Tribal Midwives and Jungle Waterbirths

Question: What do you get when you stick 13 laboring women, 6 tribal birth attendants receiving medical training, some hospital staff and a couple of American doulas all in the L&D room all day?

Answer: A very fun Saturday.

I learned a lot, for example....

1.  Don't try and play around with recently donated hospital beds that no one knows how to use.  (It ended up stuck in the  head down position.) Oops.

2. Leave your pants on if you think your baby might just fall out while you stand around visiting.  That way the baby is stuck in your pants instead of falling on the floor.  (This had happened to a lady the night before)

3.  One of the tribal birth attendants had a water birth.  She just got in a dammed up part of the river and sat there since the pain was better that way.  Eventually she delivered her own baby in the water.

4.  The TBAs were from many different tribes and it was so fun to hear about each of their birthing traditions.  A couple of them tied ropes around trees and let the woman hold on in a dangle/squat position while pushing.  Others mostly just squatted. 

5.  They have a lot of beliefs about unity and the baby not wanting to come until everyone is at peace. So when a woman is having a prolonged labor or birth, they bring in the father or other family to talk to the baby and tell it that it can come.

6.  The Tribal Birth Attendants had a very good understanding of birth on an emotional level...and were full of a lot of wisdom that way.

7.  Once again, I saw the squat position save the day when a woman was pushing for a long long time with out much progress.

8.  These tribal midwives open up their homes to laboring woman and help so many.  They are exposed to many diseases and are never paid.  They do it because they feel it is right to help their sisters.  It was a challenge to me to hear them talk about it.

It was a calm and beautiful day there with many babies being born gently and being cared for well.  It was different to have so many people there caring for the moms. 

Going Overseas? Read This First!

This blog gets a lot of traffic from midwives and doulas who hope to go get some practical experience overseas.  This can be a good thing...but not always.

Lets learn some things by examining the mistakes of a couple of North American nurses that came here to help in the labor and delivery ward last week.

They walked in eager for an experience, and a great story to tell.  They did not speak the language and are only here for a week. They boasted that they were so excited to be here because they were allowed to do stuff that would be unlawful for them to do in their own country.

They had never worked with laboring mothers, ever, and wanted to waltz in and deliver a "cute little brown baby."  One proceeded ..no kidding... to SLAP and SCREAM at a pushing woman I had been gently coaching for 6 hours already.  Not only was this white lady being rude and demeaning, she was screaming in English....which was not comprehended by anyone but me. This laboring mother who had been doing awesome, was terrified and scared and shut down...her contractions came to a complete stop.  This volunteer then yelled at her for "giving up."  

Next, this educated white nurse went on to try to sneak in a baby delivery by not alerting the midwife that the baby was crowning, but just getting ready to do it herself.  When I realized after a minute that this nurse had NO IDEA what she was doing, (I was having to tell her what to do...) I alerted the midwife myself, who came and delivered the baby.  This adventure seeker was willing to put a mother and baby's lives in danger simply to be able to say she had delivered a baby.  At least that is how I see it.

This nurse then kept correcting and pushing the very experienced national midwife out of the way, because "she wasn't doing it right."  These midwives are so experienced, (about 1000 births a year for 20 years or more) and could put most western midwives to shame, let alone an ER nurse who had never even seen a birth other than of her own.

You know what?  This woman probably is very proud of herself for "helping" these "poor people."  She probably feels like she is making a difference!  And she is.  Just not a good difference.

Here are some the problems I saw in these nurses:

1. Arrogance
2. A focus on the "experience" for themselves instead of serving the people
3. A failure to see these woman as intelligent and amazing people who are worthy of respect.
4. An excitement to do things "they aren't allowed to do" elsewhere.
5. A lack of respect for the culture and experiences of people different than themselves.

Instead, if you are going to volunteer in a country that is not your own:

1. Go in humility, with the heart of a learner and a willingness to lay down "your ways."
2. Do not go to "get your numbers" or to "have an awesome story to tell." Go to serve. Go to learn.
3. See these beautiful women of another land as strong and someone you can learn from.
4. Know your limits.  Do not do what you are not trained to do.
5. Study their language and culture.  Respect who they are and how they do things.
6. Be kind and treat people the way you would want to be treated.

None of us will be perfect, but let love be the focus of what you do and I'm sure things will go a lot better.

*I've changed the continent of origin of the offending parties.

