By Jennifer Gallardo
Rose Edith says goodbye as she heads to do the cervical cancer screening at the hospital that lends us space for this. She is carrying a bucket full of sterilized speculums. Carmel and Claudin transport a momma to the hospital because she shows up for a prenatal with pre-eclampsia. She is 29 weeks and 6 days. Blood pressure 200/140. Plus three protein in urine. Headache and severe edema. We call about the momma who transported last night who had the long labor and the big baby. She had a cesarean section. I hope she was treated with kindness. The birth center is in full motion with prenatals and postpartums lined up and waiting. I find the momma who had come with no shoes and give her a shirt and shoes.
Two first time mommas are in labor, and over 40 women are waiting for prenatal and postpartum visits. Clinic goes into full swing, with midwives and nurses and students caring for the mommas and babies. After appointments all the midwives congregate in the birth room, even though only one is on call to do so. They are visiting with each other and caring for the momma’s in labor. One was checked just two hours ago and was only 4 cm. I pull out the coconut oil and Clary Sage essential oil and start to rub the momma's belly and back with it. The smell of Clary Sage fills the air. The momma who was at 4 cm a couple hours ago starts to push. She is checked and found to be complete. Suddenly, the midwives get really excited about the Clary Sage. They are certain that it is because of it that the momma has dilated so quickly. They spring into action, asking for Clary Sage on their hands. They vigorously rub the other first time momma with the essential oil and coconut oil, everyone laughing and rubbing and showing the momma's how to wiggle their hips as they stand and rock. It is like a birth party. A big communal birth room. I feel happy. Our midwives love birth. They feel called to this work just as midwives all over the world. A common thread ties us together. I can tell the mommas trust their midwives and feel loved by them.
A student is assigned to the birth of the pushing momma, who is now sitting on the birth stool. A cloth pad is laid out on the bed and a metal bowl is under the birth stool. The first two days we had the luxury of one disposable chux pad per mother. I ask for one now, and am told we are out. I think of how we use about 10 per momma in the USA. These take up a lot of space, though they are light. I make a note to myself to make a shipment of 500 chux pads. Maybe they will allow each momma two if they have a large surplus, and this will cut down on the hand washing of all this bloody laundry. I think of how many births they will do without them until they get the shipment. I have already found so many things I feel we need for the birth center to function smoother, that I am concerned the next volunteer coming will not be able to bring it all.
I am assisting the student at the birth. The momma is pushing on the stool and when the student sees the head starting to come she tells the mother to get on the bed and lay down. Before I know it the mom is on her back on the bed, and the head is out, with the student pushing the perineum over the baby’s head. I want to tell her to stop, but I am trying to balance respecting the student with respecting the momma. When she starts to do head traction I cannot refrain and I tell her to stop. We count out a minute. She is anxious to get in there and do something, and the baby’s head is not rotating with the next contraction. She starts to do head traction and I say, “No. Chita! Chita!” asking that she sit the mom on the birth stool instead of pulling on the baby. The student looks confused but finally seems to understand what I am asking, though she looks incredulous that we are having a mother move with a baby’s head out of her. We roll the mom to her side and help her get off the bed, and as she starts to stand the baby’s anterior shoulder is born and so the student tells her to lay down again. She lays down and the baby comes out, though very slowly. Baby is on momma’s belly now, and is doing great, but I feel the student may be frustrated with me for interfering with how she feels comfortable attending this birth.
I am trying to teach that baby’s come out without traction, that mom’s should choose their own position instead of being commanded to lay down, and that changing a mom’s position can be a solution to a baby that is not coming out, but I am questioning if I am interfering too much? Do I have a right to take over the way they are doing the births? I haven’t even seen the midwives do the births because the students have been catching all the baby’s this week. I feel frustrated and wonder if I will ever be able to communicate and teach effectively. I am kicking myself for not trying harder to learn Kreyol. I feel defeated and leave the birth room to take a shower.
