By Jennifer Gallardo
It is 7:am and we have to leave for the airport in just a few hours. I know I should be upstairs packing, but another momma has come in to the birth room, and I am drawn there like a magnet. This room, vibrant with life, with wailing and singing and moaning. This room, full of blood, and tears, and sweat. So raw and real. I will miss it and I want as much of it as I can get before I get on the plane for home. I also have a selfish desire for an easy birth after the difficult shoulder dystocia birth I just attended, and I want to check in on the two momma’s who just had their babies and are recovering in the birth room as the four beds in the postpartum room are filled.
I walk into the birth room and I look over this new momma’s chart. Intact membranes, 8 centimeters dilated, baby number four, 31 years old, unknown due date but her fundus was 38 at the last appointment just a week ago. She has had a total of three appointments. I walk over to her and she grabs my hand and tells me to massage her back. I sit by her and massage her, listening to her sing a hymn. I notice that she is on the thin size but has a normal sized belly. Things are moving fast and I estimate that she will have the baby within the hour. She loves to sing, and she sings in-between contractions, and wails during the contraction. She is singing hymns in Kreyol. Some I recognize and some I do not. When she wails, the sister of the postpartum mom who had a shoulder dystocia birth shushes her because she wants her sister to rest. Considering that her sister had wailed and moaned for over 18 hours, I don’t think that is fair. I say “Man Manh chante belle” (mother sings beautifully).
Momma sits on the birth stool and drapes her arms around my neck and leans her head on my shoulder. When she feels the urge to push she gets off the birth stool and chooses to lay on her side. As the birth gets closer she lays on her back and gives a big push. Her water breaks and amniotic fluid splashes on the bed and a baby foot pops out. I have a lot of experience with breech babies, and I am brainstorming on how I will help baby come out should baby get stuck, as I am used to momma’s being upright for their breech births, but then the baby just comes out with the next contraction. All of it. I check quickly for gestational age and calculate baby to be about two to three weeks early. I dry baby briskly and she takes a breath and cries. Momma asks with urgency whether it is a boy or a girl. “Fi” I respond. She looks upset and turns her face to the wall and won’t look at her baby.
I am focused on this little baby, when Rose Edith shouts, “Gade!” (Look!) as she points to momma’s belly. I see another baby in transverse position (this means baby is laying sideways, horizontally, which is an impossible way for baby to birth). We have twins! Our work is not done yet. I listen to FHT’s which sound great. I ask for two plastic cord clamps so that I can cut first baby’s cord and leave a plastic clamp on the end of the cord that is hanging out of momma. With the cord cut, baby girl is dried and swaddled and passed off to grandma. I now focus on getting the second baby in a vertical position, either butt or head down. I rotate baby by gripping baby firmly from the outside of momma’s tummy and kneading baby into the correct position with my fingers and hands. Baby no longer looks transverse, and I ask for a glove to check. I check momma and feel a bulging bag. I push up farther and feel through the bag a rump and a foot. I feel the toes carefully to be sure it is not a hand. I feel five small toes and the outline of a foot. I again check position externally, and it appears baby is vertical.
Momma is frustrated with my hands on her belly and rolls away from me onto her side. As she lays on her side and gets a contraction, I watch her belly and see a huge shift happen. Baby moves right back into transverse position, at the same time as momma pushes and clear amniotic fluid bursts out of her, splattering the wall, the sheets, the floor, and the clock I had placed on the bed. I hope that the shift I saw happen on her belly was not really the baby moving back to transverse. I ask mom to let me check her with a vaginal exam, but she does not want checked. Rose Edith pleads with her to let me check her but she will not open her legs. Finally she allows me, as she lays on her back on the bed. I feel an arm and a hand. No cord. With much pleading and explanation, we get momma to get on hands and knees. I have to reach in and find baby’s feet and do a manual extraction, pulling baby out. I put my hand in and follow baby’s back and reach baby’s butt off to the side of momma’s pelvis. As I reach up higher into the uterus for baby’s feet, momma yells and moves away from me, flipping around and sitting on her bottom on the bed with her feet firmly planted on the floor.
I am sure it hurt her for me to reach high into her like that for her baby. I feel so sad for her that she is confused and in pain. I ask her to please let me try again, and Rose Edith is talking to her, but I don’t think she understands the urgency of the situation and is asking us to wait. We cannot get her to change position and we try to find heart tones without success. Rose and I try to lift her off the bed to get her onto hands and knees again so I can get baby, but she begs for us to leave her alone and wait. She pulls away from us and drops to the floor. She sits on the floor on her bottom, with her legs stretched out and closed in front of her. I have the thought that the floor is not clean enough for her to be sitting on naked and I worry about an infection.
I am losing track of time and how long it has been since her water broke and we lost baby heart tones, and I am losing hope. I cannot speak well enough to communicate with her. Rose Edith is trying but without success. I feel a blanket of defeat come over Rose and I as we realize it has been too long for us to save baby. I tell Rose the baby will not live if we do not get baby out NOW. The grandma hears us from the hallway and storms into the room and begins to yell at her daughter that she is not listening to the midwives and her baby will die. The grandma says, you are refusing to push and now your baby will die. I have the thought that now the momma will have this trauma of feeling she is responsible for the death of her baby, as if losing her baby were not enough already.