Do You See What I See?

My last doula adventure was a crazy one.  I have seen a lot since I last updated you all.

1. I have seen two new doulas (that I have had the privilege of training) spread their wings and do very well. 

2. I have seen a baby born right on the dirty hospital floor.  Both mom and baby were fine. 

3. I have seen a woman punched repeatedly  while her baby was crowning. 

4. I have seen God answer my prayers over and over again when a mom is having a very hard time or when a baby is not breathing.

5. I have seen an HIV positive mom shunned and shamed. 

6. I have seen serious hemorrhages and babies that took a long time to breathe.

7. I've seen the midwives be very kind and show great skill in order to save a mom and baby.

8. I've seen the midwives share their own things and go the extra mile to be kind to a patient.

9. I've seen a movie on maternal death in childbirth put on for the laboring women to watch.

10. I've seen the squatting position spare many women from c sections and vacuum extractions.

Baby Heads and Doula Smiles

I smiled a lot yesterday while I was with all the laboring moms.

I smiled when Rosa pushed out a baby boy with ease.

I smiled when Rosa dressed him up super cute and I could tell she was in love with her new little bundle.  She had her tubes tied a few years ago, so he was quite a surprise.

I smiled when Helley gave me a skeptical look when I told her that her baby was coming soon and she was going to be okay.  It was a look that said "you are insane, I know I am going to die."

I smiled when Helley came back from the bathroom a few minutes later and lifted her skirt to show me what was going on.  I could see quite a bit of baby head.  She was holding a baby boy just a few minutes later.  Now she had a look on her face that said she was quite pleased with herself for having delivered her first child.

I smiled when Toola and I finally worked out a system to get her calmly through her contractions without going screaming and rolling around in panic and terror.  I had never seen a woman quite so active and creative with her laboring postitions. 

I smiled when Toola's baby girl finally emerged.  It took awhile and the little one arrived with a short cord 3x around her neck. I smiled because she was okay despite that.  I was so glad the midwife had arrived on that one, her head was halfway out before the midwife came.

I smiled when Toolah made it safely through a post partum hemmorage and when her baby girl finally latched on and nursed.

I smiled when Mallinah delivered her ten and a half pound baby boy (most babies here are between 5-7lb).  She was 44 weeks pregnant.  Yes, I meant to write 44.  She measured 44 weeks, and her dates said 44 weeks.  She had been completely dilated for hours, but the head was too high and not engaged.  She walked, she lunged, she sat on the toilet.  We had no birthball, that would have been helpful.  She was so drained and still the babe was high.  Her water finally broke and eventually she felt like pushing.  After 2 more hours I finally convinced her to squat and push.  She did and within 15 minutes there was a baby head.  The midwife was there just in time to see the rest of it's body slide out.

There were five births and 7 moms and it was just really fun as well as really amazing.  I'm getting more comfortable in my role as a doula and in trusting the mom's own instincts.  I am also amazed at what a woman can birth if she squats instead of laying on her back!

Double Doula-ing

I have been mastering the art of double doula-ing.  No, I am not talking about mom's having twins. I'm talking about two moms moving into one space so that I can support them both at once.  I would never ask them to do this, it's their idea.

It is much easier if their contractions are opposite of each other in timing.  Then I can support through the pains one at a time.  Unfortunately this is not usually the case, which leaves me trying to massage/focus on two women at once.  It reminds me of trying to pat my head and rub my stomach at the same time.

I feel rather silly looking, rubbing two backs at once, but I'm glad to be there for them.  I think it is time to train some more doulas to come along with me.

Is He Dead?

I thought he was dead, but I prayed and prayed that he would be okay.

 I had been attending his mother as her labor support person for many hours.  There was no sign that there would be a problem, but when he was born, he was grey, limp, and he did not start breathing or crying on his own.  There was a cord around his neck that was not removed by the student that was delivering him.  Maybe that was the problem, I don't know.

After a couple of minutes, the student realized that this baby needed more than a little stimulation.  I had run and gotten the ambu bag thingy for them just in case.  Sure enough, they started to try and resuscitate him and after what seemed like a very long time he started to cry.  Soon he was nursing. 

I thanked God for another little one that lived.  It was the 2nd close call in one day.

