Day 3: Haiti

Day 3

This day was Saturday, a free day at the clinic. No prenatals or classes scheduled. I slept in a little but not too much as I knew I needed to go check in on Medaline and probably discharge her. Not being woken by Martha let me to believe that her contractions stopped and she had slept. I was right and after she had some breakfast, oatmeal, I sent her home with a prescription for a syphilis, and HIV test plus and ultrasound order with instructions to do them all on Monday and return for a prenatal on Tuesday unless the bleeding worsened or she was in labor again. She happily agreed. I ate breakfast and some Benadryl and Tylenol for the cold and promptly fell asleep on the couch in the family room where I slept for 90 minutes or so. I woke disappointed that the power was out again, but Mary invited me to go on a walk 1/2 a block away to the cemetery which had manicured lawns and huge shade trees. I agreed and here I am now.

I think I am going to take this time to describe MBH the best I can. It is a large concrete building painted a pale yellow and white. The yard is compound like everything else in the neighborhood, probably .5 of an acre. There are three doors on the front of the house. The one on the left leads into the kitchen which has a refrigerator, oven, back up propane powered cooking station and falling apart cupboards full of dishes and pots and pans all covered with clean cloths or mesh screen to attempt to keep out insects. A wall of 5 gallon water bottles for the water cooler lines one side. If you continue through the kitchen you enter the court yard where they have the outside kitchen to cook, do laundry and wash dishes. Dishes are washed in three large tubs. One for soaking and cleaning, one for rinsing, and one for disinfecting with bleach water. Through the second door on the front of the house you enter the teaching and post partum room. Four single beds line the walls. There is a baby care and weight station and pictures of teddy bears and nursing mothers on the walls. The room is separated by another little entry room by a navy blue drawstring curtain. Yesterday this room was full with Mama Baby class participants, Mamba baby families, and postpartum families, about 20 in all. Through the blue curtain is an entry room from the postpartum room, kitchen and reception area. It has one bed there for triage and treatment plus a child sling scale where the child sits in a special cloth that is suspended from the ceiling on a scale. There is a small cabinet with pregnancy tests, HIV tests, glucose tests, thermometers etc. When you enter through the third door on the front of the house you enter a screened porch. This is where the mothers sit to wait to be called in for appointments. You don't make exact appointments. You tell them to come in 4 weeks and they come back around then. The first to arrive gets the seat closest to the door and is the first called. So they begin to arrive around 8 am and by 9 am when it is devotional time we have 10-30 women there. That room leads into the small reception area with a desk and an armoire that holds medications and vitamins. To the immediate right is the garage which has been converted into a large store room for supplies. On the far end of a reception area there is another bed that is used for triage or as an extra prenatal space. To the left is the hallway to the kitchen and postpartum rooms as well as the stairs to the upstairs. Just past the storage under the stairs is a labor room with the MBH logo painted on the wall. Two beds and a bathroom plus a supply shelving area.  From reception to the right there is a single labor room decorated with birds. A bathroom. A double laboring room decorated with painted flowers. There is also a hall way that leads out the back of the house to the grounds keepers’ home. Up the stairs opens into a great room with a small desk and office supplies. There is a large family sized black table with benches and two love seats and a coffee table. Shelves along the walls hold books and food supplies and condiments that belong to the midwives and other house staff. There is a door that leads to a covered deck. I spend a lot of time out here and often nap there. Off the great room is another large room called the over flow room. It holds overflow baby supplies and medications that will get too hot in the garage plus 3 more bunk beds for over flow staff. I often sleep on the top bunk as a breeze from the deck on the end makes me feel less clausterphobic.  Off the great room are the midwives quarters with a bathroom and 4 sets of bunk beds. Mine is a bottom bunk in the far corner away from both windows. Thus the closterphobia.  Another midwife room off the great room leads to Mary’s room where the directors stay, there are two beds. There is a bathroom and a third bedroom which has four bunk beds where the site manager, Santo, who I have not met yet because he is out of town, sleeps. The yard has a huge empty swimming pool, a chicken coup, two green houses and plants everywhere including beans, peas, tomatoes, corn, egg plant, lettuce, greens and other plant foods. Trees of mango, papaya, banana and sugar cane are also around. The whole house is very clean. The cleaning woman wipes the walls and mops every floor with a bleach solution every day. Building materials are difficult to come by so paint is chipping, windows need caulking etc. but they keep things very clean and tidy and I feel very safe even with all of the insects around. I am hoping for a few labors to come in today.

