A Birth In Guatemala

The Western Highlands

  A soft knock at the door, and midwife Anna Maria popped her head in.  She told me there was a birth downstairs, and I was welcome to come if I would like. Of course I would like! She then went on to say that the woman was nine centimeters dilated. My sense is that women here typically labor at home with their families until advanced labor.  I asked if this was her first baby.  Anna Maria answered no, her second.  But her first was a cesarean.

  A VBAC. How fitting that the first birth in Gautemala I observed would be a VBAC, after all the trouble I'd gone through for attending VBACs in California. I followed Anna Maria downstairs and entered the Sal de Parto, a spare room with a big,comfortable bed, a shelf of supplies and a chair for the woman's mother. The father of the baby, the woman's sisters, and her own father sat in a waiting room.

  I could tell that birth with Mayan midwives is low-fuss.  The laboring mother, at nine centers, rested silently in the bed. She smiled and politely greeted me when I entered and introduced myself.  The two midwives did not change into scrubs, but wore their "street" clothes - gorgeous hand embroidered colorful blouses and skirts. Just before the baby's arrival, Anna Maria tied a robe over her clothes to protect them. During the contractions, the woman quietly endured them, between them, she chatted with her mother. The energy reminded me of births I attended while a student at North Central Bronx Hospital, for Central and South American woman.  It is fascinating to me that the response to the sensations of labor truly is a cultural thing.  The only hint she gave that she was enduring pain, was that she asked "How much longer?"

   The midwives asked if I wanted to deliver the baby and I declined.  I was here to observe, support, and learn about their methods, not "take over".  I said would just help them, however they needed me to.

 Soon, the mother was pushing, and we could see baby's hair with the pushes. Every one was calm, quiet, and relaxed. The laboring mom kept smiling at me, for some reason she was happy I was there, murmuring in my goofy Spanish that she was doing well, just relax between the contractions, until the next one.  I noted that the unmistakable scent of human childbirth is the same, no matter where in the world you are.

  With one more contraction, the baby crowned and then came entirely out.  My first thought was, he is premature! The baby was tiny, as in 4 and a half pounds. TEENSY. He looked 34-36 weeks to me, not quite full term. He was pink, but floppy, and made no effort to breathe.  I handed  Anna Maria a towel and she dried him, and stimulated him.  He opened his eyes and stared up at us, but still did not breathe.  I handed Anna Maria the bulb syringe and she suctioned him well.  Imelda vigorously massaged his chest and I felt the base of the umbilical cord to determine the heart rate, which was normal and strong.  "Come on baby!" we cooed in our various languages, Mam, Spanish, English.  Also, we stayed calm and no one rushed or panicked.  After maybe three or four minutes, I could see that his tone was not improving, and I offered to give the baby repsirations.  The two midwives stepped aside, I tilted the baby's head and breathed into his open mouth, inflating the alveoli and initiating respirations.  I could feel his minscule lungs expanding with each breath I gave, and was very careful to keep them small, and not injure them.  After four breaths, his tone improved and he grimaced. Anna Maria cut an onion in half and placed it beside his nose. I gave a few more breaths, and then his engine began to purr  He cried, he breathed, he snuffled and snorted.  I worried, watching his skinny chest heave and ho, that he may continue to have trouble breathing, as I have seen in early babies.  But not this little guy.  He adjusted, and was fine.

  The room was cool, so after a few minutes of skin to skin with mom, the midwives dressed him.  I mean DRESSED him.  Three shirts, two pants, two hats, socks, two blankets.  The guy was so wrapped in soft knits and woolens, one had to peer down through the layers to find him in there.  I kept a close eye on him, still concerned about his size, his breathing.  But the midwives were less concerned.  They placed him in his mothers arms, and went to see another woman, who had arrived for a prenatal consultation.  I stuck around, and helped the mother to breastfeed.  i suggested that she feed him every two hours to bring her milk in quickly and get him growing.  We also talked about other methods for increasing milk supply, and Imelda told me they have herbs for that to give her. Imelda told me he was 37 weeks by dates, not premature, just small.  Most babies born at ACAM are six pounds or so.

  The baby nursed on and off for an hour, and the mother prepared to go home with her family in another hour or so. I brought them water to drink and peeked at the baby one more time.  He was warm, with rosy cheeks, red lips, and busily suckled.  I told the mother and grandmother, in my funny Spanish, that he was small, but mighty, like Napoleon.  They laughed at that, the woman took my arm and thanked me, and I went back upstairs.

