A Sacred Moment

I’ve been able to help welcome so many lovely new little lives into this world.  With this amazing job of witnessing life we also have to be prepared to handle death.   Although it’s not commonly talked about many women experience early losses and miscarry.  As midwives it’s something that we sadly handle more often than we would like to.  However, it’s less common that we witness a delivery of a baby who has passed on.   Since being in St. Lucia there have been three stillborns.  After the first I asked the midwife how common it was for this to occur here and she told me it’s been a while since they’ve had any.  I’m that person who believes these types of things happen in three and I had a feeling after the second one that another may occur.  

 I walked into my morning shift just after a mother delivered a 28 week stillborn baby.  The midwife who did the birth told me the family would return and the mother wanted to say goodbye and take some pictures with her baby boy.  I was then asked to dress the baby and arrange for all of this to happen.

I asked the mom for a onesie, socks, a hat and a blanket that she wanted to dress her baby boy in.  

I’ve held so many new lives in my hands it was the first time for me to be holding death.   She told me his name was Trevon.  I dressed Trevon’s delicate cold little body and wrapped him in his blanket. When she was ready we walked together to the basket that I had placed him in.  I stood there with her as she said her final goodbye.  She was trying to be so strong but after a few minutes of looking lovingly at her son it was clear she couldn’t hold back her tears and neither could I. I handed her baby boy to her and took one last sweet picture of her kissing him, an image that will stay in my heart forever. I told her he looked peaceful and she smiled. We sat together not saying much. When she was ready I walked her back to her room where she showed me pictures of her 5year old son who she promised to snuggle tight when she returns home.  Before leaving my shift we hugged and she thanked me for being with her.

As much as I feel it’s a privilege to witness life, I felt privileged to be there in these last moments with this mom and her baby.  It felt sacred and a good reminder to me how fragile life is. 

What Mothers go through for their children

A few days ago I had the pleasure of being at a birth of a mom who thought she would never get pregnant. She tried for years  and after 8 years of trying she gave up. Soon after she found out she was 2 months pregnant.  It was beautiful to see the Joy on her face and her sweet husbands face when their son finally made his debut.

Last night was an interesting shift. I walked in to find out there was an 18 year old mom who was at about 5 cm and not coping well. I did some back rubbing and breathing with her but at the peak of a contraction she screamed almost every time. I was starting to think she was more than 6 and luckily so did the new nurse coming on the shift with me. So we checked her and she was fully meaning  shes complete or fully dialated. I know this term is used in Canada and I’m guessing the UK, I just love it for some reason. 

The nurse and I set up and suddenly there were about 5 eager medical students in the room watching our every move.

Let me back up. So the midwives do the births and they have nursing students and midwifery students. The doctors help with high risk situations but don’t tend to be the ones to manage births unless there is a complication that comes up or a need for a C-section.  These medical students usually follow the Doctors around but they are all new and EXTREMLEY eager to see birth and learn about it in all its glory, which is great but something I’m so not use to. Having 5 other bodies that just stand and stare as you do your job feels really weird for me so I can only imagine how I would feel if I was the one pushing this baby out.