Chicken Coop and Banana Trees

Green Houses and Mango Trees

Women Waiting for their Prenatal

Birth Room with MBH Logo

Sun Room Birth and Prenatal Room

Birth Room Birth and Prenatal Room

Flower Room Birth and Prenatal Room

 Laundry is almost always drying around the Clinic yard

Sugarcane

Papaya Tree

Staff Family and Dinning Room

Clinic

Swimming Pool- This made me laugh because there is almost a page in the volunteer handbook about how you need to dress modestly when you are using the swimming pool :)

Passion Fruit Vine

When we got back I spent several hours napping as did the other midwives. We then decided to go for a walk up to the rock quarry about half a mile away. We stopped by the MBH children’s library and met the family featured in the you tube video. We saw many different people, animals, and houses. When we got to the quarry rain water had collected to form little pods where people were bathing and animals were watering. We climbed a steep hill and we were able to see all around us up the mountains to the east and the ocean to the north. It was very beautiful.

When we got back a labor was there a first time mom named, Tetalley. She was very sweet. We had spaghetti for dinner and mom and her sister Nahnah walked around. We told them to come and get us when things got more intense. I crawled into a new bed under a mosquito net out on the porch and waited. Around 10 Martha came and got me and told me she was active. I went down and found her rolling in bed with the pain. We got her centered and I did an internal exam and found her to be 100% and 5 cm. Her mother had shown up by that point and kept pulling up her skirt and opening her legs wanting her to push out the baby. I finally got her to leave her alone and she labored with us holding her hands, rubbing her back, and putting water on her belly. Around midnight she said she had to poop and I checked her and found her ready to push. Martha went and got Mary and they were going to turn on the generator when a miracle happened and the power went on. She had a very tight hymeneal ring. I was worried about her tearing on the birth stool so she pushed a few contractions there and then we moved to the bed. She would not have torn except for a nuchal hand that popped out. Baby had great apgars and cried eagerly.They worked beautiful together and grandma was so happy.

 I ended up needing to suturing her up a bit. She showered and then we moved her to the postpartum room where we worked on breastfeeding. I crawled into bed at 2:30 but still didn't sleep well as the baby was up often during the night and I went down to help the mama. She was exhausted and a little shell shocked which is pretty normal for a first time mom no matter where you live.

Photos of individuals shared with permission that was obtained prior to taking photo.

Birth Photography for St. George and Cedar City Utah

I have had the privilege of working with Rachael Steele of Steele the Moment Birth Photography several times. Here is her fabulous facebook page.  If you are interested in birth photography I would highly recommend looking at all of the wonderful local options. The photos will be something you will cherish forever and everyone I have ever spoken to about them have found them well worth the cost. Below you will also find some beautiful examples of her work. I was at several of these births as a second midwife to Laura Hopper another wonderful local midwife resource. 

Here is my interview with Rachael:

When did you first become interested in photography?

I have always had a fascination with the idea of being able to photograph and freeze moments in time…a fascination that started very young and was inspired by many artists including Anne Geddes. I remember even at about the age of thirteen, setting up a fur rug to take a picture of my newborn sister, as well as a close-up picture of a beautiful flower and thought somehow that I was going to put it together to make this beautiful piece of art! Not quite sure how I thought I was going to do that to be honest, haha. Yet the desire to make art out of a precious new life while at the same time capturing all her little details forever was definitely already there at that point!

What about birth photography?

I first heard about birth photography from a fellow twin mom on the mothering.com twins forum actually! I had just started to really get into the world of professional photography, and as I also had such a love for the whole birth process (but no desire to be any kind of medical personnel) I could not believe what I was hearing! Two of my passions all wrapped up into one! And not only that, the whole idea of the sentiment behind it…I am a very sentimental person. Yes, I save everything. I wrote every single detail down in a pregnancy journal with both of my pregnancies, did baby books, kept little sentiments, had hand and foot molds done, etc. Everything I can get my hands on to sort of capture those little details that are so soon forgotten. What a wonderful idea, to be able to preserve those memories and at the same time, allow the support team to work with mom and not even worry about taking pictures! Phenomenal! Not only did I wish I had thought of it with my births, but I wanted so badly to be able to provide such an invaluable service to as many families as I could.