Imelda, midwife and up-and-coming
 leader in her community

The Further Adventures of Chico's Embattled Midwife

This not-working,

this not-feeling like mopping again

this cleaning out dusty corners,

is BORING.

I sit and stare at my phone,

willing an arm to just

reach out of it and pull me

into the next chapter.

I scribbled this not-poem into my journal exactly two weeks ago, on the girls' first days of school. I have always worked to provide for my family, to serve and better the world, to make my days meaningful. Yet, since the probation of my nursing license began in February of 2016, I have not worked a day. The Board of Nursing denied my home birth practice as a work site for my probation, (without being able to provide me with a single reason why, I might add). Nonetheless, with that work site denial, they shut Sacred Ways Midwifery down.

I used the first four months of my probation to dive into a creative project that had taken on a life of its own. In late June, I completed my manuscript, a midwifery witch-hunt and travel memoir titled Relax,Nothing is Under Control; A Family Pilgrimage to India. I was grateful for the space the BRN's shenanigans had made during those weeks when I lived, breathed, and dreamed my book. Now my manuscript is being shopped to literary agents, a process that mostly involves – molasses. I mean, waiting.

While the languid summer heat stretched its arms across our Sacramento Valley, reality settled itself like a blanket over my summer plans. Sure, go camping, go to festivals, have fun with your family, but also, it is time to find a job. Two reasons: 1. I cannot finish my probation and clear my license if I do not work for six months as an RN. And, 2. there is the eensy teensy matter of living off of our dwindling savings for the past months because my husband earns about half of what we need for our monthly budget. Yikes.

So between family trips, I went in search of RN jobs, figuring I could land a position in OB, family planning and reproductive services,or home health. All of which I am extremely qualified for and experienced in. For the first twelve of these jobs, I was turned down , due to my license being on probation. Ouch. Big Ouch. Each interview involved walking in wearing organic lip gloss and my grown-up clothes, carrying my fat Board of Nursing probation folder to explain with an outer smile and an inner wince that I am a wonderful Yale trained nurse with twenty years of experience who just happens to be on probation but you really should consider hiring me anyway. And each time the sinking feeling I got as I was smiled at and told “You are amazing and over-qualified but No Way” was like swallowing a stone.

While camping up at Juniper Lake, at music festivals in Oregon, and on Mt Shasta, I lay in my sleeping bag while Adam and the girls snoozed around me and grappled with these things: I may end up surrendering my RN license because no one will hire me! I may have to move away from Chico to work, or commute three hours to the bay area, or look for RN work in prisons, or go back to school to learn an entirely new profession, or, or or.

My friend Kelly came over one evening and looked at my home office, with my wall of beaming, baby-holding mom photos. “You need to take this bulletin board down. And put up something else. Something representing your present, not your past,” Kelly said. So we took down the pictures and cleared out my closet of birth supplies. The following morning I made a new bulletin board display; a few of my favorite birth photos, along with pictures from India and Nepal, pictures of my family, of my ancestors, of Burning Man. It felt well-rounded, beautiful, and more representative of ME.

Tranforming my office seemed to work a bit of magic. On the thirteenth job interview, I was hired for an RN position in a local convalescent home. But I still cannot work a day until the Board of Nursing approves the work site for me. Which could take....? A month? Two? And will this new employer be patient enough to wait for that, really? It seems so, although I am done counting chickens when it comes to RN biz.

Ten days ago I received an email with a job offer that combines my three loves: Midwifery, travel, and teaching. While the pay is minimal, the position is very part-time, so I can also work that RN job my license depends on. I have been hired as the Global Service Learning practicum instructor for the Birth Institute, and I leave for a month in Guatemala next week, taking four students to learn from Mayan midwives at ACAM, a Mayan-run birthing center in the Western Highlands:

 Check out this incredible organization for the preservation of Mayan Midwifery  here!

Suddenly I have a calling besides a sink full of dishes, a purpose besides shopping for kids' school supplies, career moves that are beyond scrolling for RN jobs I know I will be turned down for. It feels that there are building blocks for my future in global maternal/child health being set. I feel inspired, fired up, happy to be using my skills and talents instead of watching them lie fallow and whither away. I am grateful for this opportunity provided by the dynamic team at the Birth Institute and will keep the community posted of my experiences among the Mayan midwives of Guatemala.

Abrazos!

