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...

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.

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

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.

Welcome!

I'm here to share the bits and pieces of an adventure that I will be soon be embarking upon. An adventure that I anticipate with great delight and gentle timidity. Thanks for joining me! It is my intention to share with you all what it is that I encounter along this journey with a depth of spirit, integrity, humility and maybe some humor along the way, tho I've never been the comedian in the crowd.
I haven't been overseas in....well let's just say WAY too long. My passport is much to shiny for my liking and I find that I am all to ready to settle into a sense of comfort and routine. So, I guess there is no better way to switch it up a bit than to head to where the sun shines hot all day, the ocean warmly welcoming and the Caribbean babies abound.
I have an amazing opportunity to spend 5 weeks with the midwives and their "patients" at Victoria hospital in the capital city of Castries, St. Lucia, West Indies. My adventure begins with fervor on the 27th of March and will carry me through to May 2nd at which point I return to the states to let the rest of my midwifery education and experience unfold in ways I cannot yet conceive of.
I am hopeful that my time away will be fruitful in mind, body & spirit. That I return with a renewed sense of self, a deep commitment to integrity moving forward and an unshakable belief in the competence of my skills as the emerging midwife I am unfolding into.
Deep, deep gratitude for those that have held space for me along this journey, for those that continue to encourage me through dark moments, those who revel in my joy and those who believe in me.
~Merka

P.S. If you are called to do so, please check out my widget, to the left there, and share as you are willing and able. Money raised will assist in supporting the financial needs to make this journey happen on a variety of levels. I will update you all on funds raised and the donations made possible by such generosity.