How do I Know When I am Going to go Into Labor?

How do I know when I am going to go into labor? 

Oh how I wish I could answer this question for all of you. If I had a crystal ball and could I would be rich! This is such a common question in my practice. Women in the United States have been lulled into a false sense of planning by the medical community making them believe they can detect when they go into labor. 

Here are a few things that will not detect that you will go into labor soon:

1. You are dilating. But but but. Nope. Doesn't matter. I have seen women walk around at 7 cm for a couple weeks then go on to have a normal length labor. I have seen women go from 1 cm to baby in one hour. It is not a good assessment of when you will have your baby.

2. It is your due date. See #1 below.

3. Your baby has dropped. This can happen in labor.

4. Your previous baby was born at 39 weeks (or 40, or 37). Your previous gestation amounts can play into the equation but based on 11 years of birth work I would never put money on it.

For those of you (like me) who appreciate a good check list here are a few warning signs (party signs?) that labor may be on it's way in the next week or less:

1. You are over your estimated due date. I tell every first time parent to add 8 days to their EDD based on their last period and count on baby coming no sooner that that. Make sure you share your new EDD with everyone. But what if the baby comes early you ask? You have your baby a few weeks early and no one raises an eyebrow, but go over your due date and the texts and phone calls won't stop until the baby is out. Even mom's who have had a baby before often hit their due date.

2. You have had a seriously good cry. This usually occurs as a prenatal appointment after you come in puffy and glaring at your care provider that you are still pregnant. The cry often occurs from the build up of hormones in your body preparing you for labor.

3. It has been one week since you have had a night of contractions where you were "Sure this is it."  and you almost called(or did call) your midwife.

4. You have loose bowels. You have spent most of your pregnancy more blocked up than usual thanks to iron supplements and slowed down digestion which helps with greater absorption of nutrients that is typical in pregnancy. Suddenly things change the other direction. Emptying becomes the word of the week.

5. You have lost your mucous plug although these regrow all the time and it is not uncommon to loose them a couple of times before baby comes.

6. You get up in the middle of the night to fold baby clothes. Nesting anyone?

7. Everyone in the family has gotten a really nasty cold, flu, or stomach virus and it now starting to feel better. It sounds crazy but  this almost always happens. Every one gets sick about a week before baby comes. Mom is super stressed about being sick or having sick kids while in labor. Everyone gets better and then the baby is born.

8. Your toddler has decided s/he is ready to toilet train. Completely serious. You wanted to do it all your first trimester but didn't have the stomach for it. You tried to do it your second trimester but the child wasn't ready. You had given up hope the third trimester and were sure that they would be in diapers in college. Week before the baby comes and wamo they want to use the potty and you spend a week washing pee soaked underwear.

9. Your mother-in-law who came into town to be here for the birth just caught their flight back home. Your body has a way of waiting to go into labor until it can be a private event. This can also be the sister, best friend, mother etc. I really do not have a vendetta against mother-in-laws.

10. Baby is moving less. It is very important to pay attention to baby's movements in utero as this is a positive warning sign that baby is doing well. Often right before labor there is a moment of calmness from your little one as s/he prepares for birth. They have just plain run out of room and their head is wedging deeper into your pelvis. This comment usually comes up during a prenatal appointment, but more than a handful of times I have gone to a clients home to check on things because mom was concerned that the baby wasn't moving and there was something wrong only to arrive assure her everything is fine and she is in early labor.

Regardless of everything above your baby will come when it is the right time for him or her. There is a point when almost every woman meets a point of surrender. She will be pregnant forever and she is ok with that. For now she will enjoy the joy of the baby growing with in her. Then the baby will come. The beautiful thing about birthing at home is that we get to follow the Divine plan and allow our bodies to do what they were meant to do, birth a baby perfectly.

Family Forum May-Baby Wearing

Come join us for this months family forum event on baby wearing. 

My wonderful husband wearing our third child while home on a lunch break. He decided to let me take a nap and he did the dishes. Now that is an amazing man!

