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!

 

 

 

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!

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....

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.

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.

What do I take to the hospital?

What do I bring when I go to the hospital here as a doula?

1. Pads to share with ladies who did not bring any.

2. Soap so that I can wash my hands.

3. Toilet paper because well, it's nice to have in the bathroom.

4. Last time I brought and donated 15 cups, because all the women in labor were sharing one cup for water and there was no dish washing going on.  I have lived in the jungle long enough that it didn't bother me too much at first...but then I thought about TB.

I have my kids make me a paper fan and I bring wash cloths to cool foreheads.

That is about it.  The contents of my "doula bag."

Kindness and an Answered Prayer

It was a Saturday, and I was at the hospital helping the women who were in labor.  They said I was the “watch mama” to all of them, since their own mothers are not allowed there. 

I was running back and forth between two ladies when I noticed Hati.  The midwives were yelling at her. “You aren’t trying hard enough! What is wrong with you! Your baby is going to die if you don’t listen to us!”  She looked so tired, barely even conscious.   

I asked what was going on with her. They told me that she had labored at her house and had been trying to push out her baby for close to two days.  Her family was concerned that the baby had not been born, and brought her to the hospital.  When she arrived, she was fully dilated and they hooked her up to Pitocin.

She had been there 2 hours and nothing had happened.  She was too tired, and she seemed to have given up.

I asked if I could talk to her.  They said yes.  I held her hand and spoke kindly to her.  I told her that she was a good mother, and that I knew she loved her baby.  I talked to her about how to push, and I asked if I could pray with her.  She opened her eyes briefly and nodded. 

I began to pray that God would give new strength to Hati so that she could push this baby out and that it would be born safely.  About ten seconds after I started to pray, she sat up and started pushing with all of her might….and the tiniest bit of the head appeared!

I called out to the midwife.  Within ten minutes, a healthy baby girl was born.  It was an answer to prayer.

 

 

"Am I doing it wrong?"- a birth story

She is in her third year of university...quite an accomplishment for a girl in these parts.  Today though, she is having baby.

Koris was dropped off at the hospital at 7am.  I arrived a half hour later to help support the women in labor.  The ward was crowded .  There were 12 postpartum moms and newborns piled into the back hall, they laid on the floor and nursed their precious bundles.  They reminded me of teenagers at a slumber party.

She was assigned to bed #2, but she was more interested in climbing the walls and pacing like ping pong ball.  She  made alot of noise and the midwives asked me to care for her. 

I held her, talked her through what was happening to her body, gave her food and drinks, prayed with her, and helped her with whatever she needed.  Pain medication is not an option here, although the artificial rupture of membranes and pitocin to speed labor are common.

Concerned, Koris asked me, "Am I doing it wrong? Is all this walking the wrong thing to do?"  I told her she was doing awesome, that when I was in labor with my 4 boys, I walked for hours.  I told her she was going to get this pain over with, and get this baby out, at the rate she was going.  Mostly I just kept encouraging her that she was doing great.

After 5 more hours, a lot of back rubbing, counter pressure and squatting...she was ready to push.  She didn't want me to leave her side. 

A beautiful baby girl was born.  I got to see 7 other babies born that day. Each one a miracle.