Ok back to the birth. So this first time mom pushed for about 15min and her sweet baby boy was out.  (back home it’s typical for first time moms to push an hour or maybe two) We put her baby on her chest and she started glowing!!  Next comes the hard part, the placenta. Usually placentas come out within 15min after the baby is born and in my world if the placenta isn’t out 30min after we get a little anxious. (If we can’t get it out and she’s bleeding we go in for it, and if she’s not bleeding and we've tried everything we can to get it out we go to the hospital)   So her placenta wasn’t coming and she wasn’t having any contractions to help it come. Basically she went from 5cm to fully to baby really fast and her uterus was tired and didn’t want to keep working. We gave her oxytocin in her IV bag, I made her do nipple stimulation, the midwifes have patients breath into a brown paper bag to get them to relax and they say this usually helps. I asked the midwife to rub her stomach to make sure her uterus wasn’t filling up with blood and sure enough gush after gush came and then it would stop. In St. Lucia if the placenta doesn’t come after 30min they call the Dr. and find out how to manage the situation. (Although they know how to manage they just need the okay from the Dr.)  It’s now 45min and she’s still bleeding and in my head I’m thinking “OMG people just go in and get it out PLEASE” But I of course just stayed calm and waited because I’m trying to be respectful of different management styles and seeing how the retained placenta that happened last week was in for 4 hours and came out without anyone going in after it I was feeling hopeful.  So I rubbed (Mind you every time I rub her uterus she’s screaming at me and pushing my hands away because as all you mothers who have had this done know, it does NOT feel good) and I rubbed some more and gush gush, PLACENTA!!! Woohoo!!!  I soon learned upon inspection that this was not an ordinary placenta it had what’s called a succenturiate lobe (almost like a mini placenta attached to the normal placenta) and a battledore cord insertion (the cord inserted at the edge of the placenta). The lobe explained why it was likely not coming. Phew glad that one was over.  After controlling her bleeding and her blood pressure finally going down I was happily able to snuggle her and her baby back to their room for the night.

After they were all settled in we had a readmission of a mom who I became close with last week. She was induced and labored for a few days and eventually ended up with a C-section.  After that she stayed in the hospital to recover for about 5 more days.  Both Caity and I became close to her and helped her with breastfeeding and postpartum support. I really enjoyed her and was excited to learn she was going to be moving back to NJ where the father of the baby lives in a month or two once she was strong enough.

She was back because she had a seizure at home that day and when she came in I didn’t even recognize her. She was likely hit by the silently and occasionally deadly eclampsia. I think pregnant moms know about pre-eclampsia happening prenatally because it’s talked about so much but it’s not talked about as much postpartum. 

At home I feel like I’m constantly reviewing the signs and symptoms with moms who have elevated blood pressure. It goes like this “If you have a really bad headache, vision changes, right upper quadrant pain or any extreme swelling especially in your face please page the midwife”

 When she was discharged her blood pressures were on the high but normal side.  And in 24 hours things changed fast. It was heartbreaking to see this typically smiling chatty woman in this state, her baby crying to be fed and her unable to hold her baby or even focus on your face.  

This situation happens no matter where in the world you are. It’s happened with midwives I know and it came very close to happening to a client I had this past year. So scary and so frustrating because we don't really know why it happens!

I guess I shouldn’t end on a sad note. So here is a sweet picture of the baby boy I caught. I held him for a bit last night to allow his mom the opportunity to eat.  He just kept staring at me and it's always so sweet to see new moms instantly fall in love!

Getting My Wings....

Midwives have told me that going overseas will give you more experience and help solidify you feeling like a competent midwife and although I heard this I didn’t really know what this would look like or feel like. 
It’s been a busy week at Victoria Hospital, 3 babies born on my shift today two yesterday and one the day before.  Yesterday the nurse I was working with left me alone for a bit in the labor ward and told the nursing students to follow me and watch how I do things.  Wait a minute, I’m teaching them??!! Ok I got this I thought.  There were three moms in the ward. One in early labor who was not coping well, one that needed a NST (Non stress test) and one new admission who was in labor and needed a full physical assessment, NST and eventually an enema. I was totally juggling it all and somehow managing to teach these three eager students how to do things.  The supervising nurse would come back check on me make sure I was filling out the forms right and then disappear to do paperwork or help other patients on the maternity ward.  (We had done two births together, one being the toilet birth so I guess she trusted my ability) I was doing everything!! I answered the students questions, did vaginal exams, checked the NST strips to make sure the fetal heart rate looked good, got the women back to their rooms who weren’t in active labor and checked on the other ladies who needed help with breastfeeding.  I walked back to the labor ward and the mom who we just admitted under 2 hours ago and was 4cm when I checked her was brought back by one of the students and looking like she was about to push her baby out.  We got her to the room, the nurse now joined me and soon after, we welcomed a baby girl into the world. 
 I had an hour left of my shift and was thinking no other babies would be born.  And then a patient came walking through the door who was a second time mom and was admitted last week in early labor and sent home because her labor stopped and she was just walking around at 3cms.  I had spent many hours already with her and was excited to see her back on my shift ready to push her baby out.  She was 8cms and working hard so I set everything up and the nurse wasthere and then gone again.  I checked her soon after the first check and she was 9cm and sounding pushy.  She started to push and I could see her sweet baby boys head.  We were alone in the room and in my head I was thinking, “Hmmm I could totally do this birth on my own”.  I kept waiting for the nurse to walk in but she didn’t.  So I yelled for her and as she walked in the baby was out and in my hands.  Today I was doing a birth and the baby’s head was out when the nurse walked in the room and realized that I was totally fine and thought “Oh this is what those midwives meant”.  It feels good to be in this place of trusting myself and being able to feel like I could manage whatever comes my way. 