Benefits of baby wearing per babywearinginternational.com

Benefits of Babywearing

Medical professionals agree that infants thrive through touch; “wearing” your baby is another way to meet this need. But the benefits of babywearing don’t end there … babywearing offers many other advantages, some of which include:

• Happy Babies. It’s true … carried babies cry less! In a study published in the journal Pediatrics, researchers found that babywearing for three hours a day reduced infant crying by 43 percent overall and 54 percent during evening hours. (1)

• Healthy Babies. Premature babies and babies with special needs often enter the world with fragile nervous systems. When a baby rides in a sling attached to his mother, he is in tune with the rhythm of her breathing, the sound of her heartbeat, and the movements his mother makes—walking, bending, and reaching. This stimulation helps him to regulate his own physical responses. Research has even shown that premature babies who are touched and held gain weight faster and are healthier than babies who are not. (2)

• Confident Parents. A large part of feeling confident as a parent is the ability to read our babies’ cues successfully. Holding our babies close in a sling allows us to become finely attuned to their movements, gestures, and facial expressions. Every time a baby is able to let us know that she is hungry, bored, or wet without having to cry, her trust in us is increased, her learning is enhanced, and our own confidence is reinforced. This cycle of positive interaction deepens the mutual attachment between parent and child, and is especially beneficial for mothers who are at risk for or suffering from postpartum depression. (3) (4)

• Loving Caregivers. Baby carriers are a great bonding tool for fathers, grandparents, adoptive parents, babysitters, and other caregivers. Imagine a new father going for a walk with his baby in a sling. The baby isbecoming used to his voice, heartbeat, movements, and facial expressions, and the two are forging a strong attachment of their own. Baby carriers are beneficial for every adult in a baby’s life. Cuddling up close in the sling is a wonderful way to get to know the baby in your life, and for the baby to get to know you!

•Comfort and Convenience. With the help of a good carrier, you can take care of older children or do chores without frequent interruptions from an anxious or distressed infant—which helps to reduce sibling rivalry. Baby carriers are also wonderful to use with older babies and toddlers; you can save those arms and go where strollers can’t. Climbing stairs, hiking, and navigating crowded airports all can be done with ease when you use a well-designed baby carrier!

I will have many different types of carriers to try out plus babies of all different ages. You won't believe how much happier and content your baby is if they are worn regularly. Free up your hands!

Thursday May 9th at 7pm. Partners and kids are welcome. Bring a snack to share if you would like and any carriers you have. 

See you there and contact me at completebeginnings@gmail.com for more information or for directions.

Super Sibling Preparation for Baby Class-Free!

The birth of a new baby is a wonderful and life changing event. This change is not diminished with each additional child you add to your family. I find such joy in watching my children interact and play with each other. We have been fortunate that our children have great relationships and I think they started at birth. Preparing your child for a new addition to the family can make the transition so much smoother.

 I offer a monthly Free Super Sibling Preperation for Baby class every 4th Thursday of the month at 6pm at the St. George Library. The class is aimed at ages 2 1/2-10 but all ages are welcome. Homebirth, birth suite and hospital birth familes are all welcome to attend.  Normal baby behavior, helping with baby care and communication skills will be addressed. The final 15 minutes of class will be for those children who might be present or in the home or hospital when their sibling is born and will cover birth sounds, sights and thoughts. Please feed your child prior to class, we want everyone happy and focused, and bring a baby doll or a stuffed animal to use. I look forward to seeing you there please RSVP to completebeginnings@gmail.com

Dixie State College Radio Show 1Voice-Maternal Health Disparity a Utah problem, a US problem a worldwide problem

I had the privilege of doing an interview with Wendy Worthington, the director of a local radio show at Dixie State College called 1Voice on the issue of maternal health disparity. Maternal health disparity addresses the issue that regardless of the fact that we are one of the most industrialized nations in the world we still loose far to many mothers and babies, especially of non white back ground, during pregnancy and birth. Why? I address that question and many more including education of midwives and Mamababy Haiti in this podcast.

1Voice Podcast on Maternal Health Disparity

Day 4:Haiti

Day 4- Sunday

I was up most of the night with Kesseley and her baby girl but I decided to eat my pumpkin soup which was delicious.

 The history of pumpkin soup begins with the celebration of Haitian Independence in 1804. On Jan. 1, 1804, Haitians worked together to create a unique soup to celebrate their independence from the French Colonists. Until that time, the Colonists believed that the blacks under their rule could never work together to create anything. Today, the traditional pumpkin soup known as "soup joumou," is made and served to friends and family in Haiti in remembrance of their fight for freedom. While under French Colonial rule, Haitians were limited to eating a bland bread soup. They would not have been permitted to eat such an extravagant meal comprised of pumpkin, beef stock and other vegetables. This unique soup was created as a symbol of unity in the face of adversity. It was served to everyone at the first Independence celebration and Haitians continue this tradition today.  

 Haiti was the first independent nation in Latin America, the first post-colonial independent black-led nation in the world, and the only nation whose independence was gained as part of a successful slave rebellion.