 Tell me about the first birth you attended whether you took pictures or not?

Well, the first birth I ever attended would have been my oldest sisters. I was probably 17 or so and just there to support my sister. Even at that young single age I remember being a little bit shocked since I had never really seen a baby be born before, but I have been so amazed since then and continue to be amazed at the human body, the things that it can create and the hard things it can do! I attended several other family member births after that and it never ceased to amaze me. Following a long period of training and being mentored specific to birth photography I took on my first birth client, a dear friend of mine where I was able to photograph her breathtaking home birth. It was such a remarkable thing to be a part of. And from that moment on, I knew it was my calling in life to be able to preserve these special memories for people. 


Why would someone want birth photography?

As one of my birth photographer colleagues says, “Because they only take their first breath once.” You know, this is the hardest thing for me to answer sometimes. I know the answer…but it is hard to describe. Each one of my clients could tell you, but kind of like having a baby, you will never fully understand until you have had the experience. For many mama’s it is so very healing and empowering to be able to actually see the work and the labor of love they put in to bringing their child into this world. To be able to see the love and support that surrounded them throughout the whole process. To me, there is no greater gift a person can give themselves, their baby, and their posterity than to have professionally captured those fleeting moments.

Why hire a professional?

As much as it would be nice to be able to have just anyone record your story, the sad truth is that many of those special moments will be missed, and those moments are things that you cant get back. As a professional birth photographer I am trained to hone in on the details and quiet moments that matter the most, often times they are little bits of importance that the average person may not catch as “important” but is very much a part of the journey. Many people may think it’s just the difference in the camera, but that is not the case. Yes…I have a nice big camera, but it is just a tool, and knowing how to use it properly is what makes the difference. I chose my camera and lens’s specifically to be able to capture great images in low light situations and have been trained in just about every aspect/scenario that comes along with birth. The difference in training as not just a professional, but a professional birth photographer is of immense importance.

Can't dad take pictures?

Words cannot describe! Please if I may share a link that will show you exactly what moments you would have missed if dad were behind the camera instead. As a member of the International Association of Professional Birth Photographers, a group of us got together to share our best images that just begin to describe the answer to this question. Please, enjoy our video “Hold her hand, not the camera” 

What if I don’t want pictures of the baby coming out?

This is what makes birth photography so great! It is totally up to you how much or how little you want in your photos. Either way, rest assured you will have a complete birth story start to finish regardless of what you choose. It is purely personal preference. Some people want images they maybe even just want to keep to themselves to see the hard work they did, some may just want the images of babies head coming out where you cannot see anything else revealing, and then some choose to wait until baby comes up for their first breath. There is no right or wrong choice; it is absolutely up to you!

What about modest pictures?

Again, it is completely up to you how you want the images to turn out. There are almost always angles I can use to take the images in a way that it is as modest as you would like it to be. I am always very conscious and respectful of the birth space and my clients’ privacy and do everything I can to make it comfortable…more like a “fly on the wall” kind of experience.

What if I do want pictures of the baby coming out?

Absolutely. I have no problem with however my client decides they want their images taken. 

What type of editing do you do?

Well, to start off…each of my clients gets a folder of color images as well as a folder of black and white images. Many birth photographers will just do black and white, but often times I find that I absolutely love the color image and I don’t want to take that away. For that reason, I provide both. So it is up to my client to decide which ones they like in color and which ones they like better in black and white. As far as actual editing, I “process” each of the images a certain way, I don’t ever “touch up” the images. I won’t remove things out of the photo or change anything in a way that does not depict the trueness of the actual experience. Most of what makes the images what they are, is the way that I actually “take” them in the first place. It’s true there is cropping and tilting and converting to jpg format, etc. and all my images go through a similar process, but it’s all just a way to get the images into a usable format. 

How do the doctors and midwives like working with you?

I have a really good working relationship with a lot of providers including midwives, doctors and nurses. I have worked with a lot of them in the area so most of them are familiar with me and it has been a great experience! I have had both midwives as well as doctors tell me that they actually really enjoyed being able to see their job from that perspective as well.

When do you like to get called to the birth?
Basically once my client is in active labor I want to be there. For most home births, I will show up shortly after the midwife does. I want to be there soon enough to get “laboring” shots as well as pictures of those moments when their support members are there for them and helping them through their progress. I want to be able to get detail shots before hand also, in a way that sets the seen. Pictures of all the stuff that is out and ready for baby, maybe what other family members are doing while waiting, the weather, the date on a newspaper or calendar, and things like that.

