of the small whining radio was more like the buzzing, electric drone of a mosquito in your ear: incessant, diabolical & eternally frustrating.  

The four-alarm fire lady was continually and without fail chastised for her birth song.  (One, of many things that break my heart here on a daily basis.)  I have witnessed great love here among the midwifery crew at Victoria Hospital.  I mean no disrespect here, but I have also had the unfortunate opportunity to witness the absolute opposite, with consistency, from a couple of women in particular.  It’s so challenging for me to appreciate where some of these midwives have misplaced their compassion. 

Are they tired? Certainly they must be.  These midwives do, on average, at least 100 deliveries per month.  In March of 2011, they delivered 168 babies; only two handfuls were cesarean births. They are understaffed and underpaid, full stop.  Is it some cultural incompetency on my part? Is my ignorance getting in the way of me seeing the verbal insults and tongue-lashings as anything other than just that?   I have seen an abundant of warmth among the majority of these midwives, who are also underpaid and overworked as equally as their bitter counterparts and yet, they move forward with laboring women from a place of respect, some measure of patience and with a patient’s best interest at heart.

I digress... The woman in labor room one was fully (eventually) and set out to push out her baby.  Exhausted, she gave her best efforts; chastised with every push by the midwife attending her.  “Push harder!”  Women here have the shortest 2nd stage I have witnessed to date, routinely and without fail thus far.  So it baffles me why you would offer anything other than your kindest and most enthusiastic support for someone who is working very hard to push her baby out!  (With particular regard for first time mothers who have never had the experience of doing such an epic thing before.)  When all was said and done, it took her less than 30 minutes to push her baby out.   It was clear that she was “out of gas” toward the end and her baby arrived rather slowly but without complication. 

He arrived; limp, onto the receiving blanket. “Why is he not crying?” his mother asked.  “You made him tired,” replied the midwife.  He was left to lie there as he was dried off & stimulated until he let out a short and quiet cry. His cord was cut and clamped, and I handed him to his mother for the 60-second obligatory “look see.”  She melted, clearly in love and adoring of her first child.  Reluctantly, she let her son go & I wandered across the hallway with him to perform the newborn ritual routine administration of Vitamin K & Tetracycline eye ointment (mandatory for every child-no informed consent-no questions asked).

As I carried him to the warmer in the room across the hall I found myself feeling resentful that these women are not given more time with these new souls before the business of poking and prodding begins.  I have to work hard to imagine if I were as busy as these midwives are from time to time that some of my practices would be augmented to meet the busy demands of any given day.  You just never know when another “four-alarm fire” will be wheeled through your door.  However, I hope that allowing for the unadulterated bonding between a mother and her child will always take priority, unless life or limb is at risk. 

It was clear that all was not healthy and bouncing about this baby boy.  He was pink, his vital signs were appropriate, his lungs sounded ‘wet’ and thus he was suctioned. He was also tremulous as if he was struggling with a most exaggerated startle reflex.  I administered the necessary bits and pieces, monitored his vital signs and tidied him up a bit.  Dressed, warm and with an oxygen hood (for some mildly high respirations) I left this little boy under the warmer and ran next door to meet another little one (a 35+ weeker whose mother received no prenatal due to her experience of “being shunned” at the clinic in town.)

By the time I returned to his side the pediatrician had stopped by to take a look at both of babies.  Doc said to take him to his mother to nurse to see if he would settle down.  So, I wandered down to the pantry bed where his mother was resting (yes, pantry, a.k.a: dining hall-the 32 bed ward was chocked full), assisted as this little boy attempted to nurse (rather unsuccessfully, even though his sucking his fingers might have indicated otherwise) and shared with the Dr. what I thought.  She said she would swing by after she wrapped up with the near preemie that had just arrived. 

I had been asked by the mother to call her husband to let him know that they had a son and to come when able.  I have not heard a man so deeply moved by the news of having a son.  He asked me a million questions about his son and told me how proud he was as this is his FIRST child.  “Is he cute?” the father asked me.  “Your wife says he looks like you.” I replied. 