In the tribe I lived with for years, they do not stimulate a baby after it is born.  They just watch and wait to see if it is alive or not.  They never pick it up or touch it unless it cries.  So many of their babies were "stillborn."  In reality though I wonder if they could have lived if they were helped along a bit to take that first breathe. 

Whatever the case, I hate that 50% of children there never have the chance to grow up.  I want to help see that change.

Walk that Baby Out!!!!!!!

I volunteer in the labor and delivery ward here mostly because the laboring women are not allowed to bring even one support person with in with them.  I love it though when a brave mother in law or grandma comes marching in anyway.  I never tell on them, so sometimes they manage to hide out for a hour or so. 

Yesterday this wrinkly, ancient and very wise looking old woman came bursting in.  Policy meant nothing to her.  She had squatted on banana leaves and borne 13 babies in her lifetime.  This is what she had to say to her granddaughter who was in labor with her first child.  "Get up! Walk, walk, walk,  faster.  GO!  Do want this pain to last all day? If you do, then lay down.  If not, then get up and go!"

Amen Grandma!  I have seen many other veteran mothers here offer the same advice.  I also noticed that the women who just walk and walk have their babies so much faster than the ones who just lay on their sides.  I personally was a walker in all of my 4 labors and recommend it to anyone!

Twins and a Prolapsed Cord

This weekend at the hospital was nuts.  There were  naked women on the dirty floor yelling, "The baby is coming!"  There were not enough beds for them all, and there were more pukers than usual.

The operating theatre was not "in service" due to the air conditioner being broken.  I am not sure why the air-con is necessary to operate, but apparently it is.  The vacuum extractor was also broken. 

So into this environment, a lady named Malley (not her real name) walked in.  Her belly was HUGE (in an adorable way) and she had not had prenatal care.  She walked around until a baby started to fall out bum first. A little girl was born breech.  Then another baby started to make his way into the room head first.  Unfortunately his umbilical cord led the way.  So now the midwives were dealing with a prolapsed cord.

The midwives flipped her over to a head down/ on her knees position and tried to push the cord back up into the mom.  They also pushed the head up and then flipped her back to her back and applied suprapubic pressure in an upward direction to hold the head up off the chord while trying to fix the vacuum extractor.  They couldn't get it to work and they called the doctor.  Meanwhile there was still a heartbeat.  I was holding Malley's hand, praying with her and comforting her.  She asked me to sing a hymn while we waited.  Singing is not my gift, but we sang anyway.

The doctor arrived and without the option of C section or the vacuum, he proceeded to just have her try to deliver the baby quickly.  Two contractions later the head was in the birth canal and the chord had stopped pulsating.  Two more contractions.  We all started to anticipate a dead baby.  I prayed and prayed.  A very grey and limp 5lb baby emerged.  After some stimulation though he pinked up and cried.  I checked on him a lot throughout the rest of the day.  He was a champion nurser and very alert little guy.  I'm so thankful that he is okay.

A Chicken, a Needle and a Natural Birth

When I was pregnant with my first child in the USA, I read a lot about childbirth and how to have a natural childbirth.  I wanted this mostly because I went to the epidural class at the local hospital (just in case) and the guy there passed around a GIANT needle and talked about sticking it into my back and how there were many risks with an epidural, including death.  Hmmm...do I want to go with the contractions that have never permanently damaged a person, or the giant needle that may kill me...?

I may be the only person in history who chose natural childbirth, not because I am so brave, but because I am a chicken.

So after that, I decided to skip the drugs, and I read every birth story I could. I wanted to learn all the "tricks" to getting through labor on my own. 

I have been to over 40 births here now, and helped almost 40 other women in labor besides that.  I have noticed something.  None of these women have ever seen a pregnancy book.  Not one of them has been to a childbirth education class, and only some have attended other women's births.  They have natural labors because the other choice is a C section. 

The thing is, they seem to just go with their instincts as far as positions and laboring....and it lines up with all the things we write books about and think we are so smart to know as doulas.  Funny how moving around, changing positions, and using gravity to our advantage is just what they instinctively know to do.  I guess so much of what we read and are taught is supposed to just come "naturally."

Maybe we are born with the knowledge of how to give birth well, just like the rest of the creatures in creation. 

.

Vaccuming a Baby Head

So, apart from accidently cussing and fainting yesterday...I also got to see my first vacuum extraction birth.  It was brutal, but mom and baby are alive and happy, so it seems to me it was worth it in the end.