What if I have a c-section?
Well, in general the rule is that as long as it is not a complete emergency and the doctor and anesthesiologist are okay with it, then it is allowed. There are no actual policy’s set in place at our local hospital that prevents photographs from being taken, as long as there are no photographs of any actual procedures. Even if something turned into c-section and I was not able to photograph that part of the birth story, there is still a story to be told. Even if the birth story images went from mom and dad walking into the OR, a picture of the empty room they were in and a picture of the clock at the time, then a picture of them coming out with their new bundle of joy. Then a lot of times they can wait to do the length, weight and footprints til they are in a regular room, so everything is still there and the story is still complete.  

Tell me about the difference in shooting photos at a hospital birth verses shooting a homebirth?
Really there isn’t much difference as far as my job goes. The hospital ones I do tend to mostly be medicated, not all, but most. So those ones are easier to gauge how long I have. But that’s not always the case. The only other difference besides the “security” at the hospital is that the lighting is usually always the same in the hospital, very 2 dimensional. Because of that, I shoot a little bit differently in order to create 3 dimensions. Just technical stuff though. Each birth is different regardless of whether it is in the hospital or at home.

Do you do maternity and/or newborn photos?
Yes, absolutely! I specialize in maternity, birth and newborn. I have packages for each so you are able to combine either of those options together, which makes it nice for my clients to sort of be able to build their package how they want between those options.

Tell me about the birth where you learned the most about taking birth pictures?
Oh gosh, that’s a tough one! I’d say I have several. No matter how long a photographer is in the field, you learn something new at every single session I think. For me it was important to learn everything I needed to know about taking birth photos, before ever stepping foot into a birth to “practice” on, as birth is not something you can retake if you miss something. But if I had to pick, I would probably say some of my “firsts”. For instance my very first home birth, my very first hospital birth, first twin birth, first c-section, etc.

How long after the birth do I have to wait to get pictures?
I will usually give you a sneak peek within the first 24 hours of the birth. That way you have some beautiful images you can share with family and friends immediately to announce the birth of your new little one! I always say 4 to 6 weeks for the CD of all 150 to 300 images, although I have gotten them back within a couple of days. It sort of depends on how much work I have at the time. But is never beyond the 6 week mark and usually by 4 or sooner. If you need images for birth announcements, etc. I am always really flexible with emailing you a couple if you would like.


How much do you charge and what is included? 
Well, I always tell my clients in the beginning that it may be something you need to save up for. I do take payments as well, but it is along the lines of wedding photography (except that a wedding photographer isn’t on call 24/7 like I am ). Right now I am currently charging $400 for the birth, and have packages that include either the newborn or a maternity session for $575 and my “Whole Bundle of Joy” package which includes a maternity session as well as the birth and newborn sessions for $750. (These are my current specials that require a $100 deposit to hold at that price)

Any final words?

I just want to emphasize how priceless and invaluable birth photography is. No matter what your concern, I have never once had an unsatisfied customer. It definitely isn’t something you will regret! But I can’t tell you how many people I have talked to that never quite get around to booking their session until it’s too late and they say how much they had wished that they had done it. For me, it’s not an option. Not just as the professional birth photographer, but as a mother myself. My next birth, no matter what the obstacle, I will make sure I have my birth documented in a professional way so I can freeze those moments in time so the memories can always be fresh in my mind.

Day 2:Haiti

Day 2
I woke up earlier than I would have liked but I heard voices and felt guilty being in bed. It was around 6 am. I must have had a few mosquitoes in my net last night as I woke with a dozen new bites. These ones are mean and the itch was driving me mad. I walked out on the deck to Mary doing her daily devotional. We talked a bit and got ready for the day. I went down to discharge the mom who came in false labor again last night. She headed home. I was not feeling well at all.Some sort of cold probably caught on the plane. Breakfast was scrambled eggs and the most delicious pineapple I have ever tasted. 

Friday is the day MBH teaches Family Planning and Mama Baby classes. We also saw a few kids for a national program called Medika Mamba. Mary went to teach the baby class with an interpreter, and Martha who is a nurse, helped do informed consent and screening for women wanting the Depo-Provera injections for birth control. Two new women came, and six returned who had come before. Of those 6, 2 were risked out due to high BP. It is amazing to me how often high blood pressure is a problem here. It leads me to ponder everything I have studied. Is it nutriton, genetics, stress or a combination?