The doctors are still uncertain about what may be going on for this baby boy.  Among some points of discussion: an anomaly with the baby’s fontanelles, perhaps some Trisomy, though not Down syndrome (T21).  The extreme tremulousness remains.  They have done a blood work up, though no DNA karyotyping as the expense falls to the family.  They did a brain scan here at VH today for him and should have results sometime in the next 24-48 hours.  They have had access in the past to a neurologist from Martinique, though I was told today: “We may no longer be using his services...” So, unless the family can come up with some measure of cash to get to the bottom of it all, they will be left with nothing but ambiguity and questions that will likely remain unanswered. 

I wonder how many women and families here are left to wander without closure when things like this arise?  How many are left to deal with these unforeseen events in silence and to whom do they turn for help in trying to make sense of it all.  I have seen so many silent tears shed within the walls of VH & do my best to offer my kindness, soothing words, a warm heart and a gentle touch. 

I am reminded that I am only here for some deep breaths.... and with a few more off again I will go back to the comforts of what I know.  I am here to witness, to watch and learn.  These women will be left here to labor alone, receiving what appears to be an obligatory tongue lashing from time to time as they make their way through some of the most intense moments of their days.  It is my hope that more than some may be lucky enough to have the great fortune of coming into the ward when they will be blessed with some measure of compassion and warmth from the midwives who believe in sharing a kind word and a gentle touch. 

It is also my hope that (sooner rather than later) these babies that make their way are welcomed into the open, warm & loving arms of their mothers and not sent to lie under the artificial heat of a warmer.  To rest safely next to the strong beat of their mother’s heart will offer immeasurable comfort for both parties.

Send a little prayer, shout out and bit of warm love not only to the women on the maternity ward but also to little baby boy as he makes his way into another day.

Signing off with a bit of a heavy heart.... 
Victoria Hospital on my way home yesterday

 On the brighter side of things... This handsome boy & his mama were discharged home yesterday afternoon.  


  1. Heyu! You are one of the best things to hit St. Lucia in a long time! I do not know how you women who are midwives or mothers do it....i think resolve is something sought after by many folks. Good for you...

    I love you...

  2. Hi Merka, Ali Tromblay here. Sitting at my desk after catching 2 babies, it's 3am and I'm reading your words, remembering my time in that very hospital 13 short years ago. I clearly remember the newborn ritual there...the little comb and shampoo bottles, trying to get the birth goo out of their soft thick curls. I found it as disturbing as you find it to seperate baby and mom so quickly, and so I took peace in singing softly to the babies as I washed them and explained to them what I was doing. Their big brown eyes staring at me with such light. I think of all my experiences in St Lucia those times with new souls were some of the sweetest. Now in my life, I catch a baby and sometimes don't even hold it until moving it to the scale at the 2 day home visit. Between prioritizing bonding and family connections and then students learning newborn exams my time with new babies is brief.
    I hope the remainder of your journey there is rewarding, full of learning and that you get to have some fun. I do remember the rum punch, but by far the best oral memory was of sucking the sweet pulp off the big cacao seeds that were lined up so beautifully inside the cocoa pods. Oooo, and the passion fruit!
    Much love and hugs,
    ps: not sure who bubbie is...did my mother sign in on my computer??!!

  3. Hi Ali!
    Thank you for your thoughts. I'm not sure the babies would enjoy my singing quite as well as yours...but I speak to them with soft, kind words of welcome. They are truly little exquisite beautiful little beings; I feel so honored & grateful to be here with these women. This experience has been steeped in learning, on a variety of levels.
    Paula & I went on some adventures this weekend and encountered some Cacao. It was comedy trying to get a cacao pod out of the tree with a 14 foot-long piece of heavy bamboo! They hold tight to their trees!!!!
    Warm Caribbean love to you!