The hardest part about being here is developing relationships with the moms and babies and after they have their baby they only usually stay for a day or two and then that’s it, they’re gone never to be seen again.  I’m so grateful for the relationships we form at home with the moms and partners before their birth and after and I really miss that here. It’s hard to think I’ll never see these families ever again, but I’m so glad I got the opportunity to be there in the moments they needed me.  

St Lucia Tid Bits

Things to know about St Lucia:

It rains every day. And by rains I mean pours buckets so you always leave your house with an umbrella

It doesn’t matter if you wear scrubs or short shorts you will get SSSSS’ed at. Yes that’s right SSSSSS like a snake

Grown Men wear Jelly shoes. You know the ones like you had in the 80’s that were hot pink and made a comeback in the 90’s with the buckle? Yes those.

Dogs sleep with roosters and follow chicks around. There are so many street dogs and some cats. But whenever I see a street dog I see a Rooster nearby.

Horses and goats roam the side of the streets.

The people of St Lucia are extremely friendly and helpful. This is especially true when they see a girl walking the hot streets with bags of groceries and a jug of water.

Its loud outside!! Dusk through Dawn sounds of Dogs crying and barking, music playing and frogs and insects chirping through the night until the Roosters take over in the morning. The roosters also continue on and off throughout the day with the chirping birds.

It’s gorgeous here but very poor, the streets I walk down to the Hospital are definitely not paradise, which is personally very humbling.

You can always tell when the cruise ship docks because the vendors are out trying to sell their goods and the cabbies are eager to give rides and you can spot the white people with their bags full of souvenirs looking lost.

Walking the hot streets of St Lucia reminds me of walking down Fulton Street in Brooklyn

To have a vaginal birth here cost $100 EC, If you need a C-section that’ll cost ya $1000 EC. Translation= These Midwives don't make much at all!!

The mangoes are the most delicious mangoes I’ve ever had

Food here is expensive. Cereal can cost anywhere from 10-18EC’s which is about 5-9 USD. Yogurt is $4EC and we spend the most on the gallons of water that we consume which runs us about $8EC’s for 5Litres. (See empty jugs below from past 4 days)

There's no "hot" water. Cold showers for everyone!! (Which hasn't been an issue because it's so hot) Not to worry electric kettles can be found everywhere including the hospital.

 The local beer Piton the Rainier Beer of St Lucia.

Arrival

We've arrived in St Lucia!!! After waking up at 3am flying from Seattle to Texas to Puerto Rico and finally to Castries St Lucia Caity and I arrived to our new apartment at 1am. Needless to say it was a long journey and I think we are both still in shock that we're here.

