By Jennifer Gallardo
No sooner do we arrive at the birth center when I hear they are transporting the mom in labor. I want to know why. Rose Edith, one of our midwives, lets me know that the mother had a blood pressure of 150 over 112, was 5 cm, and had protein in her urine. Good call to transport. The family is upset about going to the hospital. I ask them what their concerns are, and they tell me she will not be treated well at the hospital, and at MamaBaby we are kind to her. Our driver helps her and her family into the back of our "tap tap" `pick up truck and takes them to the hospital.
At 9:pm a new momma comes in, already at 8 cm. I am excited to watch the midwives do a birth, so I put on my scrubs and grab my camera.
“Photo’s? Oui o no?” “Oui…photos” says the mother. The midwives put the mom on the birth stool, then they let me know her water is bulging and intact. Carmel lets me know this by puffing her cheeks up like a blow fish. I feel certain that the midwives are trying to please me by putting the mom on the birth stool and leaving her bag intact, as I have told them before that we should teach the women to give birth upright and that it is not necessary to break every bag of water. Last trip I gave up as I quickly realized that it is a very ingrained cultural custom for the women to lay on their back to give birth, and the first water bag I refused to break drenched me and my shoes with meconium. I am sitting off to the side, out of the woman’s eyesight. The midwives look concerned and tell me she is about to give birth and I should come closer. I tell them I am fine where I am at. They then tell me I am catching the baby. They insist. They are giggling and want to see how I do things. The mom is on the birth stool at the foot of the bed. I glove up and stand to the side of her, a few feet away. They are a little concerned that I might not be close enough for this baby that might fly out. They say, “Closer, she is about to have the baby.” The momma hears them and stands up and lays down on her back on the bed. I smile at her. This is what is familiar to her. The midwives roll a stool to the foot of the bed for me. I sit in it for just a moment, before rolling it to the side of her. Just after I roll it to the side of her the Momma pushes and her bag bursts, splashing meconium stained amniotic fluid all over the floor and bed. I am certain the midwives were disappointed that I didn’t stay where they had put me, as I think the plan was that I would be drenched. They giggled and spoke amongst themselves about me not being in the line of fire. With the next contraction the momma pushes and you can quickly see a little of the baby's head. The student midwives get excited and start shouting urgently for momma to push, and they reach over to pull her legs into McRoberts. I go to the foot of the bed where I can shoo their hands away. “Patience, Patience” I say over and over quietly as I remove their hands from Momma’s legs. Then the head is born and they are concerned I am doing nothing. They shout, “traction, traction” and I make eye contact with them, raise my hand in the halt sign, and say, “no traction. patience”. They smile quizzically. They seem unsure about what I am doing, or rather, what I am NOT doing. I tell them we are going to wait, “Deus minute” and they grab the clock and show it to me, saying it has already been 90 seconds. I think it has been more like 45 seconds, but I can tell they are nervous. The next contraction comes and I make eye contact with the momma as she pushes her baby out to the waist and baby takes a first cry while just halfway born. I take Momma’s hands and place them on her baby and help her lift baby up to her belly. As is often the case here in Haiti, it is hard for me to read her emotions. The midwives ask if baby is “garçon” or “fi” and I reply that momma should find out. They all look confused, and I realize that my preconceived notion that it is empowering for the mother to discover the sex of her baby on her own does not fit in this setting… even mother asks me what her baby is and when I tell her to look she says no. I let them know baby is a “fi”. As I do the newborn exam the midwives ask me what to do as there are no diapers and the mother did not bring any. They say she walked here barefoot on the dusty roads and does not own shoes. My heart wells up with compassion for these women and I stand in awe at their courage and strength.
I have much to learn from the midwives here about their culture and way of birthing. I am so pleased with how hard they work and I can see they really do care for the women and babies and that they are respected and loved in the community.
I finish the newborn exam and am surprised to see another momma sitting quietly on the edge of one of the beds in the birth room. She is at 4 cm and a multip. She said she wanted pictures as well, so I take a picture of her in labor and then leave the birth room as it looks like it might be a while and it seems as if she wants privacy as she wanders into the dark and private corners of the birth center.
I shower in cold water that I wish was even colder. I climb the stairs to the roof, which is a few degrees cooler than the room and catches a breeze, and I lay down by Fernando while he sleeps. I try to sleep. Dogs bark. Roosters crow (hello? It isn’t morning time yet!) Neighbors blast their music. Sleep evades me and I think about the mom that is in labor. I hear a newborn cry. Oh, good! Then I worry, was she relieved I left the room or is she disappointed I didn’t get that photo I promised her? I get up and go back to the birth room, grabbing my camera. She smiles when she sees me (though won’t break a smile for the photo) and says yes to a picture of herself and her baby boy who is laying on her chest.
After I snap the picture the electric goes off. We are shrowded in darkness. Headlamps and flashlights come out, as midwives finish the newborn exam and tuck momma into bed. I notice the neighbors music went silent.
I hear moaning on the porch, and go out to greet an excited poppa, and a laboring mom. I bring her into the birth room. Dilation 2. Blood Pressure 200/140. The midwife checks it too and asks the mom if she has a headache. The answer is yes. She tests the mommas pee. Plus three protein. I go out to tell the poppa they must go to the hospital. He looks like the weight of the world has landed on his shoulders. He puts his head in his hands and cries. He leaves the birth center to collect himself. I hear him tell the guard “I have no money. The hospital will ask for money. How will I pay?”. I go upstairs and take $40 from my suitcase. Tears roll down my face and I send a prayer heavenward. "Dear God, help these women and families.” I give poppa the money, telling him it is for medications and asking him to come back after the birth with the receipt for the birth so we can help him with that.
Two mommas risked out today for pre-eclampsia due to the malnourishment on this island. I go to the roof and lay down. It is 3:30 am. My heart is breaking open for the poverty and struggles I have witnessed today. I pray that I can know the right thing to do and make a difference. I pray that I can make an even bigger difference than what I am currently doing. I finally drift off to sleep, looking at the stars and feeling comforted that someday everything will be made right.