I am sitting on the dark porch with my computer, writing about my day, when Rose Edith, one of our midwives, comes up and asks for a massage. I go get my oils from the birth room and she lays on her mattress on the porch (it is hot at night, so the midwives head to the porch, while the volunteers head to the roof). I give her a 30 minute Aromatouch Technique Massage. I feel so much love for her and am grateful for how hard she works to serve the women and babies. She is our head midwife at MamaBaby Haiti. I am happy to serve her in this small way. The massage finishes and she gives me a hug and thanks me. I take a shower. I’m considering going to sleep and missing the second birth as I am falling asleep writing on the computer and I can’t get the internet to kick in fast enough to download a picture to Facebook. Just as I am about to head up the stairs at 12:30 am to sleep on the roof, the student midwife who I was worried I may have offended asks me for a massage. She lays down and I give her a 30 minute massage. Maybe I didn’t offend her after all. I wish I could communicate with her! She gives me a hug and a kiss good night. All is well.
I decide to go sleep in the birth room on the bed in the corner so that I can watch the next birth. I get down there with a pillow and a sheet, and see all the slats have fallen to the floor and the mattress has collapsed. OK. Another thing for Fernando to fix tomorrow. Carmelle is loving the Clary Sage. She keeps asking me for it on her glove and she rubs it vigorously on the momma’s back and legs. It is 1:30 am. Momma has just started pushing. I decide I am going to just watch and not interfere, even if they do head traction! Unless they actually ask for me to help. :) Momma is on the birth stool and when they can see the head she moves to the bed of her own accord. Carmel, one of our midwives, is very energetic and active in the birth room. She rubs and encourages the momma, and she gives her a twisted blanket to hold onto so that Carmel can pull her up a bit during the pushing. I sit a ways off, but as it gets more exciting and they can see a lot of baby head, I pull my chair closer, to the side of the momma. Carmelle is coaching a second student and I keep hearing my name mentioned. I think she is telling her to keep her hands off, because the student looks eager to touch the perineum and baby’s head, but then looks as me, and then Carmelle, and she just lets her hands hover. She yells at the mom a couple times to push the baby out (don’t take this wrong… I am sure she feels this is her job… she is actually super sweet and quiet, so I am surprised to hear her power). I know I said I won’t interfere, but from my chair (while I SIT on my hands) I say, “nómal. yon lot kontraksyon bebe vini”. Of course I am lying, because I can’t know what contraction the baby will actually come, but come it will, that I know. She stops yelling at the mom to push. The baby rocks back and forth for a while. Finally, baby’s head comes out, and then the student looks up at me and says something in Kreyol. I think she is asking me what to do next, so I say “de minit”. I get the phone that is in the room and show her it is 3:30. I say we will wait until 3:32 to do something. I had just taken heart tones, so I am not worried. At 3:31 baby’s head rotates and the students hands are hovering and she wants to get the shoulders out (you can see a tiny bit of shoulder). I show her the clock and say, “yon minit”. She moves her hands away, and then about 30 seconds later, with the nerves of the midwives and students mounting, the baby’s anterior shoulder is born, and then he rotates, spinning that beautiful birth spin, until his face is looking at us and he is born to his belly. At this point, I take the students hands and put them under the baby’s back because I’m worried he will fall on the floor as momma is close to the bottom edge of the bed. She lifts the baby onto momma’s belly. Then the student squeals in delight. Jumps up and down, and proceeds to high fist me with a goopy glove. Carmel is literally jumping up and down screaming “ti bebe a te fé li!” (translation: the baby did it!). The student relives the experience, as she excitedly chatters in Kreyol. I can’t understand every word but I catch that she is talking about how the baby did it himself. She moves her body just like the baby and enacts the scene. They are so excited, and so am I.
It’s 4:22am and I am finally ready to head to the roof. Even if another momma comes in, I will sleep through it, at least until the hot sun wakes me up at 7:am.