Finally, a birth!!
Trip Start Apr 21, 2013
32Trip End Jun 30, 2013
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She told me that she and Olga had been observing births and helping with the customs surrounding the birth since they were 18. Adela has a daughter who is 28, so she has clearly been doing it for a long time. She also said that she loved her work and for her it was all about helping new lives come into the world, and not about the money. I told her that I think it is the same across the world, because no one would become a midwife for the money; there are far easier ways to make money, without all of the emotional stress of being a midwife, but women do it because they are passionate about midwifery.
I asked Adela about the land that the clinic was on and she said that they owned 2 hectares, which was mainly covered in plants and trees, which could be used for medical purposes. She asked me if I would like her to walk me around and for her to show me what they had; clearly, I almost bit her hand off at the chance. As we walked around their overgrown jungle-like garden, Adela stopped at each plant and told me what it could be used for. They had something for every ailment I could think of. They had plants for cataracts, for stomach ache and leaves to be taken to stop heavy bleeding following a birth. I was amazed as she showed me about 30 different plants and told me how it was prepared. I told her that I loved that the traditional ways of treating illnesses was continuing in this area, and I hoped that she passed them down for the generations to come. She said that many people in the area had forgotten about the strength of natural medicine and now took western medicine instead, especially as it was free and easily available for all Ecuadorians
So, as I was called for dinner I was told that Olga's (one of the parteras) daughter in law was in strong labour, because they had given her some natural medicine to bring on the contractions more. Adela also showed me a thick, green, strong smelling liquid that the new mum would drink straight after the birth to prevent haemorrhage. So, the scene was set, we were 10 minutes away from a hospital in a ambulance with lights on, or 20 minutes in a car, but there aren't any cars here. It is 7.30pm, and raining heavily. The whole family is here, kids and in-laws and all. There are 2 parteras and me, although I have told them that I am on taking photos duty and just observing. I am really excited to experience the culture around the birth but I am also really nervous about the birth and what could happen. I am clearly with some extremely experienced midwives though, and I am about to experience something completely outside my parameters of normality. Ahhhh!!!
So I was told to be quick, because she was getting further along in her labour, but when I saw her I thought she was still in the fairly early stages. She was coping really well and smiling and chatting in between contractions, which were about 6-7 minutes apart. She was walking up and down the corridor and the midwives were encouraging her to breathe slowly and walk around. Ok, so far so good, all the same advice as I would give. She was encouraged to relax, and given lots of chicha de yuca, which is a slightly fermented drink, made from yuca, as it was meant to bring on strong contractions and should make the woman stronger to cope with them. I watched as she drank about half a liter of it, and then her husband did the same. He seemed to need a bit of strength too. There was much laughing and joking and she was surrounded by her parents, her husband, her husband's sister, (and her 5 month old daughter), and another child but I don't know who she belonged to. Then there were the two parteras and me. The parteras thought she was almost ready to birth, and got her into lots of different position, including holding on to a rope from the ceiling and kind of swinging in a squat position. The parteras were with her with every contraction and there was lots of back massaging and hugging and hand holding during each contraction. They wrapped her up in a blanket, and told me that it is better for the baby to be warmer and better for her spine/hips to allow everything to open up properly. She however, seemed to be roasting and I wanted too give her a cold compress for her face at least, but I was purely observing, so did nothing.
The girl (18 years old) did a great job, and barely muttered a word during the contractions. The parteras kept her focused on her breathing and she never once asked for pain relief. They also had bars on the walls at varying heights for the women to hang from, and I wondered if their arms hurt in the morning as all of the positions involved them supporting their weight with their arms above their heads. Anyway, the midwives got prepared for the birth, which means that they put on aprons, had one pair of gloves between the two of them and checked that they had a piece of ginger handy. The ginger is used to wake the patient up a bit, if she gets drowsy during the pushing stage (or maybe faints). Ok, all ready to go. There was no neonatal resuscitation equipment, anywhere that I could see, but they had a really strong leaf mixture in case of haemorrhage.
All seemed to be going well, but they had a nervous air about them, that made me think they thought it was going too slowly. She hadn't been in labour for a long time but they had given her lots of the mixture and her contractions were still about 6 minutes apart. She didn't seem to have a strong urge to push, so they told her to lie down on her back and sleep, which she did for an hour. I, of course, wanted to tell her to lie on her side, not her back, but I kept quiet. Occasionally her pulse was checked (without actually timing it), her forehead was felt for a fever and her abdomen was touched to check for fetal movements. That was the extent of the observations. Nothing was recorded and I couldn't help but admire how much more time the parteras had to support the woman, rather than having to write everything down. They stayed with her for every minute, and it felt like we were all in it together. Once she had slept for a while, she was encouraged to move around again, and I suggested that perhaps she should try to go to the bathroom, as it had been three hours that I had been there and no one had suggested it to her.
After standing up and going to the bathroom, it seemed like all hell broke loose. Suddenly there was a mass panic (I have no idea why, because nothing had changed) there were three people applying fundal pressure, they had her jumping up and down on the spot, trying to thrust the baby out and I could barely see the elbows of the partera who was conducting the birth. I swear, I will have nightmares about this birth. I stood there in shock, but tried to keep a reassuring face on for her family members. After, maybe 10 minutes, they pulled a flat baby into the world (no muscle tone, no attempt to breath, but a fairly good heart rate) and then started to give him direct mouth to mouth. He was lying there, covered in blood, and as no one was making any effort to dry him off, warm him up, stimulate him, or check his heart rate, I decided to leave my purely observational role. I couldn't help it. He needed a good bit of stimulation and numerous mouth to mouth respirations (which I was not prepared to do), and after 4 minutes he made an attempt to breathe. I don't think that my help was received well, because as I was trying to dry him off (the room was also quite cold, and he was tiny) the parteras were putting more blood on his face. Whoops, but my training kicked in and I couldn't see this tiny, little baby (about 2400g) left in a puddle. Anyway, they gave her the strong concoction of leaves and within about 5 minutes she birthed the placenta. There wasn't a huge blood loss, and within 20 minutes, they had her washed, and in a clean bed, with a hot water bottle on her abdomen and lots more chicha de yuca. The baby on the other hand was grunting, with nasal flaring (signs that he was really cold). I had tried to instigate skin to skin after the birth but had been pushed away, by everybody....crazy white girl! The cord was tied with a piece of string and then cut with a piece of sharp wood. He was handed to his grandmother, who only under my insistence cuddled him in and tried to warm him up. Two hours after the birth, there had been much talking and much drinking of liquids for pain relief, and mum (or dad) and baby had still not been united yet. I was also struck by the fact that the huge elation and joy, which usually overwhelms the new parents was missing, they seemed quite neutral about the whole event and neither of them rushed to see the baby. I guess she was just tired, but from the point of view of the observer, it seemed more like there had been a bad outcome, as everyone was quiet and there were no big displays of emotion that I am used to.
As they were all talking in Kichwa and my brain was fried, I decided to go to bed. What an experience!! As I grabbed my things, I saw a cupboard, labelled (in Espanol) things for after the birth, I couldn't help but sneak a peak. Inside were two pillows, and a hammer. To be honest, this seemed to sum it all up for me, and I chuckled as I left the scene of a birth that I know will stay with me for a long time and I need to spend some time truly reflecting on. At the end of the day, everyone was fine, the first time mum had a quick birth, that she made look easy, and now she has a healthy baby boy, but also so many things were so different from what I have been trained to do. There will definitely be lots to think about.