Friday, September 9, 2016

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


happyfeet54 said...

This was wonderful, Dena! Bring it on...let's get this into other 'areas' where other mothers, nurses and even maybe doctors can see what's going on (OR do we need to stay 'under the wire')

Oh, my...

Great stuff woman, keep it coming!!! Happy for you !!!

Carmelo Intersimone said...

Beautiful storytelling. Thanks for sharing your adventures.

Janet Chawla said...

So writing runs in the family!....your description is fascinating! Question tho...they don't stimulate the placenta as in India to revive a breathless newborn?

Keep up the great work and reporting...I do so appreciate it...

Adam Moes said... that's why we sent you to Guatemala for the month.