You’re ANIMALS, all of you!

I had the pleasure of spending some quality time with a laboring mama this week.  A lot of time.  More than seems to be the average here at Victoria Hospital.  In fact, Paula & I had the opportunity to spend a virtual eternity-a whopping 10 hours- with this woman. We showered her with love & compassion.  We offered her support, encouragement & all the healing touch that we had to offer a laboring woman.  At one point, one of the midwives wandered into the labor room.  She looked at the woman standing upright against the bed (it isn't often that you'll find a woman in labor doing this here), her eyes then turned to me leaning over next to the woman and with a teeth sucking smirk (a usual and frequent custom among St. Lucians) and a sideways smirk, unimpressed, she left.

This woman was laboring hard with her third baby.  She was tired.  Beyond tired, actually.  There were several intense points at which her eyes grew wild, unfocused and absolutely panicked as the urge to push was beyond what she thought she could manage.  She said, on more than one occasion: “She’s coming!  The baby is coming!” On exam however, it was evident that she had too many centimeters to go before she could give the big, good push. We were prepared for her to surprise us & push her baby out despite what my fingers said was going on...  She wouldn't be the first to do such a thing.

We tried position changes, massage, essential oils, verbal encouragement, etc. All of which did not do much to encourage her baby girl to make her entrance.   It was her third girl & we figured she just needed to make her own way in her own time.  She has two sisters to compete with after all.  This woman was not particularly keen on this child’s en utero independence, she had already been laboring for nearly 10 hours and she was over it.  Her last birth had taken just about 6 hours from start to finish and she was taken by surprise with what felt like a marathon labor to her.

The whites of her eyes had turned red with exhaustion, eyeballs turned toward the sky, she prayed, loudly, to her God.  She prayed that He would not forsake her, she asked for forgiveness for all of her sins.  She begged that He would have mercy on her.  She begged that He might ease her suffering and that He knew better than any that she had experienced enough suffering in her life....  She then begged, once again, for the doctor to cut her.

She was sedated instead.  As well she was given Buscopan to encourage continued cervical dilation. She wandered in-between waking and “sleeping” before and after each wave of pain washed over her body.  She was eventually augmented with Oxytocin to encourage labor to proceed along the “normal” trajectory.  However, I think that normal left the building hours before.  She sat at 8 cms for over 5 hours, with a baby that refused to come down.  On exam, her baby’s head was hanging close to the stars, maybe kickin’ her feet out over the edge of the big dipper.  In those moments, one is left to wonder what the “hang-up” is.

She begged, once again for the doctors to cut her and to take her baby.  “I cannot do this any longer!!!”  How many times have we midwives & doulas heard women make that very statement?  Just about the time women say such things we work to reassure them that their babies are “just around the bend.”  At what point do you listen with your ears wide open, and appease them.  When is enough, enough? How exactly do you differentiate those women who simply need to ask vs. those that really mean it!  For most midwives in the states, this means a transfer of care.  For the midwives here in St. Lucia, it means a mix of Pethidine (Demerol) & Phenergan to ease the pains of labor before a consultation is made.

At the peak of her frustration and ever-waning desire to continue onward she uttered: 

“You’re ANIMALS! All of you!” 

When I saw her the following day I am certain she had no recollection of what thoughts she shared in those moments where she felt forsaken.  Her smile was bright, she was a woman renewed and refreshed by a short nights rest.  Proud and beaming with her beautiful baby girl in her arms she sang praise to the moon and back for the care-full attention Paula & I paid to her.  Her kind words, soft brown eyes & bright smile were enough to remind me that my time here has, indeed, made a difference in the experience for the women I have had the pleasure of sharing time & space with.  A debt of gratitude, once again...

Proud mama headed home...

Am I really a mother now?

She’s a 25-year-old mother of one 5-year-old boy.  She had a miscarriage last year.  She’s come into the maternity ward, in labor and excited to meet her baby.  Her bag of water breaks while she’s sitting waiting to be admitted.  She’s 2cms dilated.  I put her on the EFM machine & her baby “looks” and sounds great.  We have some time and centimeters to go...

She comes well prepared with ALL of her records, a rarity here.  She has with her, all ultrasound reports (of which there are several), all prenatal lab work (to include not the customary one, but 3, rapid HIV), her last annual exam and her card from the health clinic detailing all her prenatal care.  She’s well spoken, obviously eager, and very healthy.

Upon admission, I do a physical exam and look her over from head to toe. Any swelling? Mild. Any tattoos? Nil.  Any scars?  Well, yes.  As she looks down to her abdomen- I see a thin, well-healed 7-inch long scar along her bikini line, previously obstructed by her gravid belly. “I had a c-section.”  

