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. 

 

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!

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.

Lost in the Jungle

Have you ever wondered what you would do if you were really lost in the wilderness?

One night, about two years ago, I discovered what I would do….

"Hka hka hka" I could hear the familiar cough in place of a knock outside my door. I went outside to investigate.

There was a middle aged woman with one blind eye, two teenage girls, and two young men at my door. I hadn't seen any of them before. They had come to get my friend and I.  A woman with twelve previous children had given birth to twin girls the night before. Both babies were fine, but the woman was bleeding a lot, had a retained placenta, and they feared for her life. They wanted us to come and help.

It was a four hour hike to where she was in her banana leaf garden shelter. I got what I might need and we all started out. It was 4pm and our husbands weren't going to expect us back until the following day.

It is a treacherous hike. It seemed to be either straight up or straight down most of the time. Now it is the custom here, to yodel messages back and forth between the mountains.  About 2 hours into our hike we heard yodeling from the mountains across from us. The woman had died.

We told them to go on ahead, as it was their mother and sister who had died. I had a nine month old baby and wanted to get back.

Our guides would have led us back…but we figured we could find our way back through the jungle. (Don’t ask me why two California girls thought that) So after about a half hour on our own, we could not find the trail. We went up…all we could find was thick bush.  We went down and it was the same. So here’s what we did.

1. Sit down

2. Pray

3. Yell/scream really really loud.

4. Shine our flashlights to the mountain villages across the valley.

What did we yell? Well, we perfected our yodel (The way they yell from village to village). We yelled “the white ladies are stuck in the bush!” in 5 different languages. (Spanish and French were just to mix it up for our sakes) We figured as long as we were making noise, it could attract help.

We yelled once or twice that we didn’t have any toilet paper so someone really needed to help us.

Eventually (a couple of hours later) two young men from the next mountain range over (yes we had been that obnoxious) came to get us and lead us home.

So we were home before 1am and slept safely in our own beds.

If this woman had a skilled birth attendant with her, she would still be alive today. One of the twins died a week later.

 

They Are More that Just Statistics

This is a true story from when I lived a two day hike from any roads or maternity care. Warning: this is graphic; it may not be suitable for everyone to read.

Limaka and I sat together on the dirt, our machetes by our sides.  I twirled a piece of grass in my fingers and watched as my sons climbed trees and cut trails in the jungle.  We had been clearing the weeds around my house to keep the snakes away. 

 “My husband is dead and I had nine kids, but only one is still alive, I want you to meet her.  I’m so excited, she is pregnant and I am going to be a grandma!”   Limaka was bursting with pride as she spoke of her only living daughter, who had recently married and moved to a village 2 hours away.

I told her I would love to meet Lisi, her daughter.  But I never got the chance.

A few days later I heard that Lisi died.

This is what I gathered as to what had happened:

~ She went into pre-term labor (it seemed she was around 30 weeks)

~ The baby was a footling breech who slipped part way out.  It was stuck that way due to the cervix which was not completely dilated.

~ She tried to push for days, and she bled.  They offered to cut the baby.  She refused to let them hurt her half born child.

~They left Lisi and her baby under the house to die.  And they did.

I attended the funeral.  I sat in the smoky hut for hours with her dead body, and joined in the death wail. 

I found out the next day that I was pregnant with my fourth child.  I went to the USA where I had a doula, a midwife, a hospital that stopped my pre term labor, newborn photography, and a baby shower.

Here are some links to World Health Organization on infant and maternal mortality.

http://www.who.int/mediacentre/factsheets/fs333/en/ - infant

http://www.who.int/mediacentre/factsheets/fs348/en/index.html -maternal