Quit Throwing Your Placenta Around

Mangua was laying on the dirty floor, writhing, screaming and crying.  I guessed she was 8 or 9 centimeters dilated by the little grunt at the peak of each contraction.  (although I always keep in the back of my mind that some labors just don't follow the rules and can look like that at 5 cm.)  Her lips were dry and I offered her water.  I wiped her sweat beaded face with a cool cloth and started fanning her.  It is very hot and humid here and there are no fans or AC in the maternity ward. 

Her contractions were one on top of the other as I held her hand and rubbed her back.  She calmed down considerably.

Meanwhile I looked up at the wall and had to smile at the sign I read.  Translated, it said, "To all mamas: please take your placentas home with you and bury them.  We are tired of finding them tossed in the road and under the bushes.  Thank you!"

Then I witnessed what I think of as "the last hurrah."   I've seen it over and over again in births that have not been altered with medications.  It is when there is a 3-4 minute unbearable contraction and then peace.  It seems to be the last bit of dilation and then the mama experiences what midwives call the "rest and be thankful stage."  There is such a change in demeanor at the end of that last long contraction.  The contractions sometimes do continue, but they are different.  Has anyone else seen this?

After about 20 more minutes she said, "the baby is coming!" and I supported her as we wobbled down the hall to the delivery room.

Meanwhile Leali, I had been supporting, but who was coping much more quietly, passed us in the hall with her hand between her legs.  She too was on her way to the "haus bilong karim" (the room where they are supposed to push out their babies).

Mangua and Leali both got up on delivery tables with about 12 inches between them and Mangua's water broke.  It was very stained by meconium.  A very thin, and very pale baby emerged as I fanned and encouraged her.  A boy.

Leili delivered a healthy and very vocal little girl.  It soon became apparent that Mangua's baby was not okay and needed help with breathing.  About this time, Leali began to hemorrhage.  She was weak and unable to hold her baby on the narrow table.  So my job at that point was to hold and comfort the tiny and very opinionated little newborn.  I sang to her and walked the halls while I prayed for the other baby that it would breath.  And for her mama that she would stop bleeding.

My prayers were answered.  When I left both mom's and both babies were doing great.  There was another lady yesterday too, but I'll leave her story for another day. 

 

First Day...No Babies

I'm in!  I finally have permission to work here in this new town as a volunteer doula. 
It is in a somewhat rural health center instead of in a busy town hospital.  They do serve a large area though, and most women here have between 6 and 12 babies, as the prominent religion does
not allow birth control. 

Today there were no births or seriously laboring women. I spent the morning there, learning the ropes, helping stock medicine cabinets, and getting to know the midwives.  I spent a couple of hours chatting with a lady in early labor, but she seemed like she could be days away still from holding her baby.  They told me it is usually much busier, I'll let you know if that turns out to be the case!  If

Meanwhile,  I'm happy to be in the door.  If a couple of weeks prove that this is just not a busy enough place, I may look into driving a little further to a larger hospital.  One would be enough each time, but honestly, doula-ing isn't that awesome with no laboring moms!

Not going to give up...

Well, I moved to another town within the same country.  I've been settling in, focusing on my children and family, and pursuing certification as a childbirth educator and Breastfeeding counselor.

Another friend of mine died last week in childbirth.  She died and her baby died.  She died in the bush with no medical help available and the when the news got to me, I decided to get active in my doula-ing again.

It is a pain to get these things going.  I would like to volunteer as a doula here like I did in the last place that I lived.  So many hoops to jump through, letters to write, and people to meet with.  Trying to explain what a doula is and trying to convince them to let me help.  Hopefully it will pan out soon.  Until then I am just having to persevere and not give up.  I went through all of this at the last place too, and was able to leave an open door for other doulas when I left.  Hopefully soon!

Transitions

I am moving to another town about 6 hours away from here.  I have been working to leave behind 2 well trained doulas and 5 half trained doulas.  The well trained ones will continue to train the newer ones.  They are continuing a full fledged volunteer doula program here when I go...I am pretty excited about that.  I know they will do a great job. 

I am hoping to do the same thing in my new area, but we will see how it goes. 

Meanwhile, I have seen some wild births, and some sweet births.  I'll write about those later...

Me and a mama in transition

Why Volunteer as a Doula?

Why should a person volunteer as a doula?

 

1. It is a way to show love.

2.  In many places the women are alone in a scary place (the hospital isn't exactly a friendly place) at a vulnerable time

3. A woman with doula care is:

    50% less likely to have a cesarean birth
    41% less likely to need forceps or vacuum extraction 

When you are at the local hospital here,  the these things could possibly kill you due to infections that often come with them,  I believe that being a doula can actually reduce the maternal mortality rate. 

4. In an understaffed environment like where I work with women, An extra pair of hands and eyes can make a difference of life or death.  So many times I have been the one who noticed a woman hemorrhaging or a baby struggling to breathe, 

It's not for everyone, but I sure do love it!

 

 

Doula-ing with a Language Barrier

 

 

Okay.  If you ever find yourself trying to support a woman in labor when you do not speak their language, here are some ideas for you. 
 

Tips for supporting women during  Stage 1  of labor:

 

If there is any way to watch a woman be supported by another woman in her own culture, that is the best way to learn.  

 

Are there any bilingual (English and the language where you are) people that you can interview? Ask them how to support a woman.  Also, come up with a list of things you would like to be able to say and then get a translation.  Memorize those phrases.

 

Smile, love her, be with her, touch her, hug her.  Be there to hold her weight so she can achieve whatever positions feel best to her. 

 

 Use counter pressure and massage if this seems appropriate and is well received.

 

Follow her hands, she will often rub her own back where it feels good to her.

 

 Sing softly, this says... I am calm, there is no emergency, what is happening to you is normal. 

 

Offer water or other liquids to keep her hydrated

 

Mostly just be with her

 

When Labor is Slow:

 

Consider the position of the baby. If the baby is sitting off-center on the pelvis, the head may not be able to put enough pressure on the cervix for dilation.  Changing positions and moving the pelvis every 20 minutes or so may help to change the baby's position.

 

Some suggested positions would be:

·         Lunges with one foot up on a chair or something

·         Hands and knees or standing next to the bed while swaying the hips

·         Walking

 

Tips for supporting in Stage 2

 

When they are pushing, remember that asking them to squat enlarges the pelvis and unsticks stuck babies.  Most women are hot when pushing, they often like being fanned and a cold, wet cloth on their foreheads.  They are usually thirsty too.

 

Tips for supporting in Stage 3

 

 Fill up a water bottle with hot water (not too hot) and wrap it in a towel, and put it next to her.  Most mamas end up cold and shaky after birth.  Smile at her, she will be able to see that you are proud of her and that you think her baby is beautiful.

 I hope this is helpful to somebody!

 

 

 

I am the Ambulance

I'm hoping for a phone call. 

My friend Jana is due with her second baby and hopes to deliver a 15 minute drive from here at the hospital.  She has been selling bananas so that she can afford to do so.  (My family will be eating A LOT of bananas in the near future as I have been buying them.) 

The thing is, that only the very rich here own cars.  (We do not own one but we can rent one) There is public transportation....but not between 6pm and 7am.  So if a woman goes into labor during the night and things progress quickly...she has no way to give birth under the supervision of a skilled birth attendant. 

That is why I am expecting a call from Jana.  She plans to call and have us drive her to the hospital if she goes into labor during the night. 

Unfortunately for most the women in this country, transportation is not even the issue.  For most, there is no access to skilled birth attendants unless they hike for a couple days to find one.

I'm excited to be a part of her birth.