It got really busy quickly. I helped with the Medika Mamba program. Medika Mamba means "peanut butter medicine" in Haitian Creole. Each child is weighed and measured and then compared to a chart that rates their malnutrition, severe, moderate, or mild. There were 6 children today. Two of them were in the healthy range and sent home. The others were given a certain number of Mamba packets and instructed to mix the peanut, oil, sugar and vitamin formula in clean water and administer several times a day before meals. They are expected to gain a certain amount per week. To learn more about the Medika Mamba program visit http://mfkhaiti.org/index.php/the_solution1/treatment/

 

Photo Meds and Foods for Kids

They are also administered amoxicillin and a deworming pill the first visit to eliminate bacterial or parasite issues. I got to snuggle a 10 month old little girl for almost 20 minutes while her mama went to go get some food. She was a doll and after she would fuss and I would get her calmed down she would do that little shutter babies do when they relax. Melted my heart. A very young mom, my guess would be 15 brought in 12 month old twins a boy and girl. 

Severely malnurished little tiffi twin

Moderately malnurished gason twin

The girl was severely malnutritioned and the boy moderate. They were both so cute but their little skinny legs didn't look like they had enough muscle to ever support them.The little girl vomited up the dewormer and I had to go get a syringe and figure out a different way to help her take it.  She was a good attentive mother and still breastfeeding them both. There was a Mama Baby Class taught by Mary after clinic that day with about fiveteen mothers and infants. The other mothers were so impressed when this young mom easily and with little fuss breastfed her two 12 month old twins while listening intently.

After Medico Mamba was done I helped with 2 postpartum visits. A 1 month old had gained a whole kg since birth and mom was so proud. A second mom was having high blood pressure at 1 week post partum and had me check her sutures. She was healing well but we asked her to return next week after cutting MSG from her diet to recheck her blood pressure. 

 I was doing an exam of a 6 month old baby with a cough when they announced a laboring mom came in, Madeline. I admitted her quickly. She had only had one visit and had never returned with hey HIV or syphilis testing so we did a rapid HIV test. We had trouble getting enough blood and the first one was inconclusive, but maybe positive so we did a second that came up negative. I checked her to be 1 cm so I told her and her friends to go walk around the yard. This was her second child. I have been surprised how most of the Haitians I have met only have 2 or maybe 3 children and they are spaced often 4 or more years apart. The average Haitian breast feeds for 18 months. 

I helped with the rest of the sick child visits, gave some opthamalic eye ointment, amoxicillin, and vitamin C. Then ate lunch, rice and beans, and stripped all the beds and changed them. Mary noticed I was still not feeling well despite all of my water and Emergence c packets so she told me to go lay down. I took a nap out the outside deck after covering myself with bug spray. The power has been off since yesterday and that means no fans. It is really hot with no airflow. Medeline was more active after my nap. After she vomited I checked her again, 2 cm. Her friends all left, she had bad back labor and a terrible headache but didn't want me to help. She was much poorer than the other women who have been in. As I wrote earlier most of the women who come in are very clean and although poor their clothes are well kept. Medeline was different. She was very dusty and just looked plain exhausted like she had had a harder than average life, even for a Haitian. She labored mostly naked out in the yard after the sound and smell from the generator pushed her out of the labor room. A few of her very young teen age cousins came for a visit. They laughed a lot and Medeline basically ignored them. They poked fun at her labor noises and nakedness. She had had some mild bloody show that was concerning to her but she labored along.

 I continued to feel worse and worse physically. Dinner was some sort of spicy green soup with fish and crab. Just the smell made me feel nauseous. We all climbed up on top of the roof and spent some time looking at the cities and countryside around us. The houses are all made out of concrete and many of them are huge but almost all of them are unfinished.