We've been talking for over a year about going overseas to do Midwifery at some point before graduating and now 6 weeks before graduation we are FINALLY here. We were greeted warmly by Philip who works for the apartment complex and generously picked us up from the airport and brought our 6 bags up our stairs(I did my darndest to pack light but as many of you know me it's always a struggle). Our little place is on the second floor overlooking two mango trees and Vigie Cove complete with fans and air conditioning in each room (Yes we splurged although we are doing our best not to use the AC to avoid the crazy electric bill that we've been warned about). The warm sticky air of the night brought me comfort, reminding me of my summer nights back east sleeping with only a sheet and a fan moving the warm humid air around the room. Yup that's right here if you breath here you are sweating even when the forecast says it's only 82 the humidity is something special. Caity and I ventured out to town to the bank and the grocery. From what I can gather from the midwives of SMS past things in St Lucia have changed quite a bit. The grocery had a number of things that surprised me but seeing Organic Valley milk took the cake. It was close to $20.00EC's which is about $10.00 US so needless to say I put my first world ways aside and bought the local milk. On our way back home we ran into our neighbor who had been friendly and gracious with our classmates who had just been here before us. He assured us him and his wife would show us a good time around St Lucia and if we ever needed anything such as a lift to the Hospital to not hesitate to ask. Oh thank goodness for kind people in new unfamiliar places. We start at the Hospital on Wednesday and looking forward to what the week will bring with new people and new lives and hoping to open my heart and hands to be of service to this community.

Happy Mother’s Day!

Well Caity and I have officially been in St Lucia for a week. After our first day working together we went our separate ways and she worked the 7-2 shift while I worked the 9pm-7am shift the last three nights. Because it’s not exactly safe for us to be walking or traveling at night I got a lift from our neighbor and from George.

                                                               Victoria Hospital
My first night was pretty low key, no births but lots of labor support and breastfeeding support. The first birth Caity did the mom named her baby after her and unfortunately needed a blood transfusion followed by a surgery. Baby Katie was starving and spent the night with the midwives to let her Mom sleep. We all passed her around feeding her and rocking her to sleep through out the shift.  The second night I walked in to witness my second birth and observe how these midwives do things. I sat and talked with many of the midwives at night and realized more firsthand how global birth really is. These Midwives are truly amazing, they are all kind and willing to teach me and although we do things differently back in the states we all strive for healthy happy moms and babies. Three of the more progressive midwives I’ve worked with have commented on how they wish they could come to our country and see how we do things and I hope we can make this happen in the future for them. After the second night I walked home at 7am as the roosters crowed and the sun shined.

Last night I went in and worked with yet another group of 3 midwives. I learned that a mom who came in at 33 weeks delivered a stillborn and had a PPH (Postpartum Hemorrhage). Despite what this Mom had just gone through she seemed to be coping with her loss well. I went around and checked on all the mom’s to see if they were all comfortable and needed any support. There are 8 rooms each with 4 beds and the babies all room in unless they are jaundice or have other health concerns in which case they stay in the nursery and the moms wake up and walk to the nursery to feed them. If there are no complications most moms leave after 1 or 2 days. Just so you all know there’s no AC and it doesn’t tend to get cooler than at 78 but usually feels like 90 with the humidity. I have to say I hardly hear St Lucian women complain about much they just accept what they have and seem grateful for the care and support they receive. Among laboring moms and postpartum moms we also have moms who come in and stay on the ward to be more closely monitored if they have pre-eclampsia, gestational diabetes, or threatened Pre-term Labor.

After everyone was settled in for the night the Midwives told me to go rest and they would come get me if anyone was in active labor. (We had two moms who were ruptured but not contracting much)  About an hour later I got woken up and found a 5th time mom in the delivery room. The midwives told me she was 9cm, (she wasn’t making a peep) and told me to get my gloves on. This was it!!! I was going to catch a baby after only observing two births here. Within 5 min after putting my gloves on I had a tiny 5pd 6oz baby girl in my hands. I promptly clamped and cut the cord showed the mom her baby and handed the little girl over to the nurse for the warmer while waiting for the placenta and getting the mom cleaned up.30min later this mom was snugged back in her bed with her new baby girl who eagerly latched on. Things got quite again. The nurses told me to go back to sleep, I argued with them that I was now wide awake and they demanded that I go rest. (These women are lovely but I wasn’t going to argue with closing my eyes at 2am).