These days, I tend to judge a birth by whether or not everyone lived.  I would love to see each mother satisfied with her experience...it just doesn't take much for these women...if they are alive in the end, they are happy.

I could hear Mavis (not her real name) yelling long before I got to the labor and delivery room.  This was her first baby and she was NOT afraid to make noise.  When the midwives told her to quiet down, ( they actually were pretty kind and concerned for her) she just looked at them and screamed louder.  She alternated biting the mattress, rolling around on the floor and throwing things.  ( So much for the "women in other countries just squat, push out a baby, and keep on working in the field" theory.) 

When I arrived she had been in active labor for 24 hours.  She had been at 9 centimeters for 3 hours.  Her baby was slightly transverse. (Basically it was laying diagonally with the side of  head and ear trying to head down the birth canal.  It is a good thing that she was one of the 30% of women in this country who had a skilled birth attendant for her birth.

I walked in to be with her and she clung to me and begged me not to leave.  She was sick of being alone and in pain.  It was one of the roughest births I have helped with so far (except for the ones where there was a death).  We worked with gravity trying to jiggle the baby down into the right position.  I had her try polar bear position alternated with standing and dancing the baby down.  Interestingly, it seemed that she naturally wanted to do those things anyway.

She was complete by 8:30 am and then started pushing.  She pushed for six hours.  At this point she was going on 48 hours of active labor and was refusing food and drink of any kind.  She was constantly falling asleep standing up, and I was trying to keep her from falling over.  She was about 100 pounds more than I was and it wasn't an easy task.  I used every "trick" I could think of.

After 3 hours, I begged the midwives to come check for fetal heart tones, something they hadn't done at all since I had arrived.  It took them awhile to hear anything, and when they did, the baby was in distress. Her head had moved into a better position to come down though.  After two more hours of pushing they brought in a broken vacuum extractor (it would only go up to half of the suction it was supposed to have) and gave her a huge episiotomy and finally dragged out a beautiful baby girl.

It was not a pleasant birth, but when I left, mom and baby were alive, healthy and happy.  Oh, and Mavis named the little girl after me.   I was so proud of her making it through....

A Cussing, Fainting Missionary lady

My head hurts.

I just spent a very long and wonderful day at the hospital as a doula to many lovely women. 

Unfortuately, I had to learn an important lesson the hard way.  No matter how "needed" I am, I need to take little breaks and eat and drink to keep up my stamina.  After birth number five, I started feeling really lightheaded, and yes, I passed out on the floor. 

That is why my head hurts.  It was embarrassing. 

I also shocked all the staff with my dirty mouth. They call me the missionary lady and have high expectations for what words I may or may not use.  Due to a language mess up on my part I accidently swore a few times while trying to say. "I think we need to put a new sheet on the bed." I just mixed up two words that were very close. I never did explain myself either as  there was a baby coming out right about then.  Oh well.

Part of the reason that I didn't take breaks is that I had two women in a row that were terrified for me to leave them.  Both had been laboring completely alone for over 24 hours and both would cling to me and beg me to stay if I even took a step in another direction. 

There were four girls and one boy born today, and apparently there have been five girls for every boy born at this hospital for over a year now.  This would cause future problems if we were in the USA - but here, some guys have 5 wives...so I guess it will all work out.

Tips for Doulas Working Overseas

Are you a doula who is considering working overseas ?

Here are some things I have found to be very helpful:

1. Dress like they do.  When you are entering a culture that is not your own, it is helpful to at least try to fit in.  You are weird enough without wearing tight jeans where the women wear only skirts. In a birth setting, you don't want to be making people uncomfortable. 

I wear the traditional dress of the women here when I go to the hospital.  The women and midwives appreciate that and tell me so.  Of course, once a woman hits 6-7 centimeters I don't think she would care if I was wearing only a bikini...at that point is all about getting through and holding that baby!

2.  As much as possible, speak the language.  Learn whatever you can, and interview native speakers on how they say birth related things  I am fluent in the language here, and I cannot imagine having to be labor support without being able to speak!  I know it would be possible, but hard.  I need to be able to encourage, explain what is happening and just say whatever needs said. 

3.  Be willing to swallow your own culture and "birth agenda."  Your own culture regarding childbirth and what that should look like is not the only right way.  Be a learner, be there to serve.

Dad's may not want to be there...and the reason may run deeper than "just change the hospital policy." There can be taboos that come from fear of spirits and of a woman's blood.