Next door neighbors house

 I asked Claudin about it and he said that is the legacy parents leave their children, a huge unfinished house. At around 8 pm a friend of the mamas came and gave her a hard time for just laying in the bed. I checked her again, no change. We told her that she needed to either drink and eat or we would have to start an IV. She drank a little water and Emegcen-c and we put her to bed with Martha checking on her every few hours through the night. The power was still out and the center was hotter than it had been since I had been there with the power out for 36 hours. I made a cup of chicken noodle soup and instant oatmeal, took a bucket shower and headed to bed. It was so miserable. I moved from bed to bed trying to find a cross breeze. Nothing worked. I was probably the most physically miserable I had ever been without pain. I felt like my skin was burning up from the insect repellant I covered myself with. Finally some time after midnight I felt the fan start up and the power was on. With Martha downstairs I moved the fan right next to my head and between the cool  breeze and white noise, I couldn't wear my ear plugs due to my cold, I finally fell asleep

Day 1 in Haiti

Day 1 Mamababy Haiti

A 3rd time mom N., and  her husband have arrived with mom in active labor at 7 cm. In my practice in the states women very rarely have internal cervical exams. The clinics policy is a check at arrival and then no sooner than 4-6 hours later if not necessary. They had one midwife who came who was very upset about the frequency of exams so she did a mini class for the staff midwives about other ways to assess dilation. Her main emphasis was the purple line. As the woman dilates and the baby moves down deeper in the pelvis and pushes on the sacrum the tissues spread from the buttox crease revealing a purple line.

Photos credit of scienceandsensibility.org

The clinic tried it with the next mom who came into the clinic. The woman ended up delivering alone in the bath room 10 minutes after arrival when the purple line said she was 3 cm.  Needless to say they check everyone now at least once.

She is a very calm birther and smiles when I talk to her in English. I am to only watch and chart for this birth. Her labor progresses slowly and she doesn't end up having her baby until much later. Another woman J, comes in with short spaced contractions. We check blood pressure FIRST THING. This is really different than in the states where I usually listen to baby first before assessing mom. They check blood pressure first thing as high blood pressure and pre-eclampsia is a real problem in Haiti and they send them to the hospital right away if there is a problem before mom starts seizing. Blood pressure is fine. A cervical exam is done by the student and I follow her to double check. She is only 2-3 cm. We tell her she can stay and encourage her to walk to speed up her labor. When I ask her when she ate last she says yesterday at noon. I bring she and her friend a mango and cassava bread with peanut butter. They hang out in my favorite decorated room.

Prenatals start at 9 but the women start arriving as early as 6 but most come at 8. Dressed in their best they sit on the covered porch and talk with each other. They are lovely people. I am so excited to be working with them. They laugh quickly and are so kind to each other as they tease and poke about the different aspects of pregnancy. There are 28 today. A small devotional with a scripture, prayer and song is done at 9 and then prenatals start. The interpreters gather their names and pull their charts as well as do weight and blood pressure. The two native midwives are away for some midwifery training so it is just Mary, Martha (the advanced student), myself and a native student Genni. We do two prenatals at a time with an interpreter by ourside. I watch Mary do one but she gets distracted with Martha and I work through the rest with Genni. It is very different doing prenatals when you do not know the language and culture. Thank heavens pregnancy is universal and most mother love talking about their cute growing bellies. I ask questions and they are repeated by the interpreter.  That takes some getting used to, but the interpreters are kind and very experienced. It makes me smile that they are all male. I asked a mother once if she minded having a male interpreter and she said no most of the doctors are male so she sees the interpreters in the same way.  Most of the moms are happy and healthy. They are all severely anemic. We talk and measure bellies and listen to babies. Every mom is sent home with 10 days of prenatals and iron supplements with a prescription to purchase 30 days worth. Most don't have the money to buy them so they wait until their next appointment a month later to get more. Common complaints were acid reflux and lack up appetite. I only saw one with morning sickness. More common in Haiti is "spitting" during the first trimester. An abundance of saliva causes the women the spit frequently and some of them carry around a cup. A first time mama lay down so I could do fundal height. It was the first time she came to the clinic, she was 29 weeks. When I went to touch her belly, they have the softest skin ever by the way, I palpated belly only to feel fetal head and a tiny ear right under the skin. I pulled back surprised. Sure enough you could palpate every fetal part. It was concerning. Measurement was right on and FHT strong but I called in Merry and we agreed a sonogram (costs $25) would be best. Baby implanted out of uterus? Bicornate uterus? Additional note: baby was indeed implanted out of the uterus. They did a c-section at the hospital and baby did not survive but mother did. After I wrote the prescription for the ultrasound Mary called "Baby is coming!". The mother handled her labor like an expert.  Mary broke her very, very bulging bag of water to avoid a shower and baby boy came easily over intact perineum born on a birth stool. Baby born at 11:49 and while drying baby on mom we heard a plop at 11:50. Placenta had come out in bowl. I had never seen a placenta come out so quickly. One shot of pit was given but there was no bleeding as per their protocolls. The odd thing for me was mother had no desire to touch her baby. Very different than in the states. I have seem women who have had a very undisturbed birth often wait a moment or two to touch their baby. Almost like they are waiting to come out of labor land back into reality. More often is is an ecstatic smile or sound. I wonder how much of that is cultural? We are told over and over and shown in videos that you are supposed to be very happy and reach for your baby. I wonder if that would be the case in the States if there was not that expectation. The baby was very healthy and so beautiful. The family is just beautiful together and very happy. I don't get to observe the post partum procedure because there is other work to do.