I decided to go to the local Baptist church with Santo and Mary even though I was exhausted. There were about 60 people in a cement building. It had no door or glass windows just an opening for each. They were all dressed in their Sunday best. The children were very well behaved. Shockingly well behaved compared to American children. They were happy to sit on their mothers laps. Something I noticed that was different was how parents held sleeping babies. In the US babies are often held in the cradle position while they sleep or occasionally over a shoulder. In Haiti as they lay the child over their knees similarly to how you would position them for a spanking and they would happily fall asleep there. I saw one mother at the church scowl at a 6 or 7 year old boy several times as he was getting restless before she laid him over her knees and he fell asleep with his mother patting his back. It made a lot of since as Haiti is hot an humid and that position was far less body contact and much cooler as they could fan the child while they slept. 

Photo courtesy of latimes.com
There was about an hour of worship singing and prayer followed by the preacher asking Mary and  I to come up and say or sing something. We sang How Great Thou Art.  It is such a beautiful universal hymn. It brought tears to my eyes as we sang it. The smiles from all of the lovely people was well worth the embarrassment.

 

A guest speaker, and American missionary fluent in Creole, spoke for the next 2.5 hours. About 2 hours in I was just done with sitting on the cement bench. The way the speaker spoke was different than I am used to being preached at and while I was attentive for quite a bit of time it started to get to me after a while. That combined with smoke coming in from the nearby door drove me to go sit outside. There is not real sanitation set up in Haiti so in order to deal with the trash many people have trash burn piles regularly. It smells awful and makes the air very smoky but it is preferable to the alternative. 

There I watched a 4 year old boy fill up his water containers for his family. Each plastic container, similar to a very large vegetable oil container, held about 2 gallons of water and I couldn't help but think how my children complain when I ask them to carry one gallon of milk in from the car. He pumped and filled the containers but the pressure coming out of the faucet was so great it left a good 25% of the container empty. He remedied this solution by  proceededing to fill up the tiny caps with water and poor it into the container. 50 fill ups later the containers were perfectly filled and he lugged the water back home. His eyes never left mine. Clean water is probably the number one problem in Haiti. The water from the pumps still needs to be boiled to be safe.

The water at the clinic is all braught in large 5 gallon jugs and dispersed from a cooler. Water for toilets and washing comes from a well on the property. Electric pumps pump it to the roof and store it in large containers to be used later.

                         This is similar to the ones at the clinic.

Most people get almost all of their drinking water from little plastic bags filled with water. The huge disposable water bottles used in the US seem very wasteful in comparison.

Service let out and we headed home. Lunch was chicken, so delicious, rice, potatoes and salad. I then spent the next 3 hours napping in my favorite place on the love seat. It has a cross breeze so even when the power is off, which it was again, I can be cool enough to sleep. Claudin came and we did our Creole lessons with Martha and Mary. A little known secret about me is that I really struggle with foreign languages. I almost didn't graduate from college because I started and dropped Spanish 4 times. Ultimately I took American Sign Language from another school and had the credits transferred in. Between the foreign language, my cold and missing my family so much I was just in tears. Wondering if I made a huge mistake in coming here. When we are busy I felt better but these two days off with no clinic and no births were really difficult.  Dinner was a packet of tuna and a Luna bar since the cooks have Sunday nights off.  I started the night inside but there were three mosquitoes in my net that I couldn't catch and I knew I would be miserable in the morning. I took a Benadryl and slept wonderfully in my bed under the stars. 

I finally perfected my bed under the stars. I got a lot of flack about sleeping out side. Another volunteer claimed she was going to "Suck it up inside with the heat and the bugs because she would acclimate quicker and be a true Haitian." I thought she was crazy and sure enough I was the intelligent one. 

I would get ready for bed every night which was quite the order

 *drag out the matress

* use clothes pins to hand the mosquito net

*tuck net under the matress
*twist openings and use close pins to keep out mosquitoes and check for holes

* gather my supplies which included my Nook, Jounal,eye mask, ear plugs, water bottle, flash light and hand fan (yes I was a little high maintanence)

*spray myself with repellant

* fan myself incestinatly as the DEET ate away my skin and gave me the worst hot flashes ever

*cry a little bit and miss my family

* say a prayer and beg for strentgth

*stare at the stars until I slept or if it was raining pull my fleece blanket I brought with me over my head and ignore the wetness.

I slept out side from then on. It became quite the routine and as I settled in I watched all of my Haitian neighbors settle in with similar routines on their roofs. They would wave or say hello. So who was the crazy one? Who would acclimate quicker? I am an avid camper and often sleep outside but this was the longest consecutive length of time I slept under the stars. I felt very claustrophobic when I got home.

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.