4. Love, Love, Love, the women you are with and make her birth experience the best it can possibly be.

Emergency C-Sections...tomorrow

The midwives in the hospital here are the janitors too.  They deliver the babies, mop the floors, change the sheets, train the doctors and new midwives and admit the patients.  They are often tired.  The last few times I have been there helping out, it has been one midwife running the whole ward. 

When there is a problem, it can take sometimes 24 hours to get everyone in place for a C-section.  At times, everyone just happens to be there and it goes off without a hitch.  Often though, it takes a very long time.  I witnessed this being told to a mother the other day..."Your baby is in distress, but we won't be able to even try to induce until tomorrow morning when we have a doctor on call, in case you need a C-section as a result of the induction."

It struck me the other day that most homebirths in the USA have more access to emergency help if needed than the labor and delivery ward here.  Just an interesting thought.

Speaking of C-sections, I came upon a woman the other day who was so upset when she was told they would have to cut her to get her baby out. (She was 6 centimeters and the baby was lying in a transverse position.)  It wasn't until I explained to her that she would be asleep and not awake feeling them cut her, that she calmed down at all.

Imagine thinking they were going to just cut you open while you watched, feeling everything!

Fishing in the Toilet and Interrogations.

Yesterday I witnessed a one hour interrogation of laboring and post partum women.  The nurse wanted to know which of them had tried to flush a pad down the toilet.  It ended in a very weak mother, who had delivered only an hour earlier, being forced to fish the pad out of the toilet.
 (These women have rarely seen flush toilets or used disposable pads...so it is a hard thing to get used too)

I see things in the hospital here that are very hard to see.  Interesting though, the women are NOT complaining.  They are thankful.  At the end of an awful delivery (one that would surely bring a lawsuit in the USA) she is saying..."I'm so glad I was here!  Who knows what would have happened if I had been in my hut alone."   She isn't saying this because she has been brainwashed by the medical community.  She has seen firsthand friends and relatives who died in childbirth.

It costs them one month's wages to spend the night on the floor in the hospital filled with rats and cockroaches.  They stand barefoot in a shower (if there is water) where 30 other ladies stood and bled...in a country where HIV is rampant.

The hospital situation here can be gross and sometimes even abusive.  Oh, and did I mention that you have to bring your own toilet paper?  There is often no running water for days at a time...I would like to see it changed.  I  am glad though that less women and babies are dying here in the hospital than they are in the jungles....although last weekend 3 newborns died in the hospital in a 24 hour period....so I wonder about that too sometimes.

The funny thing is that I believe the hospital staff is really trying hard to do a good job. (Except for the Nurse Interrogator)

I personally have some horrible stories about American hospitals....but I never had a nurse make me fish things out of a community toilet.

Breech in the Jungle with a Cigarette

Underage Smokers

She squatted, she smoked, she grimaced as the contractions came and went. She wore only a ragged loincloth. Under her was dirt and above her were the stars. 

This is where she was going to have her baby,  The neighbor kids giggled as they lit their jungle "cigarettes."  They weren't allowed to have the tabacco until they were at least 12, so until then, they wrapped random jungle plants in dried banana leaves and smoked them. 

I was with my friend Kira on the night her 4th child was to be born.  I had awakened to a rapping on the bamboo walls of my house by her husband telling me it was time. 

We headed out to a little spot her husband had cleared in the jungle.  He lit a fire, stuck a stick (to hold while pushing in the squat position) in the ground, and they laid down some banana leaves.  Now the baby could come.

The wind was strong that night and we were all cold.  In this tribe, there are no birth specialists.  A woman in labor is attended by whoever happens to be around.  Tonight it was me and her mother in law and a bunch of kids.  I had brought a clean razor blade, a baby hat, and clean baby blankets.  I was hoping for a good outcome, as it seemed that a lot of births here ended in tragedy.

Kira grunted and repositioned herself, then lifted her homemade cigarette to her lips again.  She smoked almost constantly throughout her labor.  The contractions kept getting stronger and then they pretty much stopped.

She was tired and we all decided to go back to the village and let her rest until the contractions started again.  When they started again they came fast and hard and out popped a big boy.  Bottom first. 

She rested and lit another banana leaf/tabacco cigarette.