 I went back to continue prenatals and did a couple post partum exams. A mom with a 5 mo with a cough. A mom who birthed at the clinic 3 days earlier with foul stitches. In the states many women due to good nutrition do not tear. If they have a slight tear we often encourage natural healing methods such as seaweed and staying in bed for a week. Staying in bed for a week is not an option in Haiti. Women tear more frequently due to poor nutrition so they do more suturing. The Haitian people are very very clean often doing bucket baths several times per day, but even with that being around all of the dust and rural living infection is common. The woman was sent home with antibiotics. Things calmed down.

We ate lunch of corn mush with black beans and a sauce made of okra and crab and beef. It was very good. Breakfast had been pancakes and dinner was spaghetti, only spicy with hot dogs in it. They tend to make everything spicy here.

 Around 6 Claudin, an interpreter who has been giving us Creole lessons in the evenings, asked Martha and I if we wanted to go on a walk around the block. We agreed and it was fun to be out in the community. The women smiled and a few men cat called but everyone was very nice. After our walk we talked about culture, marriage, and homosexuality. There are many different religious views in our little group including.. Mennonite,Mormon, Baptist (preacher in training), ex- Methodist preachers daughter, and vudoo. It was a nice evening but the mosquitoes were out in full swarm so Martha and I hid under a big white mosquito net while sitting on the deck looking ironically like two lesbian brides. We laugh a lot and Claudin likes to poke fun at our names comparing them to Creole words. Mine is similar to diarrhea, Mary means husband and Martha is similar to liar.

I went to bed when the power was turned off only to be called back by the 2nd mom from earlier who had gone home around dinner when her labor stopped. She was back but after exam was found to be no different. 2cm. She was exhausted. I gave her Benadryl and sent her to bed at the clinic. I took a bucket shower; like it sounds you sit in the shower and poor cup fulls of water from a bucket over you. It was actually very refreshing. They have running water from a well when the power is on. The city doesn't have enough power for everywhere in the city to have it at the same time so they cycle through and randomly turn off the power. You could go weeks with out there being city power. City power is also shockingly expensive even with how rarely it is on it is not uncommon to cost close to $500 a month.  The clinic uses a generator to pump water from the well into the storage containers on the roof to be used for showers and toilets. They also turn on the generator at night once a laboring mother is close to pushing.  A bucket shower is quite nice. Then I crashed and slept hard.

Haiti Travel Day

Haiti by the Numbers:

•  Less than 45% have clean water
• 74 babies due per 1000 births
• 12% of all babies die before their 1st birthday
• 1/3 of all children die before they reach the age of 5
• 1 in 71 women will die in pregnancy or childbirth
• 50% of the population earns less than $60 per year
• The average life expectancy is 53  

Haiti

Travel day July 2011

I was so anxious I hardly slept. The kids and I were very emotional when I left. Ben drove me to the airport. It was nice to spend the time with him alone. He was kind enough to help me with the 150 pounds of luggage I had to carry. The first flight from Vegas to Miami was uneventful. I had a window seat over the wing which is my favorite place to sit. I love watching the wing adjust as we fly. The plane had substantial hail damage which was a bit concerning. My two seat mates were two late twenty something brothers from Australia. A third brother sat across the isle.  They reminded me of my boys. There were two that were very similar in height and one suave looking youngest one who was much shorter. They were very nice and we spent a good amount of the time discussing similar places we had traveled over the world. 

