Tuesday, March 9, 2010

Birth sans bendy straws

Update from Kafountine, Senegal, two weeks into a three week internship at a local birthing clinic

I spell relief B-I-R-T-H-S. Lots! Four last night, not counting the two we missed while we were walking to the clinic. (One of those gave birth in the doorway, and the midwife who lives on the grounds didn't even make it.) I got to handle all kinds of fun things- retained placental membranes necessitating manual removal, severe asyclitic presentations, as well as assist with two uncomplicated births, all with good outcomes.

Okay, okay, I know all this may be kind of far out for my non-midwife friends. Just know that this is what makes me the happiest. Clinical details follow which those of you who don't deliver babies may or may not be interested in.

Yesterday, Monday, we started the day with an easy delivery. Then I sat in on appointments for five hours. What kind of appointments, you may ask? Everything from prenatals to postpartums, to well baby checks to family planning visits, to pregnancy tests. Not much "fluff" in the care here. The main goal is to keep everyone alive. So the tetanus shots and malaria prevention in pregnancy is more important that discussing nutrition, exercise, and how you are doing emotionally. But when you are across the desk from someone in their fifth pregnancy who has lost all four children to malaria in the first years of their lives, or someone who has lost several babies half way through pregnancy, or a young woman who has just been gotten a positive AIDS test, the priorities change.

That matter of fact approach extends to the delivery room. The staff sage fems and matrons (think nurse midwives and lay midwives) don't spend a lot of time giving back pressure or sips of water from bendy straws. Actually there hasn't been any running water at the clinic for days, and I have yet to see a straw of any kind.

Around here, it's all about grabbing your ankles and pushing.

But I've gained new respect for these no-nonsense care givers. They can deliver babies that would be automatic C-sections in the States. With the closest hospital that could give that C-section two hours away, you gotta do what you gotta do. Twins? Breech? Bring 'em on.

Around here, you gotta work hard and do what the midwives tell you and push your baby out, with or without your bendy straw. But when you get your baby alive in your arms and walk to the big postpartum room where your mother and everyone else who gave birth in the past three days is also staying and nurse your baby and go to sleep under your mosquito net, it's worth it.

Running water would be nice, but hey, you can't have everything.

3 comments:

  1. What about your respect for the poor women who are stoically grabbing their ankles and doing the pushing! They're not asking for a bendy straw (or an epidural)! Interesting thought: is this kind of stoicism a result of poorer conditions, or could this very attitude be what keeps them from moving forward into the more modern world of maternity care. In other words, if they were more demanding, would changes be made? Can changes be made to that cultural mindset? Blog on this!

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  2. Good point Julie! Yes, I TOTALLY respect the amazing women who gave birth! I think of the mom who walked in to the clinic alone, carrying a bucket of rags for the delivery, hopped up on the delivery table, was found to be complete, and pushed out twins fifteen minutes later. She was amazing, and her outcome had more to do with her and her great attitude than the midwife's skills or instructions.

    I think the stoicism may be a product-and a defense mechanism- from cultural attitudes and practices toward women at large, from long before a woman comes it to the clinic give birth. Understand these are women who were circumcized with a razor and no pain killer when they were anywhere from 1 year to 12 years old. That in itself can totally cause someone to shut down emotionally and force them for life into stoicism just to cope with their reality. By the time they are being told to grab their ankles and push a baby out they may have a different take on that experience than an American woman who has been pampered all her life would have. I got the idea that in spite of what we would consider sub-standard treatment, they see themselves as some of the priviledged few because they actually make it to a clinic versus giving birth outdoors on the ground in a village somewhere.

    So, yes, I do think they do have a lower standard of what good care is, because they have never seen or experienced anything better.

    And yes, just like everywhere, when women become more educated and informed about the possibilities, I think they will be able to affect change over their choices and conditions. I also believe that a woman's belief system affects this as well. When she comes to realize that she is created in the image of God and loved and valued by Him, she sees herself as worthy of better treatment and less of a victim, in every area of life, including birth.

    So, in my opinion, it's not just about getting a woman to be more verbal and demanding about choices in birth, but going much, much deeper -and earlier- in so many areas.

    I am only beginning to understand how deep.

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  3. Good words! I have confidence that you are attending the whole woman (spirit, soul, and body) as you have opportunity, and I'm glad.

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