She Decided to Help

I know someone who wasn't afraid to step forward and be a part of the solution.  The following is a guest post from a woman named Jamie Dellesky.  Look her up on her website: http://www.dellesky.com/

Jamie in the Philippines

1,000. I still remember the day that number broke my heart. Shattered it into a million tiny pieces. That’s the average number of women & young girls who die each day because of pregnancy & childbirth related complications. That’s the equivalent of the number of passengers in 4 jumbo jets crashing everyday. Experts say that 80 % of these complications can be prevented if there were simply a trained birth attendant present.  

About two years ago, as I was reading about birth in developing countries, the above statistics were what I found. Alarming. Heartbreaking.  I had spent the past 11 years serving women in my community as a doula & I could see first hand how skilled + knowledgeable care helped to protect the lives of mother’s and babies. I had no idea that my sisters in other countries, specifically developing countries, were losing their lives giving birth because of a lack of care.

As this began to pierce my heart, I then began to ask God about how I could help. Surely, there was something I could do. But what could one family do that could make a difference?  The more I researched, the more I kept finding that the world needed roughly 300,000 new midwives. Midwives that are trained in life saving skills, midwives that can go to where the women live to make accessibility possible, midwives that can give safe, kind & loving care, the kind of care that every mother and baby deserve.

A simple equation began to work itself out in my mind. If what is needed are midwives + I am capable of learning =then I need to train to become a midwife.  After much prayer and leading from God, that’s exactly what I did.

Last year, my husband & our 3 boys gave up our home, our jobs, sold most of our possessions & packed up the rest and moved to the Philippines to train with a non-profit organization that runs free birth clinics for women in poverty. I spent the year learning how to care for high-risk women & provide life saving skills for those who needed it.  We worked hard to learn more about the problems of resource poor countries & the issues that affect women and children. We witnessed not only the problems that create this global health crisis, but also the solutions. So many women that we served in the birth clinic could have very easily died during or after their births had they not had the life saving care we were able to give.  Excellent care that is free & accessible as well as loving and kind, this is what we see to be working.  This past year of training built a foundation for us that will help us to go into other areas of need in the world.

For us now, that place is Africa. Of the 20 worst countries to be born, 19 of them are in Africa. We are moving to Tanzania to partner with a local church in Dar es Salaam. We will be working on developing an outreach to mothers & babies in a very poor area of this city. This outreach will include aspects of health care that are needed such as health education, nutritional support & baby care. The life- time risk of a woman dying in childbirth in Tanzania is 1 in 23. Our long- term goal is to eventually start a free birth clinic in this neighborhood. 

We also hope to start our own non-profit that can reproduce a healthy model of care within resource poor countries.  A model that offers loving care from local midwives with life saving skills.

We have come to realize that if a lack of midwives means high maternal/infant mortality, then the answer is to provide more midwives. Its not hard to do, there’s enough money & resources in the world, it’s simply a matter of redistributing it.

 

*This family is raising funds to go to Africa.  If you feel you would like to help with that, their website is listed at the beginning of this post.

Survival

"Well, those women are just used to it, they see death all the time.  I'm sure it doesn't bother them like it would bother us."

I have heard this response so many times from Americans when I tell them that where I lived, 50% of children die before five years old.

 Just about all my friends in the bush had lost half of their children.

It is a hard thing for us to wrap our hearts and minds around.  When someone in our close community loses a child, we see it as absolutely devastating, as we should. Why then, just because a person eats differently, believes differently, and celebrates differently - do we assume that the loss of a child does not HURT?

If you held that woman as she wept, even months after the child was gone,

if you could look into her eyes,

you would know that those mothers mourn and feel the deaths of their children the same way you and I would.

They smile, they keep going...not because it doesn't hurt them as much as it hurts a middle class white lady....it is because these women have to keep going in order to survive.  Her life is hard and she does not have the luxury of shutting down.

Dangerous Doula-ing Strikes Again

(Warning, don't read this while eating)

The Facilities...

As a doula here, I get to haul water, a lot. I also get to try not to mix up the babies.  Not something you learn at a doula training.

A lot of women here hemorrage, even though they are all hooked up to pitocin as soon as the baby arrives.  Out of the last twenty births I have seen, six hemmoraged...I'm not sure how that compares to other places.

