By Jennifer Gallardo
Morning comes too soon at 6:30 am, when the heat of the sun on the roof wakes me up. I fumble down the stairs after only two hours of sleep and mumble to my husband I need more sleep. I lay down in the volunteer room despite the feeling that I am in a sauna, and fall asleep under the mosquito net. At 8am I awake, wet with sweat. I have Elio coming at 8:30 to translate for me while I take pictures of the mothers and babies that have arrived at clinic. I am frustrated that I have wasted two days of clinic where I could have taken pictures of them. I have plenty of birth room pictures, but forgot about the mommas who come in every day and fill the benches at the birth center, waiting to be seen. Elio and I go downstairs and she explains that I want to take pictures but anyone can say no. The women are not shy about saying no. Those who do not want pictures scoot out of the group pictures, leaving some benches empty. About half of the moms say no to pictures and the other half love to see the pictures I show them of themselves. The birth room is full with three mommas in labor. Today I will miss the births because I have promised to meet with our staff. Each interview takes about 30 minutes and I meet with over 10 people as Elio translates. Every once in a while I run downstairs to take pictures of the midwives and the beautiful momma’s and babies. I love interacting with them and documenting their beauty and strength.
Rasha comes to talk to me and I am delighted to see her. We discuss the Plumpy Sup program that she manages where we have 30 women enrolled. I am so grateful for this program as it monitors 30 or our most malnourished pregnant momma’s weekly and gives them extra calories and nutrients daily through a supplemental nutrition program.
Rose Edith and I get a chance to talk for an hour about the MamaBaby Haiti midwifery school that will start this fall. We are both excited about training midwives who are from the Cap Haitian area as the only other midwifery schools are in Hinche and Port au Prince. Both places are over three hours away by private car, and over seven hours away by public transportation. Word has gotten out about the school, and nursing graduates are already lined up today to talk to me and interview for the six student spots. Our class starting this September and graduating May 2018 will be small, but some day we will have funding for a larger class. I am pleased with the excitement about the school and the number of applicants.
The solar panels are installed and we are excited to test them out tonight! Fernando and one of the men went into town in search of internet that works. Two of the men took the day off from working on the hot roof and rented motorcycles and drove to the beach. It is late afternoon and the interviews are finished. The birth room is empty and the postpartum room is full. There is excited chatter downstairs and my name is urgently called. I look over the porch to see the men have returned. The first one walks in and it is obvious he is in pain. He tells me about the motorcycle accident they were in as I check him over. Nothing needs sutured, but we clean him up, and I feel his clavicle and indeed it is broken. I send Claudin for a sling. Then the other injured one shows up and he needs some sutures. We clean him up and get out the suture equipment and I prepare to suture, when Alourde, one of our midwives, gently pushes me aside and says she wants to suture him. I think she wants to show off her suture skills, which I must say are excellent. I can tell that she is very confident with the needle holder and knows just what to do. I feel pleased.
With the men patched up I head to the birth room again as I hear someone has come in labor, and we have promised Nikki, my niece, that she can catch the next baby. She is finishing up nursing school in Texas, and I invited her to join us on this trip. I am excited to be in the birth room after a day of sitting on the porch talking to staff and doing interviews. I’m also excited to help Nikki with her first baby catch!
The momma is having her fourth baby. I admire her tiger dress. I can tell she is confident and knows what she is doing. I explain to her she can choose whichever position she wants to birth. I lay down and say “kouche”. I get on hands and knees and say “Kat pat”. I squat and say “koupi byen". I stand and say “kanpe". I show her the birth stool and say, “Chita”. The momma looks amused with me, and the midwives giggle. I think they find my Kreyol funny and the fact that I show all these birth positions to women humorous as well. The tiger dress momma progresses quickly and quietly. She chooses to get on the birth stool to push, and I am surprised. I check her and she is complete, and I put pressure on the water bag thinking I will avoid a mess by helping it break now. Evidently, breaking it with your finger is not as efficient as with the amni-hook, as it breaks with a huge pop and Nikki and my scrubs are splattered with meconium. Heart tones are great, and I keep thinking with any push this tiger momma will have her baby quickly but she surprisingly is pushing for a while. She calls Alourde, one of our midwives, over to talk to her. She chatters to her in Kreyol. I can see how much our midwives are loved and respected. I ask Alourde what she needs and Alourde says she wants vaginal massage to help the baby come out. I get coconut oil, and with momma on the stool, I do some gentle perineal massage. I had noticed this tiger momma had prominent varicose veins on her legs, and as I ponder what is taking a while for her baby to come out, I feel prompted to check for any prolapse that might be happening of bladder and vaginal wall. As I do vaginal massage, during a contraction, I put three fingers inside the vaginal canal and hold everything open and out of the way. I feel baby’s head move from high up to down onto the perineal floor and crowning, all with one contraction. I tell Nikki to be ready to catch. She has a baby blanket ready. With the birth of the head copious amounts of meconium pour into the bowl beneath the stool. Momma leans back a bit to birth the body and the baby shoots out into Nikki’s awaiting blanket and arms, with a wall of green amniotic fluid that amazingly manages to splatter everything within a few feet of the mother (namely, Nikki and I). We laugh as we are ridiculously covered from the waist down in green. Baby is green, the floor is green, my shoes are green. I think nostalgically of the chux pads we use in the states, and I think about how we change them out and throw them away when there is just a small amount of blood or amniotic fluid on them. In contrast, this birth happened without a single chux pad, and the bowl under the birth stool didn’t help much as the amniotic fluid and blood missed it, and instead is pooled in slippery puddles of green and red on the tile floor. I find it challenging to walk and not slide. I make a note to myself to send down rags, towels, and chux pads.
After placenta, cord cutting, checking for tears, newborn exam, settling momma in, and many trips back and forth from the bathroom to clean the birth juice off the slippery floor with the one rag I can find, I am ready to be done for the night. I go to the bathroom that is attached to the birth room to wash the green off my arms. I wonder why when I turn on the water I hear water running on the floor. It is then that I notice the sink is hanging off the wall and not sealed to the pipes beneath it. Every bit of water that drains out of the sink hits the floor. Another major fix Fernando needs to make before we leave. I wonder how I will get him into the birth room to fix the bed and the sink when there are always women in labor and it is rarely empty! Before going up to shower and go to bed, I take pictures of our chunky green baby. Nikki’s first catch. I feel content. This was a good day.