Dena

Peace; the True Intent of Mother's Day

In the 1870s, a group of women created Mother's Day with the following proclamation:

Happy Mother's Peace Day
Arise, all women who have hearts, whether your baptism be that of water or of tears! Say firmly: “We will not have great questions decided by irrelevant agencies, our husbands shall not come to us, reeking with carnage, for caresses and applause.

“Our sons shall not be taken from us to unlearn all that we have been able to teach them of charity, mercy and patience. We women of one country will be too tender of those of another country to allow our sons to be trained to injure theirs.”

From the bosom of the devastated earth a voice goes up with our own. It says, “Disarm, disarm! The sword is not the balance of justice.” Blood does not wipe out dishonor nor violence indicate possession.

As men have often forsaken the plow and the anvil at the summons of war, let women now leave all that may be left of home for a great and earnest day of counsel. Let them meet first, as women, to bewail and commemorate the dead. Let them then solemnly take counsel with each other as to the means whereby the great human family can live in peace, each learning after his own time, the sacred impress, not of Caesar, but of God.

In the name of womanhood and of humanity, I earnestly ask that a general congress of women without limit of nationality may be appointed and held at some place deemed most convenient and at the earliest period consistent with its objects, to promote the alliance of the different nationalities, the amicable settlement of international questions, the great and general interests of peace.

 Amazing, isn't it, that these words are as relevant today as they were 140 years ago?   So what can we do, ladies?  How can we stop the wars?

with love,

Dena

What is Haibun?

  

   Today I attended Wordspring, a writer's conference at Butte College.  I took a workshop on cross-genre writing from author Gabrielle Myers, where we looked at the intersection of poetry and prose.  17th century Japanese poet Basho combined prose with Haiku, and called it Haibun. The form includes segment of prose followed by a 17-syllable poem, which is Haiku.  It often was used to describe travel scenes and experiences.  We each gave it a whirl.  Here is mine, a travel scene from my life, that happens daily at 8am.


       Reminders start a half hour before. "Fifteen minutes!" I lie. She is coiled, cobra-like, all seventy-two pounds of her crouched at her mirror, liquid liner in her hand. I yell to be heard over  the squeak of a Youtube make-up tutorial. Fifteen minutes later I call five minutes, then "Now!"  I pass her lunch, gather homework, fill water bottle, find socks.  Now, now, now, I beg. Combat boots are zipped.

      We emerge into the morning. "Forgot something!" she sings, dashes in again. My frazzle meter rises. Too many minutes later, she climbs into the car next to me. Belts click, door closes, we are off, late again.

  Annoyed, mad with love

I glance sideways at this girl.

Who will she become?

         Tee Hee.  After writing so much about our India adventures, it feels fresh to write about something, well, ordinary and close to home.

Haibun is easy and fun... try it!  Tip: most haiku are three lines:  Five syllable-seven-syllable-five syllable.  Feel free to post yours in the comments below.   

Sacred Ways Midwifery is Currently Closed

    While International Womens' Day dawns clear and pink-tinged, I announce with a deep sigh, that by decree of the California Board of Nursing, Sacred Ways Midwifery is closed. Please do not call inquiring about home birth services.


     I have served the mothers and babies of the Chico area for twelve wonderful years. I have had 100% healthy babies born under my care, and many families I have served have become like my own family.  It has been a gorgeous, love-filled, and profoundly meaningful way to make a living.  I have been honored to serve you.

   My nursing license has been placed on probation for the next three years, as a disciplinary action for charges related to two VBAC women I cared for in 2009. There was no lawsuit - but some local doctors wrote a letter of complaint to the Board of Nursing , and this is the result.  The conditions of my probation make it impossible to continue my work as an autonomous home birth midwife.  

   In witnessing hundreds of births, I have learned that one hallmark of women is Resilience, and I get to discover what next amazing work I am meant to do. In the meantime, you will see me at Wal-Mart, where I will be your cashier! (Just kidding!)