Many of the women are very weak after giving birth, and within an hour they are usually asked to get up, pack up, and bathe.  Bathing includes filling a five gallon bucket with cold water and carrying it 15 feet to the shower stall.  That is where I come in, the water bucket carrier.
Once to the shower, the woman then squats and washes.  This one shower is rarely cleaned and women file through there all day and all night.  As you can imagine, it is GROSS.  (Think blood clots)

There is also only one toilet, which is rarely cleaned.  But I will spare you the description on that one.

Did I Give Her the Right One?

During one post partum hemorrage, the midwife was getting pretty worried and asked me to grab the woman's baby so that she could nurse it and cause the uterus to contract.  I walked to the little table where three babies were wrapped like little burritos side by side.  Hmmm....no identification....how was I supposed to know which baby was hers?  I ran back to the midwife and explained my dilemma.  She replied, "the big one is hers."  So, this being an emergency situation...I grabbed the biggest looking burrito baby there and brought it back to the woman.

She stopped bleeding and fell in love with her baby....at least I hope it was hers...she seemed to think it was.

A Breech Nightmare

This story is one I've hesitated to write about. 

It has been a couple of weeks and the images are still haunting me...beware.  If you are pregnant, please don't read this.

My heart in sharing this is to open your eyes to state maternal care around the world.

I walked into the labor and delivery ward one morning to find a teenage mom surrounded by midwives and nurses.  Something was dangling between her legs.  I attended to some ladies who were asking for tea.

After a few minutes a midwife stopped yelling at the girl and explained to me: "Her baby was breech, and she was not fully dilated when she pushed the baby out. We kept telling her not to push, but she did anyway and the baby got stuck at the head.  Now the baby is dead and it is all her fault.  It's dead and stuck there."

That is when my brain made sense of the baby's grey body that hung there.  I asked if  I could talk to the girl.  They said sure.

I held her hand. I prayed with her. She asked me if it was a boy or a girl.  I had to lift the dead baby's leg to check. No one had told her that it was a baby girl.  At this point the medical staff were mad at her and just leaving her alone with her baby half born.  She asked me to get the baby out.  I explained that I could not do that.

Finally they hooked her up to pitocin and started yanking on the baby...and yanking and yanking and yelling at the poor girl.  All the while I stroked her head, trying to be the presence of kindness in a horrific situation.

After about ten minutes of this, another midwife walked over and showed them how to hook the babies mouth with her finger and tilt the chin down while putting the other hand on the mom's belly.  The dead baby popped right out.

This poor girl was terribly damaged "down there."  While they stitched her up they gave her a lecture. It went something like..."This happened to you because you got pregnant out of wedlock, you deserve it and this is all your fault."

I came behind and tried to undo the damage.  It was just awful.  She wrapped up her dead baby, got dressed, and hobbled home a few hours later.

This has not been the "norm" here, sometimes I see a lot of kindness and skill.  But this was downright awful and disturbing  I wish that all women could be treated kindly and that all births ended happily.  But, they don't. 

Four Fun Births

It seems like death and life are so closely intertwined here.  Three times yesterday, I saw babies enter the world to the eerie tune of the "death wail" just outside the window where these women were giving birth..  As people left this earth in one room, new ones entered in the labor and delivery ward.

I spent all day at the local hospital as a volunteer doula.  I walked in on the birth of twin baby girls.  They were about 6lbs each and born vaginally.  It was awesome.  After the babies, the mom hemorrhaged and was quite weak afterwards.   I got to be her extra hands for the first couple of hours, cleaning little meconium bottoms and holding the babies while mom washed up.

Another little baby was named after me. I spent a lot of time with this mom, from the time she was 2 centimetres until after her baby was born.  At one point, she had not made much progress for a few hours and the baby was very high up and posterior.  We worked on movements and positions she could do to help with this and it was so exciting seeing that within a few hours her baby had turned over and was engaged.  Little Kimberly was born up to her chest before I could get anyone to come help.

Then there was the girl who walked in just a half hour before I left.  She came in with a friend, who promptly got kicked out (hospital rules).  After a few minutes everyone suspected that this first time mom just might be pretty close to delivering.  Sure enough, ten minutes after she arrived she was completely dilated and ready to push.  I got to hold her hand and talk her through what was happening and then watch her as she giggled in delight over her precious new baby boy on her chest.  

It is such an blessing to be able to be with these bright smiling, beautiful, and strong ladies as they become mothers.  I love being able to be kindness and love to them.  It is just plain old fun.