She proceeds, gracefully, through a normal and unremarkable labor.  She pushed her baby out with confidence, ease and not a bit of (outwardly apparent) fear.  I congratulate her as I’m drying her baby girl off.  I clamp and cut the cord as I hear the midwife say to her: “You pushed your baby out! You can call yourself a mother now! “

I gave pause in that moment as a variety of emotions raged. We all know the depth and range of emotions that cesarean births are SO steeped in, for better for worse. It’s reprehensible that anyone would strip a sense of motherhood away from a woman who has undergone a cesarean birth.  

I have witnessed the power that vaginal births have to transform women.  I have also had the great pleasure and honor of also witnessing the absolute, deep and cellular healing a vaginal birth confers upon a women who have a triumphant and successful VBAC.  I would argue though, that a vaginal birth does not a mother make.

This woman looked to me after I got her all cleaned up and ready to be wheeled back onto the ward, “Am I really a mother now?”  “You already were.” I replied as I placed her beautiful baby girl into her waiting arms.

First catch!

Pink Torch Ginger

I’m no stranger to being up at all odd hours of a night.  It has largely been the story of my life over the last handful of years.  Birth is not a 9-5 job. Pregnant women do not just wander into labor land after her midwife has had the luxury of a full night’s rest, a tasty & fulfilling breakfast, and a hot shower to top it all off.

It’s rarely ever on the nights where you’ve gone to bed early, prepared to rise before the birds even begin to think about singing the sun up. No, they come calling just after you’ve crawled into bed (later than you should have), clicked your light off and your head has hit the pillow with gratitude for the end of the day.

Here at VH, with the exception of nights, I have had the opportunity to observe some variation of crazy busy on each of the “incorporated” shifts.  So, last week, I took a leap-ready for some action by the light of the crescent moon.  Isn’t that when most babies come calling, after all?

Perhaps babies here don’t love the dark of night?  Maybe the light of such a small sliver of moon isn’t enough to draw them from their warm, watery bliss?  Whatever the case may be my first night was full of anything BUT birth.  I busied myself with finding any measure of expired item I could find.  Much like an Easter egg hunt, however, without the usual anticipation of dark chocolate delights that await the eager egg huntress! 

I thought long and hard about tackling the storage closet.... and decided that it was not a battle that I was prepared to “fight.”  Bags full of questionable items, boxes filled with smaller boxes, shelves dripping with supplies of a medical nature that I have never encountered... It would have been something akin to playing hide and go seek and I feared I would not be the victor, but left to wander into perpetuity trying to make sense of it all. 

So, after sitting and staring at the Oxford Handbook of Midwifery for a couple of hours while the midwives were having a heated conversation in Patois, I decided to take my leave and “retire” to the PET room to rest my head.  They reserve the PET beds for employees who have had babies or have had some procedure as well as people of greater import than the regular admissions off the street.  I left the ladies with instructions to come gather me if there was any sign of new life on the way...

The cacophony produced between the incessant dinging alarms of the “NICU” down the hall accompanied by the occasional confused roosters, Castries rabble-rousers, and the “animals of the night” I, somehow, drifted off into some kind of slumber. It was easily the most disjointed thick paste of consciousness somewhere deep in between waking & dreaming I have ever experienced. I was all to eager to withdraw and detach myself from its grip.  That sandman can take a hike! It was with great delight that I was greeted by the beaming grin of one of my favorite midwives about the same time all the roosters were stirring & eager to begin their premature oral address for the day.  She came to let me know that there was an admission; she was at 4cms, they had already administered the customary “douche.” She was a first time mother moving very expeditiously through labor. I washed the sand out of my eyes and joined them.

“She’s a sickler.”  (Aka sickle cell disease-SCD).  Everyone is tested here for the sickle cell trait and disease (as well as the routine battery of “prenatal” tests).  The disease can complicate a pregnancy significantly with sometimes-tragic outcomes.  Women with SCD are at increased risk for things like UTIs, gallstones, and further complications of anemia leading to heart enlargement and heart failure.  The risks to the fetus are significant as well and inlcude miscarriage, poor fetal growth (IUGR), pre term birth (which has its own host of complications and long term implications), low birth weight, stillbirth and neonatal death. Some women in St. Lucia receive little to no prenatal care (even though it is free) and even fewer receive genetic counseling for SDC or Ultrasounds to follow up on fetal well-being. 

