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...

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...

All Fools' Day

                                             On the wall in the newborn room.

Day one was rather enjoyable.  Aside from the fact that they were not expecting me (surprise! surprise!), we all made the most of a rather busy day.   It’s moments like the many that I experienced today that remind me, not so gently, that I live in the lap of luxury.

One of the nurse/midwives that I was with today pointed out that they do with what they have, and what they do not have they’ve always done without so why would they need it?  Point taken.  They DO so well without all the amenities and accoutrements that I take for granted in the states. They use each and every piece of everything in ways that I had not previously considered. 

These ladies are understaffed and oftentimes there is one midwife for three, four or more clients in the delivery rooms.  I witnessed this first hand today & was taken aback by the efficiency and speed at which these women work.  The other side of that coin is that there are things they understand warrant more careful time and attention, and by default the new mothers sometimes get less than the best.  It’s what must be done when you are one person and you have four women who are sitting at six centimeters; a multip, one grand multip and two prims (first time mother).  We would all do well to learn to do more with less.

The women share 4 to a room while in labor and postpartum as well.  They are moved to a delivery room when the time comes and rest on a bedpan after the baby comes until the midwife can tend to them & repair what seem to be fairly routine episiotomies.   Meanwhile the babies are set to rest two or three to a warmer to keep one another company until their mother is wheeled back to her shared space at which point she may choose to breastfeed her baby.  The most glorious thing about the shared rooms is the brilliant breeze that flows through as if 50 fans are blowing, and with this heat and humidity it’s better than AC.

After a cesarean birth today, a nurse & I took a baby into the nursery for safe keeping (about 24hours) until the mother can look after her baby on her own.  Women who have had “normal” deliveries stay on average 2-3 days (if space allows), no idea how long women stay post cesarean.  The nursery is very small, and the “NICU” even more so, with even smaller babies.  I think about Doernbecher Children’s Hospital and shudder to imagine how the surroundings here would be perceived.  These folks here have done an amazing job with these preemies and micro preemies; cards a plenty attest to this with words of deep gratitude and heartfelt warmth for the care their tiniest of tiny received.

I know that this day is just the tip of the iceberg; I am so delighted by the women I got to share time with today.  They stepped up to show the ‘fair skin’ around and to orient me to the ways in which they operate with smiles and generosity to boot.  The women in labor allowed for me to share in their experiences without question and offered a smile where none was needed.  I stand to learn a lot here, to be humbled and am very anxious to soak it all up.   I'm looking forward to tomorrow, my second “first” day.

Thumb-sucking in mom's absence...

Gratitude

Sitting here pondering how hard it has always been for me to ask people for “stuff,” for “things,” for money, among other things.  It’s a familiar place for me to reside...that place where it so much easier for me to give than to receive.  You know, that uncomfortable place that feels needy, or imposing?  It’s probably why I have only just recently reached out, as I have known about this trip for some weeks now

Setting pride aside recently, I stepped out on a limb to ask for support, for some assistance in making this journey to St. Lucia one that feels contributive and meaningful. I have been pleasantly surprised by the delight I have encountered since asking.  

I have been reminded of a few things:

1.     It takes a village.  Some folks have offered what they perceive to be “small” donations.  Well folks, each penny adds up!  Each offering amasses into something larger & builds momentum when added to the mix of bits and pieces.  I cannot do this thing called life alone.  I am deeply grateful for each and every offering of support-emotional, physical and/or financial.  Thank you!

2.     I cannot get what I do not ask for.  Hard as it may be, I encourage you all to reach out to ask for what it is that you need & desire.  You never know what or who awaits the other side of your courageous request.

3.     The art of surrender is vividly poignant in my life right now.  I have counseled so many women to do just this throughout their childbearing process.  Surrender plans, expectations, judgments, pride, and that sense that we have any “control” about how things will unfold.  I’m working on surrendering.

May this journey be full of occasions for me to find growth (gently please), to be offered reminders of why midwifery is what I choose (or is it the other way around?), to find a deeper sense of center AND to find more joy among the moments that make up my days.  

I’m looking forward to help usher earthside babies in another locale, with some new perspective on pregnancy & birth.  I am so delighted to be able to embrace this opportunity and am grateful to all those who have encouraged me to do so. 

Excited to share with you all the first installation of donations and supplies made possible by donations already received.  Not so sure if the picture is worth a thousand words... It does, however, illuminate what I have already gathered in the way of supplies to donate to Victoria Hospital.  Thank you!

In no particular order, included in the above photo: 24 receiving blankets, 1 fetoscope, 6 tape measures, 4 amniocots, 5 pregnancy wheels, 2 suture sets, 1 infant stethoscope, 1 adult stethoscope, 6 pieces vicryl suture, 3 pieces silk suture, 150 sterile gloves, sterile lubricant, tourniquets, 3 cord clamps, 15 maternity pads, three digital thermometers, 25 chux pads, 14 newborn diapers, 10 infant combs, 20 bottles baby shampoo, 2 peri bottles, 4 newborn hats, 4 surgical blades, ball point pens and one latex-free bag & mask resuscitator.