Our sweet momma begins to wail, and she crawls on the floor towards the bed. Rose and I see a cord and a small white hand hanging out of her. It is too late. Grandma sees it too and says sadly, “Bebe mouri” (baby has died). My thoughts now turn to the mother and keeping her safe. It is too late for this baby, but what is safest for momma? Is it safest to attempt the long car ride to the hospital or do an extraction at the birth center? I look at Rose and ask if we need to go to the hospital and she says yes. I do not have the heart to put my hands inside momma again to get this baby out. We get mom to the ambulance and Rose climbs in. I cannot go as my plane leaves soon.
I walk towards the stairs and pass all the same people who congratulated me and hugged me earlier for saving the baby who was stuck with a shoulder dystocia. Now they look at me somberly. I trudge tiredly up the stairs, feeling numb and depressed. I smell blood everywhere. I shower and scrub the blood off of me. I scrub my skin over and over, trying to wash the sadness and reality away. I get dressed and I throw my things into a suitcase. The men are packing the car and almost ready to leave. I am saying my good-byes to all the staff. A heavy cloud hangs over me.
About 30 minutes have passed since they left for the hospital when Carmelle comes upstairs to tell me the baby was born in the ambulance before arriving to the hospital, so they turned around and are back at the birth center. The momma is in the postpartum room nursing her first twin. I ask whether the second twin was a girl or a boy, and Carmelle tells me she was a girl. I feel relief that the momma didn’t lose a boy that she wanted so badly. Maybe she will accept her live baby girl more fully if the baby she lost was not a boy. I ask to see the baby and Carmelle takes me to the bathroom, where the baby is laying in a placenta pan, right beside the placentas for the day that need buried. I am shocked and upset that this little baby girl has been discarded like this. I run upstairs and get a beautiful quilt. I run downstairs and glove up and fill a bucket with water and I bathe this precious baby girl and brush the blood out of her lovely dark curly hair.
My body is racked with sobs and I cannot stop them. They come stronger and stronger and soon you can hear my sobbing throughout the birth center. I clean her and dry her, and I wrap her in the beautiful quilt. I rock her back and forth and cry and cry, my body shaking and wailing as I sit on the bed of the birth room, which is now full of postpartum mommas. These same women who gave birth and then watched Rose and I try to save this baby, while they lay in bed nursing their new babies, now look at me crying unconsolably. The momma who smiled at me so beautifully in labor, the one with her hair in two buns, she now looks as me with such compassion and smiles at me tenderly as if to tell me it will be alright. I finally get a hold of myself and swallow my sobs. Enough is enough. I cannot go on like this with these women who just birthed watching me.
I stand up, holding this beautiful, blue, cold baby in her handmade quilt. I ask Carmelle if the momma wants to see her baby. Carmelle says yes. I take the baby into the postpartum room and ask the mother if she wants to see her baby. She is laying in bed with her pink little girl, and her eyes light up and she says yes. It is then that I realize the look of hope on her face is because she thinks I have somehow miraculously saved her baby, and that I am about to show her a live baby. As soon as she sees a blue baby she turns her face away and it becomes stony. She pushes her hands at me to tell me to take the baby away, and she turns to her live baby girl and pulls her towards her.
I take the baby to the grandma and auntie. They are outside washing the bloody laundry by hand, squatting by the water bucket and scrubbing, talking and laughing. They stand up and look at the baby and become very somber. They do not want to hold the baby. They ask me to carry her to a room so they can pray over her. We go to the prenatal room, the only private room available, and I hold the baby. They tell me to place her on a chair. They do not touch her. Only later am I told that it is bad luck for them to touch a dead body. They sit around the baby girl and sing “How Great Thou Art” in Kreyol. I step outside the room to give them privacy, and I hum along to the song. Maybe it will comfort me.
Someone comes in from outside and tells me everyone is in the car and ready to leave to the airport. Am I ready? A few more minutes, I tell them. The song comes to an end. The grandma and auntie give me a hug and tell us to bury the baby. They do not want to take her home. I go in and pick her up one last time. I stroke her forehead and give her a kiss. I place her in the cardboard box that Carmelle brought down for me. Carmelle closes the lid. I feel numb. “Fini," (it is finished) I think.
As we drive to the airport through the traffic and the dust I relive each detail of the birth. I should have kept my hands on her belly when she rolled over, so that the baby didn’t go transverse again. I should have tried harder to grab the feet. I should have learned more Kreyol so I could communicate better with the momma.
I wonder if the baby girl that lived will always feel the loss of her sister, with whom she shared the womb. I wonder if she will grow healthy and strong and survive until her fifth birthday in a country with the highest death rate in the western hemisphere of the world for children under the age of five. I think of all the faces that looked at me with compassion as I cried about a baby’s death. Strong, stalwart, kind, serious faces. I suddenly realize that, while I was not the only one who felt grief about this death, I did not see anyone shed tears. I wonder if all the tears have run dry in Haiti from so much suffering and death, and if there are no more tears left to cry.