This young woman was given IV fluids to prevent dehydration (which can elicit a sickle cell crisis) and was placed on EFM for the duration of her labor. As it turns out, we didn’t have to wait long.  We got her settled into a labor room and the midwives (yes, ALL three of them) set to watch me set up for my first catch here at VH.  I’m used to having one set of eyes on me, sometimes two (clinically speaking).  To have three midwives chirping various bits and pieces at me was somewhat overwhelming, especially for what turned out to be a very normal & uneventful delivery.   (For the record, I like “boring” “normal” and “uneventful”-all things that make for longevity in my work and a smile at the end of the day for all parties involved.  None of these qualifiers take away from the beauty and richness in the process of birth.  Excitement in birth is something I neither require, desire nor invite.)

We all have “our way” to go about doing things.  What works for one, may not necessarily suit another.  These ladies all had different pieces of “advice” for how to proceed on the same thing.   I am reminded, again, that I am here to “learn” not to “teach.”  However, I trust my hands to help usher these little souls earth side.  I’m finding it is a thin line to walk along in these moments.... to listen with an open mind and, at the same time, not offend if I don’t heed their bits of wisdom.  I deeply admire how some of these women go about birth.  There are juicy morsels that I will bring back with me and into my practice as a midwife, just as there are a number of things that I will happily leave behind.  (One of the midwives said, with enthusiasm, that I should bring back strong encouragement for routine “douche” in labor. Interesting to consider how that informed consent discussion for routine enemas will go over with clients.)

Amidst the hoots and hollers from the peanut gallery (In all sincerity, truly my dream team-those three were a total delight to work alongside!!!) a 3.20 kg, healthy baby boy was born into my hands.  Pink & screaming he was given to his mother for a brief moment before heading to the warmer for the routine NB ritual.  While I wrapped up the rest of her third stage and got her all tidied up, one of the midwives made it very clear to this young woman that, under no circumstance, should she become pregnant again.  The midwife pointed out that, she selfishly, had already put herself at great risk and has potentially passed the SCD (or at the very least the sickle cell trait) on to her infant... The precarious balance between the bliss of having a healthy baby & the reality of some particular piece of an individual’s story here is palpable.  I want, so desperately, for these women to have many uninterrupted, blissed out moments marinating in the smells and sounds of their sweet, delicious babies.

A girl can dream....  In the meantime, the baby biz is pickin’ up again at VH & I have had the pleasure of welcoming several other sweet souls since my “first catch” here.  Stay tuned.

Les Pitons and the town of Soufrière

On a not-so-covert Cacao mission...

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 2^nd 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.  

Do you Doula?

I came down to St. Lucia hoping, beyond hope, that it would be the catalyst that solidifies my foundation as an emerging Midwife; to soak up the experiences that would allow for deeper insights, a firmly rooted sense of (professional) self and greater assimilation of all that I have learned over the last many years.  I still believe this to be true, however, my heart & mind are catapulted back to the place where this birth journey started for me on an ordinary day in Bend while sitting next to the Deschutes River watching it roll on by. Wander back with me for a moment...

I set out my front door to wander the river trail, taking advantage of some early springtime sun that had graced us with a visit.  The sound of the river has always been a soothing lullaby & I found myself attached to a particularly warm and sun-drenched spot. It was while sitting here that a friend I had not seen in some time passed by.  She stopped to share a hug, a radiant smile and a story of her recent Doula training she attended.  I owe her a debt of gratitude; this conversation changed the course of my days.  The eddy I had been circulating somewhat comfortably in was about to be disrupted in a most delightful way.

The river is a powerful dance partner; you must give way and follow its lead.  If any of you have tried to cross an eddy line in a kayak, you know that (as a novice) it is a rather daunting task. If you navigate it just right, you are carried swiftly and with ease into the body of the rushing water. Joyful that you have been successful in this endeavor, you are set on your way with a deep breath and a mile-wide-smile.  Hooray!

The alternative, if you find yourself with ‘two left feet,’ is something akin to a cat that has taken a rather surprising, unpleasant & unwelcome dip. 

Navigation fail....

Much like a successfully navigated exit from an eddy, my journey into birth work was one of ease, joy & triumph.  I left my sunny spot that afternoon with a renewed determination to make sense of my days and to explore more about this “Doula” business.  What was it all about?  Was it something that would restore me, bring me joy in work?  I had no idea, but I had the courage to invite that unknowing into my life. My work for years as a phlebotomist was, how do you say? Insatisfaisante (unfulfilling). This disastisfaction was more than enough motivation for me to seek something more inspiring.  Without delay I signed up for a 7 day-long Sacred Doula workshop at Breitenbush Hot Springs (http://www.bigbellyservices.com/doula%20training%20bbs.htm ) that would commence in April 2007. This workshop was profoundly transformative! Thanks to Carrie Kenner and Erin Quies; two women blessed with deep wisdom, loving kindness, abundant compassion and radiant spirits. By April of the following year, I received my DONA (Doulas of North America: http://DONA.org/) certification as a Birth Doula, started Dharma Doula, LLC and in the late spring of 2008 quit my job at St. Charles looking forward to a fruitful experience as a Birth Doula.  It was one of the best choices I have ever made; I have not one moment of regret.

