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Saturday 29 June 2013

Twins and a Prolapsed Cord

This weekend at the hospital was nuts.  There were  naked women on the dirty floor yelling, "The baby is coming!"  There were not enough beds for them all, and there were more pukers than usual.

The operating theatre was not "in service" due to the air conditioner being broken.  I am not sure why the air-con is necessary to operate, but apparently it is.  The vacuum extractor was also broken. 

So into this environment, a lady named Malley (not her real name) walked in.  Her belly was HUGE (in an adorable way) and she had not had prenatal care.  She walked around until a baby started to fall out bum first. A little girl was born breech.  Then another baby started to make his way into the room head first.  Unfortunately his umbilical cord led the way.  So now the midwives were dealing with a prolapsed cord.

The midwives flipped her over to a head down/ on her knees position and tried to push the cord back up into the mom.  They also pushed the head up and then flipped her back to her back and applied suprapubic pressure in an upward direction to hold the head up off the chord while trying to fix the vacuum extractor.  They couldn't get it to work and they called the doctor.  Meanwhile there was still a heartbeat.  I was holding Malley's hand, praying with her and comforting her.  She asked me to sing a hymn while we waited.  Singing is not my gift, but we sang anyway.

The doctor arrived and without the option of C section or the vacuum, he proceeded to just have her try to deliver the baby quickly.  Two contractions later the head was in the birth canal and the chord had stopped pulsating.  Two more contractions.  We all started to anticipate a dead baby.  I prayed and prayed.  A very grey and limp 5lb baby emerged.  After some stimulation though he pinked up and cried.  I checked on him a lot throughout the rest of the day.  He was a champion nurser and very alert little guy.  I'm so thankful that he is okay.

Tuesday 25 June 2013

A Chicken, a Needle and a Natural Birth



When I was pregnant with my first child in the USA, I read a lot about childbirth and how to have a natural childbirth.  I wanted this mostly because I went to the epidural class at the local hospital (just in case) and the guy there passed around a GIANT needle and talked about sticking it into my back and how there were many risks with an epidural, including death.  Hmmm...do I want to go with the contractions that have never permanently damaged a person, or the giant needle that may kill me...?

I may be the only person in history who chose natural childbirth, not because I am so brave, but because I am a chicken.

So after that, I decided to skip the drugs, and I read every birth story I could. I wanted to learn all the "tricks" to getting through labor on my own. 

I have been to over 40 births here now, and helped almost 40 other women in labor besides that.  I have noticed something.  None of these women have ever seen a pregnancy book.  Not one of them has been to a childbirth education class, and only some have attended other women's births.  They have natural labors because the other choice is a C section. 

The thing is, they seem to just go with their instincts as far as positions and laboring....and it lines up with all the things we write books about and think we are so smart to know as doulas.  Funny how moving around, changing positions, and using gravity to our advantage is just what they instinctively know to do.  I guess so much of what we read and are taught is supposed to just come "naturally."

Maybe we are born with the knowledge of how to give birth well, just like the rest of the creatures in creation. 

.



Saturday 15 June 2013

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....

A Cussing, Fainting Missionary lady

My head hurts.

I just spent a very long and wonderful day at the hospital as a doula to many lovely women. 

Unfortuately, I had to learn an important lesson the hard way.  No matter how "needed" I am, I need to take little breaks and eat and drink to keep up my stamina.  After birth number five, I started feeling really lightheaded, and yes, I passed out on the floor. 

That is why my head hurts.  It was embarrassing. 

I also shocked all the staff with my dirty mouth. They call me the missionary lady and have high expectations for what words I may or may not use.  Due to a language mess up on my part I accidently swore a few times while trying to say. "I think we need to put a new sheet on the bed." I just mixed up two words that were very close. I never did explain myself either as  there was a baby coming out right about then.  Oh well.

Part of the reason that I didn't take breaks is that I had two women in a row that were terrified for me to leave them.  Both had been laboring completely alone for over 24 hours and both would cling to me and beg me to stay if I even took a step in another direction. 

There were four girls and one boy born today, and apparently there have been five girls for every boy born at this hospital for over a year now.  This would cause future problems if we were in the USA - but here, some guys have 5 wives...so I guess it will all work out.

Thursday 13 June 2013

Any Doula Tips or Tricks?

I get to go back to the hospital tomorrow.  I wait every Friday with anticipation, and I wonder what tomorrow will hold.  Some days there are babies popping out all over the place and others are quiet with just two ladies in labor and a bunch of post partum moms. 

Do any of you doulas out there have any simple doula tips or your favorite tricks to share?  Or maybe you have just been through labor yourself and know what worked for you.  Keep it simple as I tend to just use my hands and voice...and the favorite a the wet wash cloth on the forehead and a hand held fan for the pushing stage.  So far everyone of the ladies that I have assisted have LOVED this.  Please share in the comments section if you have new ideas for me.  I love to learn from others. 

Sunday 9 June 2013

Tips for Doulas Working Overseas

Are you a doula who is considering working overseas ?