About 45min later I heard a patient yelling “Nurse” “Nurse” I came running out to learn that a girl had just walked in,  was laboring down the hall in a room on her own and was pushing her baby out on the toilet. The patients saw that the lights were off in the main office and didn’t realize the others were resting in the back; I ran in grabbed gloves announced to the midwives what was happening and ran down the hall to find a very scared looking girl sitting on the toilet. I calmly asked her a few questions and learned it was her second baby. She was sitting with her legs tightly closed and when I asked her to open her legs I saw 5cms of baby head, moments later her water broke and her baby boy was in my hands. She looked at me and said “I didn’t know I was pregnant” and started crying. The midwives ran in and then ran out to get supplies to assist me. While they were out of the room her placenta delivered into the toilet and thankfully her bleeding was minimal. All I could keep saying to her was “it’s going to be okay “but I’m not sure that is very true for her. About an hour later I handed her, her son and tucked her into bed. She looked at me thankfully and continued to stare at her new baby, still processing the reality of what just happened.

Mother’s Day rings loud when your job is surrounded by mothers and new babies entering into this world. It’s not always an easy job but I’m so thankful to be able to be there to whitness mothers becoming mothers for the first time or for the 5th time. This Mother’s Day I'm reminded how scary it can be to become a mother especially when you’re not ready for it and hopefully this little boy and his mother will be a blessing for one another.

Rainy season brings babies; Welcome to Victoria Hosptial

Caity and I hitched a ride from George to the hospital this morning in our nurses whites (not the most flattering attire) arriving early for our 8am start.

We had no idea really where we were going or what was in store for us. After being pointed in the right direction to the 2nd floor maternity ward we were warmly welcomed by the nurses to the floor. We received a tour of the floor and the hospital,and met UK medical students who looked as lost as us. We returned to the labor units where we had just missed one delivery and were invited to join another. As we waited for the first time mom to return to her room Caity and I read over her chart and tried to familiarize ourselves with our new surroundings. Suddenly we heard the laboring mom trying to make her way down the hall and back to her room. We walked in she looked at us, grabbed our hands and said “here comes another one help me” and before I knew it I was breathing with this Momma focusing deeply into my eyes as if I was the only one who could get her through. (This is an oh so familiar look) I suddenly felt right at home breathing, looking calmly into her eyes and assuring her this was normal and she was doing it just right. She wouldn’t let me leave her side for a second and squeezed tight with every “pain”. 15min of supporting this strong laboring Momma she looked at me after a contraction and said “I love you”. She melted my heart and I knew I wasn’t able to leave her side until her baby was safe in her arms. When she was checked she was 9cm but wanting to push, we rolled her to her side and the Midwife stepped out to assess another mom who just walked in. Moments later the Midwife reported a 3rd time mom was also 9cm next door and Caity ran out to support that laboring Mom while I stayed by this Mommas side. It was now just the two of us and she started pushing with all her might. The only thing she ever complained about was how cold she was but mostly between contractions she rested and asked for us to pull her baby out (also a very common question us midwives hear). 30min after starting to push her baby girl Kiona (Gods Gracious Gift) was born. As I walked baby Kiona over to the warmer where she lay with the two other baby girls that were born only 30min and an hour before her, I realized yet again how lucky I am to do this work. I woke up not knowing what was going to happen and left the hospital sweaty and sticky giggling with Caity that we made it through our first day doing what we know how to do best, support Moms as they welcome new little souls into this world. Only a 30min walk home passed some horses, dogs, roosters and goats, we jumped in a cold shower and devoured some fresh mango looking forward to what new lives we’ll welcome tomorrow.