Do-what?

“Throughout history, women have supported other women during pregnancy, childbirth, and postpartum.  For many women today, birth can be a lonely and frightening experience, attended by strangers.  The modern remedy for this tragic situation is the ‘doula’ – a knowledgeable, experienced companion who is trained to provide emotional and physical support, encouragement and wisdom for pregnant women and their families.” (www.bigbellyservices.com)

I had the pleasure, and great honor, of working alongside many women and their families as their ‘knowledgeable companion.’  I bore witness to the immense power, vulnerability and transformation of women throughout their childbearing process. The benefits of having a doula present at one’s birth are priceless.

Among the many highlights:

 Clinical studies show that having a doula:

•   tends to result in shorter labors with fewer complications

•   reduces negative feelings about one’s childbirth experience

•   reduces the need for Pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans

•   reduces the mother’s request for pain medication and/or epidurals

Research shows:

•   Feel more secure and cared for

•   Are more successful in adapting to new family dynamics

•   Have greater success with breastfeeding

•   Have greater self-confidence

•   Have less postpartum depression

•   Have lower incidence of abuse

(www.dona.org)

So, fast forward back to my days here in St. Lucia.  In these last many days, I have become acutely aware of the glaring need for Doulas at Victoria Hospital.  The ladies here are often left to labor alone in a cold room. Absent are their partners (if they have one), caring family members, emotional and physical support, and anything other than the ‘sterile’ smell of the labor & delivery rooms.  Some are left to labor with narcotics on board while the sound of the baby’s heartbeat trots along audibly from the NST machine. During a recent shift there was a woman who had been laboring for many hours with her second child. In between stepping in for exams with the male physician, starting IVs, admits to the labor ward, births, etc...I would return to her room.  Every time I had to leave her side she would beg: “PLEASE don’t leave me.”  To say the least, her pleading was heart wrenching for me.  I spent as much time as I was able with her, which was still not sufficient in my eyes. 

I am reminded though that my purpose here is not to be with women in the role of a doula (though midwives really are glorified doulas;  in addition to our clinical education & skills, we all provide support (physical and emotional), information and encouragement where we are able).  My purpose here for a short number of weeks is predominantly to hone my midwifery skills; to soak up as much of the clinical experience that I can.  (Some might refer to this experience as medical tourism, a concept I am currently challenged by.)  The time & work load here does not typically allow for women to be supported in this way.  The midwives are busy and their attention is usually turned necessarily elsewhere if a delivery is not imminent. It breaks my heart that more women here do not have the same opportunities and (perhaps awareness) for support as women in the states as more doulas are trained and offering their services.  Culturally or not  (I mean no disrespect here), women here (everywhere, I would argue) would supremely benefit from a doula’s services. See, again, the above bullet points above about the benefits of having a doula.

As it turns out, this woman’s (above) baby was frank breech and after a great many hours she ‘failed to progress.”  Her daughter was delivered by cesarean. I’m grateful that she did not witness the lengthy resuscitation that followed her daughter’s birth.  I had the next few days off and didn’t have the opportunity to see her until I returned for my shift yesterday.  I was happy to see her radiant grin; she was a whole new woman. She smiled brightly as she showered me with praise and deep gratitude for being with her throughout her labor and birth.  “It meant so much to me to have you close...” This from a woman who hadn’t known me previously before the day she went into labor. I came into the haze of her “labor-land” a total stranger and made some not so insignificant impact on her experience. It’s these, among many, moments that I hold closest as I make my way through my days here.  I offer these women my heart, my compassion, a smile, tenderness and hopefully a soft place to land during some part of their stay on the maternity ward.

I am compelled to give a LOUD and resounding shout out to the doulas out there!  Deep gratitude to you all!!!  Women, their families AND their babies benefit from your companionship and support as well as your watchful advocacy and knowledge of the journey of pregnancy, birth and beyond. You are all priceless & contribute immensely to the stories that women have to share about their birth experiences.Thank you for sharing yourselves so selflessly. <3

Essential Oils gifted to the maternity ward. A fabulous addition to any Doula's birth bag.