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.