Here are some things I have found to be very helpful:

1. Dress like they do.  When you are entering a culture that is not your own, it is helpful to at least try to fit in.  You are weird enough without wearing tight jeans where the women wear only skirts. In a birth setting, you don't want to be making people uncomfortable. 

I wear the traditional dress of the women here when I go to the hospital.  The women and midwives appreciate that and tell me so.  Of course, once a woman hits 6-7 centimeters I don't think she would care if I was wearing only a bikini...at that point is all about getting through and holding that baby!

2.  As much as possible, speak the language.  Learn whatever you can, and interview native speakers on how they say birth related things  I am fluent in the language here, and I cannot imagine having to be labor support without being able to speak!  I know it would be possible, but hard.  I need to be able to encourage, explain what is happening and just say whatever needs said. 

3.  Be willing to swallow your own culture and "birth agenda."  Your own culture regarding childbirth and what that should look like is not the only right way.  Be a learner, be there to serve.

Dad's may not want to be there...and the reason may run deeper than "just change the hospital policy." There can be taboos that come from fear of spirits and of a woman's blood.

4. Love, Love, Love, the women you are with and make her birth experience the best it can possibly be.

Friday 7 June 2013

Emergency C-Sections...tomorrow

The midwives in the hospital here are the janitors too.  They deliver the babies, mop the floors, change the sheets, train the doctors and new midwives and admit the patients.  They are often tired.  The last few times I have been there helping out, it has been one midwife running the whole ward. 

When there is a problem, it can take sometimes 24 hours to get everyone in place for a C-section.  At times, everyone just happens to be there and it goes off without a hitch.  Often though, it takes a very long time.  I witnessed this being told to a mother the other day..."Your baby is in distress, but we won't be able to even try to induce until tomorrow morning when we have a doctor on call, in case you need a C-section as a result of the induction."

It struck me the other day that most homebirths in the USA have more access to emergency help if needed than the labor and delivery ward here.  Just an interesting thought.

Speaking of C-sections, I came upon a woman the other day who was so upset when she was told they would have to cut her to get her baby out. (She was 6 centimeters and the baby was lying in a transverse position.)  It wasn't until I explained to her that she would be asleep and not awake feeling them cut her, that she calmed down at all.

Imagine thinking they were going to just cut you open while you watched, feeling everything!

Wednesday 5 June 2013

Breastfeeding in a Topless Tribe

I have had four babies and I breastfed all of them. 

I have nursed my babies in airplanes, canoes, kayaks, helicopters, during armed hold ups, in airports, malls, restaurants and movie theatres.  I've nursed them in coffee shops, hospitals, grocery stores, churches, 21 different states and seven different countries.  I've nursed them in huts, museums, resorts, at weddings and funerals, sitting on the beach and hiking down jungle trails. 

My favorite place to be breastfeeding though was in our tribe in the jungle.  Women are often found topless, and I didn't have to constantly wonder if I was offending someone by feeding my child.  I loved it.  Here are some interesting things I have noted in a culture that has breastfeeding down.

We always say "initiate breastfeeding as soon as possible,"  (which is good!).

They often (but not always) give the baby to a lactating sister or friend to nurse for the first 1-2 days after birth (and it turns out just fine!).

We have all sorts of rules on how to do it, and first time moms fear that they won't do it right or cannot breastfeed at all.

They don't have rules about the whole thing.  They just do it, they expect
to be able to do it

They are just really not stressed out about the whole thing....I think that is the biggest difference I see.

That's good too since it is supposed to be illegal here to buy a bottle without a doctor's prescription.

I wish I had known that kind of confidence in my body's ability to feed my child when I was just starting out!

Saturday 1 June 2013

Fishing in the Toilet and Interrogations.

Yesterday I witnessed a one hour interrogation of laboring and post partum women.  The nurse wanted to know which of them had tried to flush a pad down the toilet.  It ended in a very weak mother, who had delivered only an hour earlier, being forced to fish the pad out of the toilet.
 (These women have rarely seen flush toilets or used disposable pads...so it is a hard thing to get used too)

I see things in the hospital here that are very hard to see.  Interesting though, the women are NOT complaining.  They are thankful.  At the end of an awful delivery (one that would surely bring a lawsuit in the USA) she is saying..."I'm so glad I was here!  Who knows what would have happened if I had been in my hut alone."   She isn't saying this because she has been brainwashed by the medical community.  She has seen firsthand friends and relatives who died in childbirth.

It costs them one month's wages to spend the night on the floor in the hospital filled with rats and cockroaches.  They stand barefoot in a shower (if there is water) where 30 other ladies stood and bled...in a country where HIV is rampant.

The hospital situation here can be gross and sometimes even abusive.  Oh, and did I mention that you have to bring your own toilet paper?  There is often no running water for days at a time...I would like to see it changed.  I  am glad though that less women and babies are dying here in the hospital than they are in the jungles....although last weekend 3 newborns died in the hospital in a 24 hour period....so I wonder about that too sometimes.

The funny thing is that I believe the hospital staff is really trying hard to do a good job. (Except for the Nurse Interrogator)

I personally have some horrible stories about American hospitals....but I never had a nurse make me fish things out of a community toilet.