  There is still home birth available in Chico, just not with nurse-midwives.  There are two licensed midwives, Paula Emigh LM and Katarra Shaw LM who are working in the area.  It is within their regulations to attend VBACs, by the way.
Good luck, and blessings,

Dena

Midwife Sisters

    
      "A midwife must have a deep love for other women.  She knows that all women, including herself, are sometimes as elemental as the weather and the tides, and that they need each other’s help and understanding.  The true sisterhood of all women is not an abstract idea to her.”
                                                                                -Ina May Gaskin,
                                                                                Spiritual Midwifery, 3rd addition


             :The true sisterhood of all women" is a concept that resonated deeply with me when I first read Spiritual Midwifery, twenty four years ago.  I was single and living in NYC, far from my California home.  My sisters/girlfriends were my family.   And they still are.  Over my twenty years involved in midwifery, I have seen that sisterhood is indeed a core value of the profession.  This sisterhood is one essential piece that I love about being a midwife.  Midwives train each other, help each other, advise each other, and just plain love on each other.  Because there are just some things that only a sister midwife can understand.   There is an unspoken code among midwives, that if a sister midwife asks for help, you must do your best to help her. We treat each other the same way we treat our mothers and babies;  with respect and integrity.

    I just want to take a moment to tell about midwives who have been instrumental  along my journey.  The story of my career is interwoven with powerful midwife sisters.  When I was a student midwife at Yale School of Nursing, I trained in a midwife-run labor unit at North Central Bronx Hospital.  My preceptor, Lynn Chapman Stern CNM, was a feisty, snarky, tall blonde who had previously travelled the world by motorcycle.  Lynn made working twelve hour night shifts where I would deliver up to four babies a shift, fun.  Her clear words of advice for gently delivering the head, shoulders, body of each baby, whispered in my head for years after our time together.

        When I wanted to study home birth, Rondi Anderson CNM let me come catch all the Amish babies in her rural Pennsylvania practice for a summer.  She attended nine Amish home births a month, so in a summer I got to catch 25 babies.  She arranged for me to live on a farm with an Amish family. Hippie artsy Yale student living with kind, simple Amish family - I treasure the memories.  I would drive through the cornfields to get to births, passing folks on horse-and-buggy, with Beastie Boys blasting on my car stereo.  And of course, being a part of twenty five peaceful, uncomplicated Amish births planted the seed of Trusting Birth indelibly into my being. 

   When my family moved to Chico twelve years ago, I met the only home birth midwife working here at the time - Diane Lawrence.  Paula Emigh,  the midwife of Birthdance Midwifery, was her apprentice.  Diane welcomed me to the community with open arms.  She showed me her office and even gave me the complete inventory of her supply closet so I would know what to order for mine.  My friend Cynthia Banks CNM sent me all the paperwork from her home birth practice in San Franscisco, to model mine after.  Paula and I both began attending home births on our own here around the same time.There has never been a sense of competition between us, but there has always been backup and support.  The one time in ten years that two of my clients gave birth at once, Paula came and saved the day.

     A couple years into my practice, a young student midwife landed on my doorstep with tears in her eyes.  Jessica Mairs LM had relocated her family to Grass Valley for an apprenticeship that  immediately fell through.  Although I was unsure that I was ready, I became a preceptor for her school and trained her for the next two years.  Now she has a thriving practice in Grass Valley, Sierra Homebirth.  When I hear about Jessica, the awesome midwife, I can't help but feel a little rush of pride.  A couple years ago Katarra Shaw LM joined the Chico scene with a third home birth practice.  She and I have shown up to assist at births for each other when needed.  And here we all are together, celebrating a wedding last year. 

The Midwives of Chico - aren't we something...?

   Paula, Katarra, and I have been working together with the Chico Birth Network. Our mission has been to create better communication and collaboration with Enloe Hospital.  We have made great strides in the last two years of meetings, building bridges to benefit the families of Chico when transfer of care from home to hospital is needed.  We also meet every couple months along with our assistants and students, to peer review complicated and unusual cases.  We tell the stories, listen, learn, and advise each other.  And  feast on the most deluxe potluck brunches ever. 
    
Finally ,Yelena Kolodgi CNM and Kavita Noble CNM , Bay Area home birth midwives have given me hours of support and invaluable advice as I have nagivated my bureaucratic proceedings with the Board of Nursing. The above link directs you to Stand By Your Midwives for more info on legal issues faced by California home birth CNMs.  My beloved friend from nursing school Sarah Shealy CNM flew up from LA for the day on her birthday to attend a Nursing Board meeting and speak up for home birth CNMs.    

These wonderful women, along with my assistants over the years, Serra Wells and Amber Eandi, show me again and again, that this term "sistering" that is buzzing around the web is no joke.  I will even take it further.  Here's what i think:   Women are the weavers of the cosmic web that actually holds the world together. 

Here's to you, ladies.