Many of the best things in life are things are those things after which you long for a good, solid (or should I say liquid) shower. Camping trips are a prime example. Mud fights and ocean swims also come to mind. And now I know from experience that being at a birth tops The List of Amazing Experiences After Which You Just Really Want a Shower.
My first birth was actually two births. I mean, technically I did witness one baby emerge into this world before the other, but the labours were happening simultaneously. We received the first woman, E, a nullipara, at the clinic on Friday at the start of our regular day's work and sent her home in early labour. That day I got to help with post-natal check-ups! I weighed a couple darling little babies, each about a week old, got to use an infant stethoscope to take their heart rates, and did their temperatures. E came back in active labour at 3:30 p.m. After that came about 24 hours of labour support... Hands pressing her lower back, passing her glasses of water, modeling slow breaths, telling her over and over, Ou kapab. "You can do it," and Ou fe byen. "You're doing well." E seemed afraid and resisted giving in to her labour most of the time. When it got tough she would say in a tone of panic, Pa kapab, pa kapab, pa kapab! "Can't do it, can't do it, can't do it!" The moments where she coped the best were the few when she would stand and walk around, leaning on the walls, or the door- Everything I've learned about movement and being upright in labour was backed up by my observations of E. Most of the time she wanted to stay on her back in bed. It had been a long time and she needed to rest, of course, but her progress and coping were clearly much better when she was up swaying and pacing. It was frustrating to observe this and have her resist our suggestions to sit, or walk more, or kneel with her upper body supported. E used two of Penny Simkins' "3 R's"- one of her Rituals was to place my hand low on her uterus during a contraction. She had Rhythm when she would sing and when she would tap her thigh- "patpatpatpatpatpatpat". She seemed to struggle to find her Relaxtion. Tania, the midwife on call that night, let me know that trying to doula Canadian-style may have been responding too intently to E's dramatic reactions (to even the early contractions) for the Haitian context. So I stepped back for a while; just sitting at the other side of the room without looking at her, checking her baby's heart rate periodically and making sure she had water and peed often. This was just after 3 a.m. At about 5 I went and slept on a mat knitted out of plastic bags on the office floor for 50 minutes. The other labouring woman, M, who had been with us (there are two labour/birth rooms in the clinic) since about 10 or 11 the previous night was clearly reaching a new height of intensity in her journey, and I couldn't have fallen back asleep if I wanted to. The power was out that morning, so I lit a pair of oil lamps and placed them in M's dark room. E's labour also seemed to have picked up. Between 7 and 9 Tania was constantly back and forth between the two women- Who would start pushing first? All supplies good to go there? What about here? Where's the Doppler now? M relinquished her daughter to the outside world at 9:25 a.m. after a pretty quick series of pushes. I noted the times of delivery of head, body, placenta. I hadn't been present for any of M's labour (except what I could hear from E's room next door!), and my favourite part of that birth was actually being the one to go tell the dad when he could come in... He looked so excited! When the time came and E started to push, around 2 p.m., she was still resistant and just so, so tense. Here, Tania worked some magic. She explained to E, in the gentlest, most wonderful way that she needed to resign herself to the fact that she was going to give birth, whether sooner or later and coaxed her into relaxing her whole body- squatting forward rather than arching and writhing backward as had been her habit. I'm kind of afraid I will never be able to sound like Tania did in that moment! The whole mood in the room changed when E was pushing. Everyone was smiling and calm, happy that the birth was imminent after all this time. Even though she was still afraid, E would respond so quickly to reminders to breathe through a contraction, or to bring her body forward. She was much more lucid now. We were all so proud as the sweetest baby girl came out. After all those times E thought she was pa kapab, here was this perfect little being: pink skin, big brown eyes that looked just like her beautiful mama's, pouty lips, ready to suckle the second she was placed on mama's chest. That gorgeous babe just skipped the weird-looking newborn stage altogether. Once E and her girl were settled in to snuggle, placenta delivered, it was time to squeeze in lunch. Praise the Lord for those people who brought meals during the labours- it is hard to say how much I appreciated that! Then it was back to work! M and her family wanted to get home and were waiting for us to cut the umbilical cord and Tania to do the newborn exam. At Olive Tree Projects' clinic they usually burn the umbilical cord; it's reduces risk of infection because you don't use any instruments and the opening is cauterized. Maria's daughter and I each held a candle under the cord for about 15 minutes, until it was burnt through, which we both thought was pretty cool! I explained a bit about placentas to Sophia as we did this; she is 10 and wants to be a midwife when she's older. I got to watch Tania do the newborn exam and then I did the baby's footprints with the family and soon enough they were on their way, smiling and thanking us as they went. Amidst all these happenings E had started to hemorrhage and Tania had given her a uterotonic, which seemed to be working. I watched and held E's hand as Tania tried to identify the cause of the bleeding and as she sutured a small tear from the birth. The long and short of it is E ended up staying at the clinic to be monitored until Monday afternoon: she had had a slight fever on and off and her uterus hesitated to contract fully, but eventually it remained firm and her vitals remained reassuring and she and her husband went home with their little one.
While witnessing women give birth was incredible and fascinating and awesome, I was far from shocked. I just felt kind of like, "Yep, that's how it goes!" I got to learn and practice skills which were totally new to me- but after many hours I wondered why I had found them so daunting. I was really comfortable supporting E, and was amazed how she trusted me and allowed me into her space, having met only once briefly in a prenatal visit and considering my minimal ability to communicate in Creole. Following her cues and picking up a couple tidbits from the rest of her birth team was all I had to do. I will always remember the checked pattern of baby blue and navy on white of her sundress, examined in detail as I sat by her bed as she dozed between contractions at 2 a.m. I will remember her husband's incessantly ringing phone out in the waiting area- the ringtone was "Bad Romance" by Lady Gaga. I will remember looking at our contrasting hands, hers resting over mine on her belly, and wondering at how I came to be there, then.
Well, I am up late, so it is now officially Christmas day here in Haiti and I hope you all have a very beautiful day back home or wherever you may be reading from! We have some cool plans tomorrow (think "beach")... though we are wondering if there won't be any women going into labour soon. It's been awfully quiet since Sunday; with 9 women still due in December!
Love,
Julia
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