 I arrived safely and got my bags only to have several urgent emails from Mamababy Haiti saying my flight must be wrong since the only 1130 flight arriving in cap Haitian was a cargo plane. Of course the ticket office wasn't open so that began the anxious night of attempted sleep. Every 15 minutes a loud speaker would come on and announce the time in both English and Spanish. There were several other repeating announcements in between. I had three sleep options. To try to sleep sitting up in the divided chair, to sleep alone right under a large speaker or to sleep with a bunch of traveling hitch hiker hippie surfing guys. I tried my luck by myself and got a little intermittent sleep. Evidently the Miami airport goes dead at 12 am only to wake up fully at 2 am. So I was up then as well sharing the airport Dunkin doughnuts line with cops and foreign travelers. I woke to these men walking around wearing black jumpsuits with wide green stripes running down the legs.I could not figure out who they were or what they were doing. They started pulling covers off of these contraptions that I assumed were napping pods (yes I think these napping pods to not exist but they seemed like a great idea to my exhausted body at the time.  A little pod you could climb into and nap with a secure place to hold your luggage. Why not?)  Turns out they are baggage wrappers. Wrapping you luggage in green saran wrap to keep it safe from theft. It cracked me up to see every ones luggage a bright green color.

 After walking for over an hour I finally found the tiny ticket counter in what looked like the Miami airport basement. I stood in line with many colorful Haitian people and eves dropped a bit. They were obviously wealthy in order to be able to fly to the states. I got to the ticket counter and everything was explained regarding my ticket. We would be stopping over in a city called Marsh in the Bahamas to drop off some people and refuel. The plane was small and we had to pay a ton for extra baggage and they weighed us before we boarded.  You always know the plane is small when they weigh the passengers this I learned while traveling in Africa. We proceeded to sit and wait. Two  Haitian business men started up conversations with me about what I did and what they did. One in particular worked for the better part of an hour trying to convince me that my time in Haiti would be better spent with him getting the royal tour of the city than at the clinic. I never wear jewelry when I travel internationally but sometimes a wedding ring would be nice. Our conversation ended when I showed him adorable pictures of my family and he commented that I looked too young to have a 9 year old.

The flight was very bumpy and I nearly vomited several times. An extra take off and landing didn't help much with the air sickness. I don't hate flying but I don't love it either especially flying over open ocean. The seats were so small I don't know how anyone larger than me could have folded themselves into them.

I arrived safely greeted by Mary the Mamababy Haiti site director and Martha a student intern and Otair an interpreter. They were lovely and helped me make it through customs easily.  They even got it cleared that customs did not examine by bags which turned out to be a fortunate thing. It trying to save space and weight I had taken all of the probiotics, garlic pills, cranberry pills, and prenatal vitamins out of their original packages and jars and placed them in huge gallon sized bags. I had four gallon sized bags full of questionable material. I had also taken a gallon sized bag of vanilla protein powder. It looked like a bag of cocaine and even felt like it through the bag until you opened it and vanilla filled the air. Do they make vanilla scented cocaine? They would have been confiscated for sure and I would have been detained for who knows how long if they had searched them. The men in the airport were very helpful with luggage and eager for their $1 tips almost ripping the heavy 150 pounds of luggage out of my hands. 

 

We rode to the clinic in the MBH ambulance, a Tan Landrover, was intense with many near death experiences and gawking people.  We stopped to get native cassava bread which they baked from cassava ground and cooked on large round flat stones. It is delicious and interesting to watch then make. Things are very expensive here. Gas $5 a gallon. I joked with Otair that he liked honking the horn and siren on the ambulance when he smiled and said "We are here and this is how they know to open the gate." Sure enough a compound on my right with bright red doors swung open to welcome me to Mamababy Haiti. 

 

 

 

There was a birth going on when I arrived attended by the two native midwives. I was quickly oriented and unpacked. I share a room with 3 other midwives. It is so hot and humid. I struggle with claustrophobia from the bottom bunk and mosquito net. Dinner of black beans and rice with some sauce was served and it is delicious. I crash early around 8 pm only to wake up delirious several hours later in a hot sweat. The city power had gone off, something that happens nearly every night, and with the lack of power went my fan and my sanity.   I stumbled out to the people talking on the porch and moved my bed to a top bunk in the overflow staff room which is attached to the dinning room and family room and is much more open.  Much less claustrophobic. It slept restlessly until I was woken at 5 am with two moms in labor.